Two cases of cardiopulmonary arrest patients that AED never indicated shock delivery to shockable ECG rhythm

Abstract

As the installation rate of automated external defibrillators (AEDs) increases, the more the opportunities doctors will have to operate on AEDs in hospitals. We examined the data of two cases in which patients were not deliverd shock by AEDs, although the doctors recognized the ventricular tachycardia (VT) on the monitor. Case one was a 78-year-old man who had been on admission for examination of a prostate tumor. He had a sudden cardiopulmonary arrest (CPA). AED monitor had shown VT but the heart rate was too slow to be an indication for shock. Case two was a 56-year-old woman who had received chemotherapy on admisson and had sudden CPA. The AED monitor had shown VT and prepared to deliver shock. At this point the amplitude quickly decreased and become asystole therefore no shock were delivered. The recommendation of American Heart Association and Association for the Advancement of Medical Instrumentation attached much more importance to specificity rather than sensitivity in judgement of shock indication by AED. This was to avoid inadequate shock and to insure the safe use by minimally trained personnel. Doctors should recognize limitations of the various types of AEDs and should consider preparing a standard defibrillator during cardiopulmonary resuscitation.