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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

Published in:

26-10-2022 | Shock | Reports of Original Investigations

In-hospital cardiac arrest rhythm analysis by anesthesiologists: a diagnostic performance study

Authors: Jordan Bailly, MD, Clement Derkenne, MD, Florian Roquet, MD, Maximilien Cruc, MD, Alexandre Bergis, MD, Anne Lelong, MD, Clement Hoffmann, MD, MSc, Antoine Lamblin, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 1/2023

Abstract

Purpose

In-hospital cardiac arrest is associated with high morbidity and mortality, with an overall survival rate at one year of approximately 13%. The first cardiac rhythm is often analyzed by anesthesiologist-intensivists. We aimed to determine the diagnostic performance of anesthesiologist-intensivists when distinguishing between shockable and nonshockable rhythms.

Methods

We conducted a simulation-based, multicentre, prospective, observational study between May 2019 and March 2020. The responses of the participants were used to calculate individual sensitivity (defined as the proportion of decisions to shock for shockable rhythms) and individual specificity (defined as the proportion of decisions not to shock for nonshockable rhythms). The main outcome measure was the overall diagnostic performance, defined as the overall sensitivity and specificity. Secondary outcome measures were the sensitivity and specificity of participants’ decisions for each type of cardiac arrest rhythm and their decision-making times.

Results

Among the 267 physicians contacted, 179 (67%) completed the test. The median [interquartile range (IQR)] overall sensitivity was 88 [79–95]% and the median overall specificity was 86 [77–92]%. Among shockable rhythms, the median [IQR] sensitivity was 100 [100–100]% for ventricular tachycardia (VT), 100 [100–100]% for coarse ventricular fibrillation (VF), and 60 [20–100]% for fine VF. The median [IQR] specificities for nonshockable rhythms were 93 [86–100]% for asystole and 83 [72–86]% for pulseless electrical activity. The median decision times ranged from 2.0 to 3.5 sec.

Conclusion

Anesthesiologist-intensivists were quickly and effectively able to analyze rhythms in this simulation-based study. Participants’ sensitivity in deciding to deliver shocks for VT and coarse VF was excellent, while specificity of their decisions for pulseless electrical activity was insufficient.

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Title: In-hospital cardiac arrest rhythm analysis by anesthesiologists: a diagnostic performance study
Authors: Jordan Bailly, MD
Clement Derkenne, MD
Florian Roquet, MD
Maximilien Cruc, MD
Alexandre Bergis, MD
Anne Lelong, MD
Clement Hoffmann, MD, MSc
Antoine Lamblin, MD
Publication date: 26-10-2022
Publisher: Springer International Publishing
Keywords: Shock
Shock
Ventricular Tachycardia
Ventricular Fibrillation
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 1/2023
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02346-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

In-hospital cardiac arrest rhythm analysis by anesthesiologists: a diagnostic performance study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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