Spotlight on Research

Early recognition and defibrillation of shockable rhythms is strongly associated with survival in out-of-hospital cardiac arrest (OHCA), and is reliant upon rapid and accurate rhythm interpretation of ventricular fibrillation (VF) or ventricular tachycardia (VT) by paramedics. As paramedics, we would like to think we are good at this but little data exist regarding the accuracy of paramedic rhythm interpretation in OHCA.

This retrospective study of prospectively collected data took place at a single site in the United States so may not reflect UK practice; however, it does raise some interesting questions. The primary outcome was the accuracy of paramedic interpretation of initial rhythm compared to post-incident interpretation by a physician. Secondary outcomes were accuracy of shock delivery for every 2-minute period during all resuscitation attempts (per resuscitation guidelines) and the estimated survival-to-hospital discharge for patients with accurate versus inaccurate initial rhythm interpretations.

During the 9-year study period (2011–2020), 1077 consecutive resuscitations were identified of which 863 were available for analysis. Paramedics correctly identified 176/197 shockable rhythms (sensitivity 0.89, 95% CI 0.84–0.93) and 463/504 non-shockable rhythms (specificity 0.92, 95% CI 0.89–0.94). These figures are comparable with other studies.