The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study.

Enrico Baldi,Olympia Nikolaidou,Hajriz Alihodžić,Remy Stieglis,Stefan Trenkler,Bernd W Böttiger,Jan Wnent,Simone Savastano,Andrej Markota,Pierre Mols,Julian Ganter,Anneli Strömsöe,Ruggero Cresta,Carlo Clarens,Valentine Canon,Martin Quinn,Alexei Birkun,Violetta Raffay,Ari Salo,Giuseppe Ristagno,Niccolò Grieco ,Jan Thorsten Gräsner ,Fernando Rosell-Ortiz ,Diana Cimpoeşu ,Ingvild Tjelmeland

doi:10.3390/jcm10215018

Abstract

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries. Methods: We performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

Highlights

The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA)
Regarding AED legislation, in 15 out of 19 countries, every citizen was allowed to use an AED whereas a training certificate was required in three countries
Our survey highlighted that an AED mapping system was available in just over half of the countries and this percentage dropped to only 40% if we considered only the countries with an AED mapping system available for the whole nation

Summary

Introduction

The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). AED use by a bystander or first responders (FRs; i.e., police officers, firefighters, off-duty medical personnel and trained lay persons alerted when a patient experiences an OHCA nearby) before the arrival of emergency medical service (EMS) personnel is of a primary importance when considering that the earlier the defibrillation, the higher the chance of survival [6,7,8]. This concept was proven in the early 2000s, when the public-access defibrillation (PAD) trial was carried out in the USA involving security officers after cardiac arrests in casinos [9]. Considering that no particular skills are needed to correctly use an AED [13] and no risks for rescuers are present [14,15], the guidelines have highlighted from 2015 onwards [16,17] that the use of an AED even by untrained lay persons must be encouraged

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