Automated External Defibrillators Research Articles

The impact on users of an unfamiliar AED following a recent training experience: A randomized cross over simulation study

ObjectiveThis study examined the impact of prior familiarity with automated external defibrillator (AED) models on the time of defibrillation and the emotional experiences of laypersons. MethodsWe conducted a randomized cross over simulation study with 123 participants to assess their reactions to both familiar and unfamiliar AED models. The time to first defibrillation was measured using three different AED training models, two of which were previously unknown to the participants. Additionally, semi-structured interviews were held with the participants to gather further insights. ResultsParticipants took longer to initiate defibrillation with unfamiliar (M = 34 s) AEDs compared to familiar (M = 27 s) ones. This delay was accompanied by feelings of confusion, nervousness, and anxiety. Factors such as the design of the AED covers, electrodes, and buttons were identified as sources of confusion. Nonetheless, clear instructions and similarities between devices helped facilitate their use. ConclusionThe findings suggest that AED design and familiarity with different AED designs may affect performance by laypersons. To improve user confidence, it would be useful to familiarize users with a variety of AED models as part of training initiatives. Understanding the impact of AED familiarity on rescuer’s response can guide CPR training strategies and improve outcomes for OHCA. As more AED models become available to the public, the user-friendliness of AEDs may also be improved. It is beneficial for AED manufacturers to consider the results of research when developing new models.

Abstract Su504: The Impact of Locked Cabinets for Automated External Defibrillators (Aeds) on Cardiac Arrest Outcomes: A Scoping Review

Background: Rapid defibrillation by the public with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest (OHCA) survival. Concerns about theft, vandalism, and misuse of AEDs have led to the implementation of security measures, including the use of locked cabinets to house these devices in public areas. Aim: This scoping review aims to systematically explore the existing literature on the impact of locked cabinets for AEDs during emergencies. Methods: A search of Medline, Embase, Cochrane, CINAHL and Google Scholar (20 pages) was performed on May 25th 2024. Studies of any design (e.g., experimental, observational, qualitative) that evaluated the impact of locked cabinets on AED accessibility and effectiveness during emergencies. Data were charting was iterative, and after reading included studies the studies were grouped by the outcomes studied. Results: We screened 2,096 titles and found 10 relevant studies: 8 observational studies and 2 OHCA simulation studies. Four papers were only published as conference abstract and no studies reported on patient outcomes. Data were reported on varying numbers of AEDS (ranging from 39 to 31,938) which were located inside buildings and public spaces. Overall theft and vandalism rates were very low, with the majority of studies reporting rates of <2%. Although in some studies it was unclear if the AED was stolen, or whether it had been used in an emergency and not returned. The impact of locking AEDs in cabinets was reported in one study, and showed minimal impact on rates of theft and vandalism (0.34% vs. 0.12%, p< 0.01). Two OHCA simulation studies conducted at AED locations showed significantly slower AED retrieval when AEDs were locked away. One survey of first responders reported that 50% (25/50) were injured while accessing an AED, which required breaking glass. Conclusion: Rates of theft and vandalism of AEDs located in private and public locations are low overall and in unlocked cabinets. Further research is needed on the impact of locked AEDs on patient outcomes.

Abstract 4120249: What Happens to Automated External Defibrillator Rhythm Strips after a Cardiac Arrest?

Background: Following an out of hospital cardiac arrest (OHCA), rhythm strips stored on an automated external defibrillator (AED) help guide important medical decisions, including possible implantable cardioverter defibrillator (ICD) implantation. However, this information is often difficult to obtain. Objective: To evaluate how frequently AED rhythm strips are reviewed following an OHCA prior to placing an ICD. Methods: Using the Cardiac Arrest Registry to Enhance Survival (CARES), we identified patients from 1/2015-12/2023 who were transferred to our institution following an OHCA. Patients were excluded if resuscitation was not attempted, death occurred during the hospitalization or patient identifying information was not available. Results: Of 907 OHCAs identified, 119 patients ( Table 1 ) met the inclusion criteria. The AED rhythm strip was in the electronic medical record on hospital arrival in 22% of cases and only after provider initiation in 6% of cases. None of the rhythm strips from a bystander-only delivered AED shock (n=17) were available on arrival, with only 24% retrieved during the hospitalization, taking 4.5±2.1 days from the date of arrest. Patients with an AED rhythm strip available (n=34) were more likely than those without a rhythm strip (n=85) to have a cardiac MRI (38% v. 13%, p=0.02) and genetic testing (15% v. 1%, p=0.02) done and have an ICD placed (53% v. 27%, p=0.04) or be discharged on a new anti-arrhythmic drug (15% v. 4%, p=0.04). Figure 1 Of the 42 patients who had an ICD placed during the index hospitalization, 54% were implanted without knowing the type of shockable rhythm or confirmation that an appropriate AED shock had been delivered. Conclusion: Rhythm strips help guide clinical decisions when assessing the need for ICD implantation. There is a systems gap in the process of transferring rhythm strips from AEDs to hospital providers following an OHCA.

Abstract Su507: Occurrence of Fibrillation in Out-of-hospital Cardiac Arrest Patients Presenting in a Non-shockable Rhythm when Treated with an Automated External Defibrillator

Background: Most out-of-hospital cardiac arrest (OHCA) patients who are initially treated with an automated external defibrillator (AED) and present in a non-shockable rhythm never receive a shock. This analysis reports on patients who presented in a non-shockable rhythm when the AED was initially applied and later transitioned into a shockable rhythm. Methods: Data from a convenience group of OHCA patients treated with a Philips HeartStart Home, Onsite or FRx AED were included. The AEDs were the first defibrillator on scene either in home, in public access or by a BLS team. Application of any medication during AED use was unlikely. Each patient’s heart rhythms were reviewed by an expert. All patients whose initial rhythm was non-shockable but later received at least one shock were identified and the rhythms were analyzed. Results: Out of 876 patients, 322 (36.8%) received at least one shock, of which five patients (1.6%) presented in a non-shockable rhythm and were later shocked. Three patients presented in an organized rhythm. The first patient degraded into Torsade de Pointe as shown in Figure 1; the post-shock rhythm was organized. The second patient received no CPR and A-V pacing was observed in the ECG recording. The pacing stopped when the rhythm transitioned into VF and restarted post shock. The third patient transitioned into VF during chest compressions and the post-shock rhythm was asystole. The remaining two patients presented in asystole and the rhythm evolved to fine VF after receiving chest compressions. After defibrillation, their rhythms returned to asystole. Conclusions: For OHCA patients treated with an AED, presenting in a non-shockable rhythm and later transitioning into a shockable rhythm is rare but possible. Lay-responder CPR may play a role in rhythm evolvement. The impact of rhythm changes on survivability of these patients is unknown.

Abstract Su606: PulsePoint Alert Location Features in a Mid-Sized Metropolitan Area

Introduction: PulsePoint is a smartphone-based system that alerts layperson responders to out-of-hospital cardiac arrest (OHCA) events in non-residential locations within the United States. These locations can be classified to inform public access defibrillator (PAD) placement and focus responder training and recruitment efforts in high-frequency areas. Our objective was to manually classify the locations of PulsePoint alerts to better understand how PulsePoint performs across a variety of location types. Methods: Records were obtained for each PulsePoint alert in Allegheny County, PA, USA (pop. 1.2M) from 06/24/2016 to 10/28/2020. PulsePoint generates an alert when a potential OHCA occurs in public and is within 400m of at least one responder. Alert data contains address and location name, and the number and locations of nearby responders and PADs. We placed each location into one of the following categories: “education”, “consumer goods/services”, “restaurants/bars”, “transit hubs”, “hotels”, “entertainment venues”, “recreational facilities”, “government/municipal”, “offices”, “industrial/manufacturing”, “religious institutions”, “parks/outdoor spaces”, “sidewalk/street”, and “shelters/supportive housing”. “Unspecified/unknown” was used for locations that could not be classified due to insufficient information. We excluded all outpatient health, assisted-living, daycare, and correctional facilities. For each location category, we calculated the event count and the median number of nearby responders and PADs. Results: There were 994 included events during the capture period. The most frequent location category was “sidewalk/street”, which represented 24 percent of all alerts; the least frequent was “transit hubs”, which represented 0.7 percent of all alerts. “Shelters/supportive housing” had the highest median number of responders (7, IQR 1-14), while “industrial/manufacturing” had the lowest (1, IQR 1-3.5). “Transit hubs” had the highest median number of PADs (31, IQR 31-41), while “parks/outdoor spaces” had the lowest (0.5, IQR 0-1). Conclusion: PulsePoint alert-generating events occur across a wide variety of location types. Further research is needed to understand the accuracy of the system’s location data versus EMS dispatch records. Nonetheless, the data may have implications for system improvement by highlighting which location types have low numbers of nearby responders and PADs and may benefit from strategic PAD placements and training efforts.

Abstract Su502: Is 80% a Reasonable Minimal Goal for Defibrillation Efficacy of Out-of-Hospital Cardiac Arrest ?

Introduction: There is no clear goal defined by standards or learned societies on clinical performance related to defibrillation efficacy. In literature, monophasic shocks defibrillation efficacy is mainly >70% whereas biphasic is >80%. Resuscitation guidelines define efficient defibrillation as cessation of shockable rhythm at 5s post-shock and proceed to state that beyond 5s, shock outcomes are biased by known confounders (call to AED connection time (CallAEDTime), bystander, cardio-pulmonary resuscitation (CPR), drugs…). Thus, it is consistent that automated external defibrillator (AED) performance should be assessed in terms of defibrillation efficacy right after the shock rather than in terms of restoration of a spontaneous circulation or survival to hospital discharge. This study aimed to define an acceptable goal for validation of defibrillation efficacy. Method: In this observational retrospective study, we included AED tracings of adult non-traumatic out-of-hospital cardiac arrest (OHCA) patients with initial ventricular fibrillation (VF) rescued by basic life support teams (Paris Fire Brigade) from 01/2017 to 02/2022. Cardiac rhythm was examined during the 10 first minutes of connection of the AED (DGT7, Schiller Médical, France). Shockable rhythm is defined as coarse-VF with at least 200µV peak-to-peak amplitude (ptpA). Efficient defibrillation was defined as cessation of shockable rhythm at 5s post-shock. We fitted a linear mixed model to predict defibrillation efficacy using the 4s ptpA of pre-shock VF. The model included the patient as random effect and a p-value <0.05 was considered statistically significant. Results: We analyzed 1333 shocks from 547 patients, with: median age of 59 (interquartile range, IQR[49-71]), 78% male, 36% in public places, 72% with bystander CPR and median[IQR] CallAEDTime of 13min [10-15]min. The effect of the pre-shock ptpA of VF on the defibrillation efficacy is statistically significant: OR=1.023, 95% Confidence Interval (CI) [1.010,1.036], p<0.001. That means that for each 100µv increment in VF amplitude pre-shock, the probability of success at 5s post-shock increases by 2.3%. Adjusting for age, sex, location, CPR and CallAEDTime does not change the results. The logistic regression of Figure1, shows a defibrillation efficacy at 200µV ptpA of 79%, CI [75,82]%. Conclusion: Based on 1333 OHCA biphasic shocks, this study suggests defining 80% as a reasonable minimal goal for validation of the AED defibrillation efficacy.

Abstract 4144566: Building CPR/AED Confidence through Community Volunteer Prevention Screening Sessions: The Impact of the Eric Paredes Save A Life Foundation

Introduction: Sudden cardiac arrest (SCA) remains a leading cause of death among young individuals, often occurring without prior symptoms. Public confidence in recognizing SCA warning signs, understanding risk factors, and using cardiopulmonary resuscitation (CPR) and Automated External Defibrillators (AEDs) is generally low. The Eric Paredes Save A Life Foundation addresses this gap by offering free cardiac screenings and educational sessions. This abstract evaluates the foundation's impact on participants' confidence in these critical areas. Goals: The primary objectives were to enhance participants' confidence in identifying SCA warning signs and risk factors, performing CPR, using AEDs during cardiac emergencies, and communicating youth heart health concerns to healthcare providers. Methods: Volunteer-led prevention screening sessions were conducted, incorporating educational components on SCA warning signs, risk factors, and hands-only CPR and AED training. Post-session surveys were administered to 1,123 participants to assess their confidence levels in these areas. Results: The screening sessions significantly increased participants' confidence. Specifically, 96% of participants reported heightened confidence in recognizing SCA warning signs and understanding risk factors. Additionally, 94% felt more assured in discussing youth heart health with providers. Confidence in performing CPR during a cardiac emergency rose to 92%, while confidence in using an AED reached 89%. These results demonstrate the effectiveness of the sessions in empowering individuals with essential life-saving skills. Conclusions: The Eric Paredes Save A Life Foundation's prevention screening sessions are highly effective in improving participants' confidence in recognizing SCA warning signs, understanding risk factors, and using CPR and AEDs. The substantial increase in confidence levels underscores the importance of community-based education and training programs in reducing SCA-related fatalities among youth. These findings support the need for ongoing and expanded initiatives to further enhance public health outcomes and preparedness for cardiac emergencies.

Abstract Su505: Impact of a Targeted Automated External Defibrillator (AED) Program on Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: A Landmark Initiative in Latin America

The targeted Automated External Defibrillator (AED) program in the Sao Paulo Metro has yielded promising results in improving survival rates for individuals experiencing out-of-hospital cardiac arrest (OHCA) due to ventricular arrhythmias. A longitudinal observational study conducted from September 2006 to November 2023 assessed the program's impact on survival outcomes. The implementation of the full program led to a significant improvement in survival to hospital discharge with minimal neurological impairment (0% vs. 43%, P=0.001). These findings underscore the importance of a targeted AED program in improving survival outcomes for OHCA, particularly in densely populated urban environments such as the Sao Paulo Metro. The short interval between arrest and defibrillation emerged as a critical factor in achieving favorable long-term, neurologically intact survival rates. The success of this program advocates for the strategic expansion of targeted AED initiatives in other large Latin American cities, emphasizing the potential to save lives and enhance public health outcomes through proactive emergency medical response measures.

Abstract Su406: Acceptability and Effectiveness of a Novel, Video-Based CPR and AED Education Program in Canadian Schools

Background: Early cardiopulmonary resuscitation (CPR) and defibrillation are critical for favorable outcomes after sudden cardiac arrest (SCA). Scientific evidence supports CPR and Automated External Defibrillator (AED) training in school-age children. Few studies have used gamified, video-based training to teach students. This national project aimed to assess the acceptability and effectiveness of a brief, video-based educational program (CardiacCrash™), developed by the Heart and Stroke Foundation to teach students hands-only CPR and AED use within a classroom setting. Methods/Results: This study reports preliminary data from two Canadian provinces (Ontario, Alberta). The acceptability and effectiveness of training was measured using a pre/post survey evaluating students’ self-confidence in recognizing SCA, calling for help, and providing bystander CPR, including the use of an AED. CPR performance was measured by using Little Anne QCPR manikins that collected data on CPR effectiveness throughout the training session. Results are stratified by student cohort (elementary—grades 4-8, and secondary—grades 9-12). A total of 1273 students from 6 Ontario and 7 Alberta schools were trained between October 2023 to April 2024. The average age for elementary students (n=729; 47.3% male) was 11.2 ± 1.3 years, and 39.9% had previous CPR training. The average age for secondary students (n=544; 54.4% male) was 15.5 ± 1.1, and 42.6% had previous CPR training. Both groups thought the training was easy (86%), fun (81%), the correct duration (59%) and would recommend it to their friends (85%). All outcome variables improved post-training for both elementary and secondary students, including the self-confidence to recognize and assist in cases of SCA (p=0.008 for both cohorts), (Figure 1). Secondary students were significantly better at providing effective compressions vs. elementary for most CPR measures (Table 2). Conclusion: Preliminary data suggest that CardiacCrash™, a video-based educational program, is acceptable to school-age students and effective at teaching them to perform CPR and use an AED. While both elementary and secondary students achieved acceptable CPR performance, secondary students performed higher quality CPR.

Abstract Su607: Which would be major? witnessed collapse or bystander resuscitation?

Background: Witnessed collapse and bystander cardiopulmonary resuscitation (CPR) are two variables commonly used to predict outcomes in out-of-hospital cardiac arrest (OHCA). Some published studies have shown that bystander CPR were not significantly associated with outcomes after confounders adjusted. This may imply that witnessed collapse would be a superior prognostic factors beyond bystander CPR. Hypothesis: Witnessed collapse and bystander CPR may not contribute equally to prehospital return of spontaneous circulation (ROSC), and the former may be major. Aims: To investigate four prediction models for prehospital ROSC using stratification of the witnessed collapse and bystander CPR. Methods: The study enrolled OHCA patients treated by the emergency medical service (EMS) from January 2010 to December 2022 in three EMS systems in Taiwan. Data were extracted from the records of each medical service encounter, including patient demographics, dispatch timing, prehospital management, witnessed collapse and bystander CPR. The primary outcome was any prehospital ROSC. Patients were stratified into four groups by witnessed collapse (with/without) and bystander CPR (with/without) status, namely W+B+, W-B+, W+B- and W-B-. Prehospital ROSC prognostication were identified using multivariable logistic regression analysis. Results: The analysis comprised 17,323 patients, among whom 1,165 (6.7%) achieved prehospital ROSC. The W+B+ group demonstrated the highest prehospital ROSC rate at 13.0%, as compared with the other groups significantly (9.0%, 3.4%, and 4.1%, as depicted in Image 1). Stratification of the prehospital ROSC model (Image 2) indicated that the W+B+ group had several common predictors including age, traumatic arrest, no-flow time, public access defibrillation (PAD), and resuscitation events. However, certain predictors in other groups were removed during regression process. Notably, no-flow time significantly influenced prehospital ROSC only in the W+B+ and W+B- groups. Conversely, in the W-B- group, most variables had minimal impact on prehospital ROSC, reflecting the limited effectiveness of traditional predictors within this subgroup. Conclusion: The significance of witnessed collapse as a prognostic factor may be equal to or even greater than that of bystander CPR. Further studies are needed to confirm.

Comprehensive Prevention of Exercise-related Sudden Cardiac Arrest or Death.

Exercise-related sudden cardiac arrest or death (SCA/D) is defined as SCA/D during sports or exercise, or within 1 hour of exercise cessation (1). When exercise-related SCA/D occurs during competitive sport in a young athlete, it often attracts significant media attention and concern. However, most exercise-related SCA/D occurs in middle-aged recreational sports participants (2). The effectiveness and appropriateness of widespread cardiovascular screening to prevent exercise-related SCA/D is uncertain. Appropriate resuscitation measures, facilitated by emergency action planning (EAP) and timely access to automated external defibrillators (AEDs), remains the mainstay of sudden cardiac death (SCD) prevention (1).

Knowledge, Experience and Awareness of Anesthesia Technicians in Our Country About Automatic External Defibrillator (AED) Devices: Survey Study

Background/Aims: The aim of this study was to evaluate the knowledge, experience and awareness of anesthesia technicians about Automatic External Defibrillator (AED) devices. METHODS: This study is a cross-sectional-descriptive study. The population of our research consists of people who graduated as Anesthesia Technicians in Turkey. The online survey form contains a total of 28 questions, 8 of which are sociodemographic. The data was collected online between 05.01.2024-20.01.2024. The acquired analyzes were performed with IBM SPSS version 20.0 program. RESULTS: The total number of anesthesia technicians/technicians and students graduating by 2023 in Turkey is about 63763 people. With this number of graduates, a sample group of 382 people was predicted with a 95% confidence interval and a margin of error of 0.05. A total of 392 people were reached. The average age was 28±7.72 years. 71.9% of the participants were female, 64% were single, 48.2% had been working between 1-5 years. 27.8% of the participants received First Aid Training, 20.4% received AED training, 26.5% used AED, 39.3% reported that AED device should be used by anesthesia technicians, 79.8% reported that AED device should be available in the hospital. CONCLUSION: In the result of this study, it was determined that anesthesia technician(s) had limited knowledge about the AED device and its application, and those who got first aid training did not apply AEDs in training and on patients. It is also thought that it may be useful to have AED devices in hospitals. It is thought that trainings can be organized to increase the knowledge of anesthesia technicians/technicians about the AED device, and the AED device can be kept in the hospital, thus survival rates can be increased by early defibrillation of patients.

Analysis of Prehospital Characteristics Affecting Survival Rates of Patients with Out-of-Hospital Cardiac Arrest Occurring During Work

This retrospective study analyzed survival rates of out-of-hospital acute cardiac arrest occurring during gainful work from 2013 to 2022. The survival rate at the workplace was 23.6% for patients with medical causes and 5.0% for those with non-medical causes, which was higher than the overall rate. The rate of layperson cardiopulmonary resuscitation (CPR) was 35.0% for medical causes and 11.6% for non-medical causes. Notably, cases witnessed by colleagues accounted for 72.9% of the medical cases and 76.8% of the non-medical cases, and CPR was performed in 42.7% of the medical cases and 19.6% of the non-medical cases. Survival rates were higher in both cases when there was a witness and CPR was performed. However, 45% of cardiac arrests occurring during work are still not witnessed, and the CPR performance and usage rates of automated external defibrillators (AED) remain insufficient. Enhancing the training of employees in CPR and AED usage can improve the survival rate of patients with cardiac arrest.

CURRENT LEVEL OF KNOWLEDGE AND AWARENESS OF HEALTHCARE PERSONNEL IN BASIC AND ADVANCED LIFE SUPPORT IN ARREST CASES WITH AND WITHOUT COVID-19 INFECTION

Objective: The knowledge of healthcare professionals about life support is crucial for saving lives. It was aimed to evaluate the knowledge and awareness level of healthcare professionals about advanced life support. Materials and methods: Our study was conducted between 15.02.2021 and 15.03.2021 with healthcare personnel working in our hospital. Data were collected by the questionnaire method. The researcher prepared the survey questions according to the European Resuscitation Council COVID-19 guidelines and American Heart Association Advanced Cardiac Life Support algorithms updated in 2020. 265 healthcare personnel (physicians, physician assistants, family physicians, nurses, health officers, and anesthesia technicians) participated in the study. Demographic characteristics of the participants (gender, age, duration of service, duties, duty stations), training and practice status, and level of knowledge were evaluated. Results: 67.2% of the participants were female, and 32.8% were male. The majority of the participants were nurses working in the inpatient clinics. 49.9% had a tenure of 1-5 years. 52.0% had received advanced cardiac life support training, and 19.6% had obtained and used automatic external defibrillators. 63.8% had performed advanced cardiac life support on a patient. In our study, the general level of advanced cardiac life support knowledge of the participants was found to be low. There was no significant difference in advanced cardiac life support scores in terms of gender, age, occupation, workplace, and tenure (p=0.604; p=0.986; p=0.927; p=0.982; p=0.295, respectively). Conclusion: Providing in-service resuscitation training to healthcare workers in line with current guidelines and supporting them with practical applications can provide quality knowledge and skills and increase their awareness of their responsibilities.

Is Anyone Ready to Save a Life? An Examination of Cardiac Emergency Preparedness in Schools.

This study explored the cardiac emergency preparedness of school employees in Illinois, as well as their attitudes toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training. One thousand two hundred seventy-six school employees completed an online survey regarding their school's cardiac emergency preparedness, as well as their access to CPR/AED training, confidence and willingness to perform CPR/AED, and attitudes toward CPR policies and mandates. In total, results from 1273 school employees were analyzed. School employees in Illinois are not prepared to respond to a cardiac emergency, but desire training, plans, and drills. Demographic analyses revealed statistically significant differences in cardiac emergency preparedness between individuals of different personal and school characteristics. School employees in Illinois are not prepared to respond to a cardiac emergency. To increase preparedness for cardiac emergencies at school, schools should implement CPR/AED training for all employees, cardiac emergency response plans, and cardiac emergency response drills. Policies should be implemented at the state and local level to support cardiac emergency preparedness in schools, including mandated CPR/AED training for all school employees, cardiac emergency response plans for every building, and required cardiac emergency response drills.

Advancements in automated external and wearable cardiac defibrillators.

Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice. Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence. Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.

Installation of Public Access Defibrillators for Out-of-Hospital Cardiac Arrests: Identifying Suitable Locations by Using a Geographic Information System.

Survival following an out-of-hospital cardiac arrest depends on prompt defibrillation. Despite the efforts made to install automated external defibrillators (AEDs) in crowded areas, their usage rate remains suboptimal. This study evaluated the efficiency of installing AEDs at key landmarks in Taoyuan City to enhance accessibility and usage. This retrospective cohort study analyzed nontraumatic public out-of-hospital cardiac arrest cases in Taoyuan City from 2017 to 2021, using data from the Taoyuan Fire Department and a regional registry. AED data were collected for 1163 devices. A geographic information system mapped target locations within the city, and real-world walking routes were examined to assess coverage. The primary outcome was actual coverage and the coverage efficiency ratio, calculated as the actual coverage divided by the number of facilities at a location. The coverage efficiency ratio compared the coverage efficiency of target locations with existing public access defibrillators (PADs). Top locations for superior coverage in both downtown and outside downtown areas were bus stops and convenience stores (7-Eleven and FamilyMart), which outperformed existing PADs. Convenience stores had a higher coverage efficiency ratio than the public service sector. Bus stops showed high AED usage rates before ambulance arrival. The current PAD locations in Taoyuan City offer limited coverage, which highlights the need for strategically installed AEDs, particularly in convenience stores. Policymakers should consider using the cultural relevance and accessibility of convenience stores, particularly 7-Eleven branches, to enhance AED usage rates.

Emergency Action Planning in United States High Schools.

Rates of emergency action plan (EAP) implementation and compliance with EAP guidelines vary in United States secondary schools. There are limited data on emergency preparedness in schools without athletic trainers (ATs). Rural and high poverty schools have poor emergency preparedness for high school athletic events due to financial barriers and lack of ATs. Cross-sectional study. Level 5. A web-based questionnaire was emailed by each State High School Athletics Association to ATs, athletic directors, and coaches of recipient schools to assess emergency preparedness. A total of 686 responses were received (response rate ~3.5%). Schools with an AT on staff were more likely to have an EAP (P < 0.01). Schools with a higher enrollment were more likely to have an EAP (P < 0.01), an AT on staff (P < 0.01), require additional training for coaches (P < 0.01), and have an automated external defibrillator (AED) onsite for all events (P < 0.01). Urban (odds ratio [OR], 3.514; 95% CI [2.242, 5.507]; P < 0.01) and suburban (OR, 4.950; 95% CI [3.287, 7.454]; P < 0.01) districts were more likely than rural districts to have an AT on staff. High poverty districts were less likely to have an AED (OR, 0.660; 95% CI [0.452, 0.964]; P = 0.03) or EAP (OR, 0.511; 95% CI [0.306, 0.853]; P < 0.01) at athletic venues. Lower enrollment, high poverty, and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty, and suburban counterparts as these schools are generally less likely to have an AT on staff, AEDs, and EAPs and less likely to provide additional training to coaches and other staff. This study assesses athletic emergency preparedness-a critical component of ensuring athlete safety and recovery after injury.

Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

BackgroundSocial determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). MethodsThis cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. ResultsQuery of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. ConclusionsCommunity-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.

Construction and psychometric validation in Spanish schoolchildren of a knowledge questionnaire on basic life support and Automated External Defibrillator (ConocES-BLS/AED) in Spain

The 60 % of cardiac arrests happen in the out-of-hospital setting. In 2023, the International Liaison Committee on Resuscitation issued a statement entitled “Children save lives”, recommending the teaching of basic life support to children from the age of 12. However, we have not identified validated instruments that assess the level of knowledge of schoolchildren about BLS and AED. Objective: Construction and psychometric validation of a questionnaire to assess knowledge on Basic Life Support (BLS) and Automated External Defibrillator (AED) in primary to secondary school children. Method: Cross-sectional descriptive study of validation of the questionnaire consisting of several phases: construction of the questionnaire on knowledge on BLS and AED (ConocES-BLS/AED), content validation, pilot test and psychometric validation. Results: The ConocES-SVB/AED questionnaire was constructed, content validation was carried out by 14 experts, the pilot test carried out on 105 students reported good reliability (0.84), and finally with the psychometric validation a questionnaire composed of 12 items was obtained and psychometrically validated using the Item Response Theory in a final sample of 182 participants. Adequate fit values and acceptable reliability (0.65) were obtained, demonstrating its usefulness to accurately measure the level of knowledge about SVB/AED maneuvers in schoolchildren. Conclusions: The created and validated questionnaire provides educators with a fundamental resource to identify areas of lack of knowledge, improve and design effective educational interventions for schoolchildren on SVB/AED maneuvers.