Automated external defibrillator arrhythmia detection in a model of cardiac arrest due to commotio cordis.
BACKGROUND
Cardiac arrest due to chest wall blows (commotio cordis) has been reported with increasing frequency in children, and only about 15% of victims survive. Automated external defibrillators (AEDs) have been shown to be life saving in adults with cardiac arrest, but data on their use in children are limited. In a swine model of commotio cordis designed to be most relevant to young children, we assessed the efficacy of a commercially available AED for recognition and termination of ventricular fibrillation.


RESULTS
Ventricular fibrillation was produced in anesthetized juvenile swine by precordial impact from a baseball under controlled conditions. Animals were randomized to defibrillation after 1, 2, 4, or 6 minutes of ventricular fibrillation. Twenty-six swine underwent 50 ventricular fibrillation inductions. Sensitivity of the AED for recognition of ventricular fibrillation was 98%, and specificity for nonshockable episodes was 100%. All episodes of ventricular fibrillation were successfully terminated by the AED.


CONCLUSIONS
In this experimental model of commotio cordis, the AED proved to be highly sensitive and specific for recognition of ventricular fibrillation and effective in terminating the arrhythmia and restoring sinus rhythm. These findings suggest that early defibrillation with the AED could save young lives on the athletic field.
Link
Mark S
MS
Tufts University School of Medicine and New England Medical Center, Boston, Massachusetts 02111, USA. MLink@Lifespan.org
Maron
Barry J
BJ
Stickney
Ronald E
RE
Vanderbrink
Brian A
BA
Zhu
Wei
W
Pandian
Natesa G
NG
Wang
Paul J
PJ
Estes
N A Mark
NA
D000818:Animals; D000829:Animals, Domestic; D001145:Arrhythmias, Cardiac / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D001794:Blood Pressure / Q000502:physiology; D017147:Defibrillators, Implantable; D004195:Disease Models, Animal; D004562:Electrocardiography; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D011897:Random Allocation; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D013552:Swine; D013599:Systole / Q000502:physiology; D035441:Thoracic Wall / Q000473:pathology*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000401:mortality / Q000628:therapy