Effects of AED device features on performance by untrained laypersons

Abstract

Objective Our study evaluates the impact of features of automated external defibrillators (AEDs) on the performance and speed of untrained laypersons to deliver a shock and initiate CPR after a shock. Methods This was a randomized trial of volunteer laypersons without AED or advanced medical training. Subjects were assigned to use one of six different models of AEDs on a manikin in simulated cardiac arrest. No instructions on AED operation were provided. Primary endpoints were shock delivery and elapsed time from start to shock. Secondary endpoints included time to power-on, initiation of CPR, adequacy of pad placement and subjects’ ratings of ease of use (1 = very easy, 5 = very difficult). Results Most subjects (109/120; 91%) were able to deliver a shock. Median time from start of scenario to shock delivery was 79 s (IQR: 67–99). Of the 11 participants who did not deliver shock, eight never powered on the device. Time to power-on was shorter in devices with open lid (median 12 s, IQR 8–27 s) and pull handle (17 s, IQR 9–20 s) mechanisms than with a push button (37 s, IQR 18–69 s; p = 0.000). Pad position on the manikin was judged adequate for 86 (77%) of the 111 subjects who placed pads. Devices which gave more detailed voice instruction for pad placement had higher rates of adequate pad position [38/39 (97%) versus 50/73 (68%), p = 0.001]. With AEDs that provided step-by-step CPR instruction, 49/58 (84%) subjects began CPR compared to 26/51 (51%) with AEDs that only prompted to start CPR ( p = 0.01). Participants rated all the models easy to use (overall mean 1.48; individual device means 1.28–1.71). Conclusions Most untrained laypersons were successful in delivering a shock. Device features had the most impact on these functions: ability and time to power-on device, adequacy of pad position and initiation of CPR.