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Article ; Online: Temporal analysis of continuous chest compression rate and depth performed by firefighters during out of hospital cardiac arrest.

McAlister, Olibhéar / Harvey, Adam / Currie, Hannah / McCartney, Ben / Adgey, Jennifer / Owens, Pamela / Idris, Ahamed

2023 Volume 185, Page(s) 109738

Abstract: Background: Quality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) often do not meet guideline recommendations for rate and depth. This may be due to the fatiguing nature of physically compressing a patient's chest, meaning that ... ...

Abstract	Background: Quality of chest compressions (CC) during cardiopulmonary resuscitation (CPR) often do not meet guideline recommendations for rate and depth. This may be due to the fatiguing nature of physically compressing a patient's chest, meaning that CPR quality reduces over time. Objective: This analysis investigates the effect of CPR duration on the performance of continuous CCs delivered by firefighters equipped with CPR feedback devices. Methods: Data were collected from a first responder group which used CPR feedback and automatic external defibrillator devices when attending out-of-hospital cardiac arrest events. Depth and rate of CC were analysed for 134 patients. Mean CC depth and rate were calculated every 5 s during two-minute episodes of CPR. Regression models were created to evaluate the relationship between applied CC depth and rate as a function of time. Results: Mean (SD) CC depth during the investigation was 48 (9) mm. An inverse relationship was observed between CC depth and CPR duration, where CC depth decreased by 3.39 mm, over two-minutes of CPR (p < 0.001). Mean (SD) CC rate was 112.06 (5.87) compressions per minute. No significant relationship was observed between CC rate and CPR duration (p = 0.077). Mean depth was within guideline range for 33.58% of patient events, while guideline rate was observed in 92.54% of cases. Conclusions: A reduction in CC depth was observed during two-minutes of continuous CCs while CC rate was not affected. One third of patients received a mean CC depth within guideline range (50 to 60 mm).
MeSH term(s)	Humans ; Cardiopulmonary Resuscitation ; Out-of-Hospital Cardiac Arrest/therapy ; Firefighters ; Defibrillators ; Time Factors
Language	English
Publishing date	2023-02-16
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2023.109738
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Article ; Online: Improving the Diagnosis of Culprit Left Circumflex Occlusion With Acute Myocardial Infarction in Patients With a Nondiagnostic 12-Lead ECG at Presentation: A Retrospective Cohort Study.

Daly, Michael J / Scott, Peter J / Harbinson, Mark T / Adgey, Jennifer A

Journal of the American Heart Association

2019 Volume 8, Issue 5, Page(s) e011029

Abstract: Background Left circumflex culprit is often missed by the standard 12-lead ECG . Extended lead systems (body surface potential map [ BSPM ]) should improve the diagnosis of culprit left circumflex stenosis with myocardial infarction. Methods and Results ... ...

Abstract	Background Left circumflex culprit is often missed by the standard 12-lead ECG . Extended lead systems (body surface potential map [ BSPM ]) should improve the diagnosis of culprit left circumflex stenosis with myocardial infarction. Methods and Results Retrospective analysis of a hospital research registry (August 2000-August 2010) comprising consecutive patients with (1) ischemic-type chest pain at rest; (2) 12-lead ECG and 80-lead BSPM at first medical contact; and (3) cardiac troponin-T 12 hours after symptom onset and/or creatine kinase MB fraction, were undertaken. Enrolled in the cohort were patients with culprit left circumflex stenosis (thrombolysis in myocardial infarction flow grade 0/1) at angiography. Acute myocardial infarction AMI was defined as cardiac troponin-T ≥0.1 μg/L and/or creatine kinase MB fraction >2 upper limits of normal. Enrolled were 482 patients: 168 had exclusion criteria. Of the remaining 314 (age 64±11 years; 62% male), 254 (81%) had AMI : of these, 231 had BSPM STE -sensitivity 0.91, specificity 0.72, positive predictive value 0.93, negative predictive value 0.65, and c-statistic 0.803 for AMI ( P<0.001). Of those with BSPM STE and AMI (n=231), STE was most frequently detected in the posterior (n=111, 48%), lateral (n=53, 23%), inferior (n=39, 17%), and right ventricular (n=21, 9%) territories. Conclusions Among patients with 12-lead ECG non-ST-segment-elevation myocardial infarction and culprit left circumflex stenosis, initial BSPM identifies ST-segment elevation beyond the territory of the 12-lead ECG . Greater use of the BSPM may result in earlier identification of AMI , which may lead to more rapid reperfusion.
MeSH term(s)	Action Potentials ; Aged ; Body Surface Potential Mapping ; Coronary Occlusion/complications ; Coronary Occlusion/diagnosis ; Coronary Occlusion/physiopathology ; Coronary Occlusion/therapy ; Electrocardiography ; Female ; Heart Rate ; Humans ; Male ; Middle Aged ; Myocardial Reperfusion ; Non-ST Elevated Myocardial Infarction/diagnosis ; Non-ST Elevated Myocardial Infarction/etiology ; Non-ST Elevated Myocardial Infarction/physiopathology ; Non-ST Elevated Myocardial Infarction/therapy ; Predictive Value of Tests ; Prognosis ; Registries ; Reproducibility of Results ; Retrospective Studies
Language	English
Publishing date	2019-03-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.118.011029
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Article: In search of optimism.

Adgey, A J

The Ulster medical journal

2001 Volume 70, Issue 1, Page(s) 40–46

MeSH term(s)	Cardiology/history ; Cardiology Service, Hospital/history ; History, 19th Century ; History, 20th Century ; Humans ; Northern Ireland
Language	English
Publishing date	2001-05-30
Publishing country	Northern Ireland
Document type	Historical Article ; Journal Article ; Portrait
ZDB-ID	603342-8
ISSN	2046-4207 ; 0041-6193
ISSN (online)	2046-4207
ISSN	0041-6193
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Article ; Online: Improved detection of acute myocardial infarction in patients with chest pain and significant left main stem coronary stenosis.

Daly, M J / Adgey, J A / Harbinson, M T

QJM : monthly journal of the Association of Physicians

2012 Volume 105, Issue 2, Page(s) 127–135

Abstract: Background: Non-invasive diagnosis of acute myocardial infarction (AMI) associated with significant left main stem (LMS) stenosis remains challenging.: Methods: Consecutive patients presenting with acute ischaemic-type chest pain from 2000 to 2010 ... ...

Abstract	Background: Non-invasive diagnosis of acute myocardial infarction (AMI) associated with significant left main stem (LMS) stenosis remains challenging. Methods: Consecutive patients presenting with acute ischaemic-type chest pain from 2000 to 2010 were analysed. Entry criteria: 12-lead ECG and Body Surface Potential Map (BSPM) at presentation, cardiac troponin T (cTnT) ≥12 h and coronary angiography during admission. cTnT ≥0.03 µg/l defined AMI. ECG abnormalities assessed: STEMI by Minnesota criteria; ST elevation (STE) aVR ≥0.5 mm; ST depression (STD) ≥0.5 mm in ≥2 contiguous leads (CL); T-wave inversion (TWI) ≥1 mm in ≥2 CL. BSPM STE was ≥2 mm in anterior, ≥1 mm in lateral, inferior, right ventricular or high right anterior and ≥0.5 mm in posterior territories. Significant LMS stenosis was ≥70%. Results: Enrolled were 2810 patients (aged 60 ± 12 years; 71% male). Of these, 116 (4.1%) had significant LMS stenosis with AMI occurring in 92 (79%). STEMI by Minnesota criteria occurred in 13 (11%) (sensitivity 12%, specificity 92%), STE in lead aVR in 23 (20%) (sensitivity 23%, specificity 92%), TWI in 38 (33%) (sensitivity 34%, specificity 71%) and STD in 51 (44%) (sensitivity 49%, specificity 75%). BSPM STE occurred in 85 (73%): sensitivity 88%, specificity 83%, positive predictive value 95% and negative predictive value 65%. Of those with AMI, 74% had STE in either the high right anterior or right ventricular territories not identified by the 12-lead ECG. C-Statistic for AMI diagnosis using BSPM STE was 0.800 (P < 0.001). Conclusion: In patients with significant LMS stenosis presenting with chest pain, BSPM STE has improved sensitivity (88%), with specificity 83%, over 12-lead ECG in the diagnosis of AMI.
MeSH term(s)	Aged ; Body Surface Potential Mapping/methods ; Chest Pain/complications ; Coronary Angiography ; Coronary Stenosis/complications ; Electrocardiography/methods ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/complications ; Myocardial Infarction/diagnosis ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/complications
Language	English
Publishing date	2012-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1199985-8
ISSN	1460-2393 ; 0033-5622 ; 1460-2725
ISSN (online)	1460-2393
ISSN	0033-5622 ; 1460-2725
DOI	10.1093/qjmed/hcr134
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Article ; Online: On the blindside of the ECG lies critical coronary disease.

Daly, M J / Spence, M S / Adgey, A A J

QJM : monthly journal of the Association of Physicians

2011 Volume 104, Issue 4, Page(s) 365–366

MeSH term(s)	Coronary Angiography/methods ; Coronary Disease/diagnosis ; Coronary Disease/diagnostic imaging ; Coronary Disease/physiopathology ; Electrocardiography ; Humans ; Male ; Middle Aged
Language	English
Publishing date	2011-04
Publishing country	England
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1199985-8
ISSN	1460-2393 ; 0033-5622 ; 1460-2725
ISSN (online)	1460-2393
ISSN	0033-5622 ; 1460-2725
DOI	10.1093/qjmed/hcq097
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Article: Real-world insight into public access defibrillator use over five years.

Torney, Hannah / McAlister, Olibhéar / Harvey, Adam / Kernaghan, Amy / Funston, Rebecca / McCartney, Ben / Davis, Laura / Bond, Raymond / McEneaney, David / Adgey, Jennifer

Open heart

2020 Volume 7, Issue 1

Abstract: Background: Public access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a ... ...

Abstract	Background: Public access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period. Methods: Data were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack. Results: Data were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events. Conclusion: This is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Defibrillators ; Electric Countershock/instrumentation ; Female ; Health Services Accessibility ; Humans ; Infant ; Male ; Middle Aged ; Out-of-Hospital Cardiac Arrest/mortality ; Out-of-Hospital Cardiac Arrest/physiopathology ; Out-of-Hospital Cardiac Arrest/therapy ; Recovery of Function ; Retrospective Studies ; Time Factors ; Time-to-Treatment ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2020-06-08
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624 ; 2044-6055
ISSN	2053-3624 ; 2044-6055
DOI	10.1136/openhrt-2020-001251
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Article ; Online: The importance of witnesses to maximize survival from out-of-hospital cardiac arrest.

Kee, Frank / Hamilton, Andrew / Adgey, Jennifer

European heart journal

2010 Volume 31, Issue 3, Page(s) 378; author reply 378–9

MeSH term(s)	Cardiopulmonary Resuscitation/methods ; Emergency Medical Services/methods ; Heart Arrest/therapy ; Humans ; Sweden ; Treatment Outcome
Language	English
Publishing date	2010-02
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehp520
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Article ; Online: A support vector machine for predicting defibrillation outcomes from waveform metrics.

Howe, Andrew / Escalona, Omar J / Di Maio, Rebecca / Massot, Bertrand / Cromie, Nick A / Darragh, Karen M / Adgey, Jennifer / McEneaney, David J

Resuscitation

2014 Volume 85, Issue 3, Page(s) 343–349

Abstract: Background: Algorithms to predict shock success based on VF waveform metrics could significantly enhance resuscitation by optimising the timing of defibrillation.: Objective: To investigate robust methods of predicting defibrillation success in VF ... ...

Abstract	Background: Algorithms to predict shock success based on VF waveform metrics could significantly enhance resuscitation by optimising the timing of defibrillation. Objective: To investigate robust methods of predicting defibrillation success in VF cardiac arrest patients, by using a support vector machine (SVM) optimisation approach. Methods: Frequency-domain (AMSA, dominant frequency and median frequency) and time-domain (slope and RMS amplitude) VF waveform metrics were calculated in a 4.1Y window prior to defibrillation. Conventional prediction test validity of each waveform parameter was conducted and used AUC>0.6 as the criterion for inclusion as a corroborative attribute processed by the SVM classification model. The latter used a Gaussian radial-basis-function (RBF) kernel and the error penalty factor C was fixed to 1. A two-fold cross-validation resampling technique was employed. Results: A total of 41 patients had 115 defibrillation instances. AMSA, slope and RMS waveform metrics performed test validation with AUC>0.6 for predicting termination of VF and return-to-organised rhythm. Predictive accuracy of the optimised SVM design for termination of VF was 81.9% (± 1.24 SD); positive and negative predictivity were respectively 84.3% (± 1.98 SD) and 77.4% (± 1.24 SD); sensitivity and specificity were 87.6% (± 2.69 SD) and 71.6% (± 9.38 SD) respectively. Conclusions: AMSA, slope and RMS were the best VF waveform frequency-time parameters predictors of termination of VF according to test validity assessment. This a priori can be used for a simplified SVM optimised design that combines the predictive attributes of these VF waveform metrics for improved prediction accuracy and generalisation performance without requiring the definition of any threshold value on waveform metrics.
MeSH term(s)	Electric Countershock ; Female ; Heart Arrest/complications ; Heart Arrest/physiopathology ; Heart Arrest/therapy ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Support Vector Machine ; Treatment Outcome ; Ventricular Fibrillation/complications ; Ventricular Fibrillation/physiopathology ; Ventricular Fibrillation/therapy
Language	English
Publishing date	2014-03
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	189901-6
ISSN	1873-1570 ; 0300-9572
ISSN (online)	1873-1570
ISSN	0300-9572
DOI	10.1016/j.resuscitation.2013.11.021
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Article ; Online: Theory and practice of defibrillation: (2) defibrillation for ventricular fibrillation.

Adgey, A A J / Spence, M S / Walsh, S J

Heart (British Cardiac Society)

2005 Volume 91, Issue 1, Page(s) 118–125

MeSH term(s)	Cardiography, Impedance ; Electric Countershock/methods ; Health Services Accessibility ; Humans ; Treatment Outcome ; Ventricular Fibrillation/therapy
Language	English
Publishing date	2005-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1303417-0
ISSN	1468-201X ; 1355-6037
ISSN (online)	1468-201X
ISSN	1355-6037
DOI	10.1136/hrt.2003.019927
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Article ; Online: Epicardial potentials computed from the body surface potential map using inverse electrocardiography and an individualised torso model improve sensitivity for acute myocardial infarction diagnosis.

Daly, Michael J / Finlay, Dewar D / Guldenring, Daniel / Bond, Raymond R / McCann, Aaron J / Scott, Peter J / Adgey, Jennifer A / Harbinson, Mark T

European heart journal. Acute cardiovascular care

2017 Volume 6, Issue 8, Page(s) 728–735

Abstract: Introduction: Epicardial potentials (EPs) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EPs derived from the 80-lead BSPM using a standard thoracic volume conductor ... ...

Abstract	Introduction: Epicardial potentials (EPs) derived from the body surface potential map (BSPM) improve acute myocardial infarction (AMI) diagnosis. In this study, we compared EPs derived from the 80-lead BSPM using a standard thoracic volume conductor model (TVCM) with those derived using a patient-specific torso model (PSTM) based on body mass index (BMI). Methods: Consecutive patients presenting to both the emergency department and pre-hospital coronary care unit between August 2009 and August 2011 with acute ischaemic-type chest pain at rest were enrolled. At first medical contact, 12-lead electrocardiograms and BSPMs were recorded. The BMI for each patient was calculated. Cardiac troponin T (cTnT) was sampled 12 hours after symptom onset. Patients were excluded from analysis if they had any ECG confounders to interpretation of the ST-segment. A cardiologist assessed the 12-lead ECG for ST-segment elevation myocardial infarction by Minnesota criteria and the BSPM. BSPM ST-elevation (STE) was ⩾0.2 mV in anterior, ⩾0.1 mV in lateral, inferior, right ventricular or high right anterior and ⩾0.05 mV in posterior territories. To derive EPs, the BSPM data were interpolated to yield values at 352 nodes of a Dalhousie torso. Using an inverse solution based on the boundary element method, EPs at 98 cardiac nodes positioned within a standard TVCM were derived. The TVCM was then scaled to produce a PSTM using a model developed from computed tomography in 48 patients of varying BMIs, and EPs were recalculated. EPs >0.3 mV defined STE. A cardiologist blinded to both the 12-lead ECG and BSPM interpreted the EP map. AMI was defined as cTnT ⩾0.1 µg/L. Results: Enrolled were 400 patients (age 62 ± 13 years; 57% male); 80 patients had exclusion criteria. Of the remaining 320 patients, the BMI was an average of 27.8 ± 5.6 kg/m Conclusion: Among patients presenting with ischaemic-type chest pain at rest, EPs derived from BSPM using a novel PSTM significantly improve sensitivity for AMI diagnosis.
MeSH term(s)	Aged ; Body Surface Potential Mapping/methods ; Diagnosis, Differential ; Electrocardiography/methods ; Female ; Follow-Up Studies ; Humans ; Image Processing, Computer-Assisted ; Male ; Pericardium/physiopathology ; Positron Emission Tomography Computed Tomography ; ROC Curve ; Reproducibility of Results ; Retrospective Studies ; ST Elevation Myocardial Infarction/diagnosis ; ST Elevation Myocardial Infarction/physiopathology
Language	English
Publishing date	2017-12
Publishing country	England
Document type	Journal Article
ZDB-ID	2663340-1
ISSN	2048-8734 ; 2048-8726
ISSN (online)	2048-8734
ISSN	2048-8726
DOI	10.1177/2048872616671010
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