Automated External Defibrillators Programs Research Articles

“Drones are a great idea! What is an AED?” novel insights from a qualitative study on public perception of using drones to deliver automatic external defibrillators

BackgroundThe quickest way to ensure survival in an out-of-hospital cardiac arrest (OHCA) is for a bystander to provide immediate cardiopulmonary resuscitation (CPR) and apply an automated external defibrillator (AED). The urgency of OHCA treatment has led to the proposal of alternative avenues for better access to AEDs, particularly in rural settings. More recently, using unmanned aerial vehicles (or drones) to deliver AEDs to rural OHCA sites has proven promising in improving survival rates. ObjectiveA pilot drone AED delivery program is currently being piloted in the community of Caledon, Ontario. The purpose of this study was to develop an understanding of public perception and acceptance of the use of drones for this purpose and to identify tailored community engagement strategies to ensure successful uptake. MethodsIn-depth qualitative descriptive study using interviews and focus group data collection and inductive thematic analysis. Purposive sampling was used to recruit 67 community members (40 interviews; 2 focus groups of 15) at existing community events in the project area. Interview guides were used to ensure consistency across data collection events. Detailed field notes were recorded when audio-recording was not possible. ResultsThe central message seen throughout the data was quickly identified as the potential impact of low levels of CPR and AED literacy in the community over anything else including concerns about the drone. The impact of the community’s existing relationship with the EMS; the need for bystander CPR & AED promotion prior to the program launch; and the value the community places on transparency and accountability related to the research and the drones were also key findings. In general, the drone concept was found to be acceptable but concerns about providing CPR and using the AED was what created anxieties in the lay public that we underestimated. ConclusionDrone-delivered AEDs may be feasible and effective but successful uptake in smaller communities will require a deep understanding of a community’s cardiac arrest literacy levels, information needs and readiness for innovation. This work will inform a robust community engagement plan that will be scalable to other locations considering a drone AED program.

CPR and AEDs save lives: insuring CPR--AED education and CPR--AED access in schools.

Sudden cardiac arrest and sudden cardiac death are less common in children and adolescents than in the adult population. The outcomes from sudden cardiac arrest are generally quite poor in all ages and some data suggest that they are worse in the child and adolescent age group. In addition, the incidence of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use is generally quite low although it is somewhat variable across communities. This review has been written in order to review the data for pediatric bystander CPR and AED use as it relates to out-of-hospital cardiac arrest (OHCA) survival. The purpose of this article is also to review endeavors at CPR--AED education in the context of improving both community bystander CPR/AED interventions and OHCA survival. Finally, this review will attempt to suggest some potential educational interventions in order to increase both bystander CPR-AED use and OHCA survival in local communities. Findings from several recent studies suggest that the incidence of bystander CPR--AED intervention is relatively low and that OHCA survival is also quite low in most communities. Several studies also suggest that community educational efforts can increase bystander CPR--AED interventions. The increase in OHCA survival may be attributed to the community educational efforts, yet that increase in survival is relatively small. A prospective high-school study has shown that in this very specific environment, a high incidence of CPR--AED use can be achieved, and that as a result the OHCA survival can be relatively high. It would be beneficial to attempt to ensure that all schools have a CPR--AED program along with a group of individuals trained to do CPR and use an AED. Not only should all schools have a cardiac emergency response plan (CERP) but all schools should have CPR--AED programs and all students should learn CPR and AED use prior to graduation. This strategy will ensure that we will have a community of individuals who would perform CPR and use an AED in the community and that in so doing we could increase the incidence of bystander CPR/AED use and increase the OHCA survival rate.

P1702ARIADNA: first steps in the development of a collaborative initiative to create a map of automated external defibrillators and improve survival in out-of-hospital cardiac arrest in Spain

Abstract Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Although some geographical variation in the incidence of OHCA can be found, clinical outcomes are globally poor, with an expected percentage of survival to hospital discharge below 10% worldwide. Up to 60% of public OHCAs present with ventricular tachycardia or ventricular fibrillation. Early OHCA recognition and early defibrillation are key elements to increase the chances of survival with a favorable neurological outcome. To make this possible, easy access to automated external defibrillators (AEDs) must be warranted. Public AED programs have been implemented worldwide and have shown a significant improvement in survival and better functional outcome after OHCA. However, installation of public-access AEDs without linking them to responders appears to be meaningless and might not improve survival. Ariadna is the first collaborative approach to improve survival in OHCA in Spain. Endorsed by the Spanish Society of Cardiology and the Spanish Red Cross, Ariadna is a smartphone app that aims to create a map of all available AEDs within the Spanish territory using GPS functions available on smartphones. This app is also directed at establishing the first national network of lay responders trained in cardiopulmonary resuscitation (CPR). In the future, this network will serve as an enhancing tool to provide a rapid response to OHCA under the coordination of the emergency medical services. Purpose To analyze the preliminary results in terms of dissemination and implementation of Ariadna in the first months after the release of the final version of the app. Methods Ariadna app is available for free on iOS and Android. Users can sign up as “seekers” to locate and validate AEDs within the Spanish territory. All AEDs are displayed on a map, including those pending validation. “Seekers” who provide proof of valid CPR training can become “responders” and agree to be alerted in case of OHCA nearby in the future. In this preliminary analysis, the number of registered users along with the amount of registered and validated AEDs were retrieved from the app database. Results The final version of app was released September, 8, 2018. Since then and until February 2019, Ariadna has recruited 10846 users. A total of 3975 AEDs have been registered, 1037 of which (26%) have received validation from at least a different user. These numbers represent a growth rate of 70 new users and 26 new AEDs every day. Ariadna App growth in numbers Conclusion Ariadna has experienced an exponential growth in the first months of functioning and is already helping raise awareness for cardiac arrest in Spain. This proves the social engagement and successful dissemination of this collaborative initiative. Every effort will be made to progressively increase the number of users and registered AEDs in order to link them to trained responders and finally improve survival in cardiac arrest. Acknowledgement/Funding Financial support from the Spanish Society of Cardiology

"It Doesn't Make Sense for Us Not to Have One"-Understanding Reasons Why Community Sports Organizations Chose to Participate in a Funded Automated External Defibrillator Program.

Implementation of automated external defibrillators (AEDs) in community sports settings is an important component of emergency medical planning. This study aimed to understand motivations for why sports organizations participated in a government-funded program that provided AEDs and associated first-aid training. Face-to-face interviews. Community sports organizations in Victoria, Australia. Representatives from 14 organizations who participated in a government-funded AED program. Motivations to participate in the AED program were explored using a qualitative descriptive approach. Two overarching themes emerged: awareness of the program and decision to apply. Awareness was gained indirectly through grant advertising in newsletters/emails/web sites and directly through their sporting associations. For most organizations, there was no decision process per se, rather, the opportunity to apply was the key determinant for participating in the program. A duty of care also emerged as a key driving factor, with recognition of AEDs as a valuable asset to communities broadly, not just the participants' immediate sports setting. Reflecting on participation in the program, these participants identified that it was important to increase awareness about AED ownership and use. The program benefits were clearly summed up as being best prepared for a worst-case scenario. This study provides new understanding of why community sports organizations apply for an AED and training. The strongest reason was simply the opportunity to acquire this at no cost. Therefore, for wider implementation of AEDs, additional funding opportunities, targeted awareness of these opportunities, and continued promotion of AED importance are recommended.

School Nurses’ Perceived Barriers and Perceptual Influences When Implementing AED Programs

School nurses' experienced barriers and benefits with perceptions of self-efficacy are important factors to consider for program implementation in the school setting. Little research has been done in the area of automated external defibrillator (AED) program implementation by the school nurse for the treatment of sudden cardiac arrest. The purpose of this study was to identify benefits of and barriers to AED program implementation in public schools and measure school nurses' self-efficacy related to their role as a change agent in program implementation. Results revealed that school nurses are functioning with a high level of self-efficacy in their ability to influence major health-care decisions in the school setting, and despite barriers, AED program implementation is considered beneficial and a necessary component of emergency care.

Experiences and outcome from the implementation of a national Swedish automated external defibrillator registry

BackgroundEarly cardiopulmonary resuscitation (CPR) and defibrillation with an Automated External Defibrillator (AED) increase survival from out-of-hospital cardiac arrest (OHCA). Although international guidelines recommend the use of AED registries to increase AED use, little is known about implementation. The aim of this paper is to describe the development of a national AED registry, to analyse the coverage and barriers to register AEDs. MethodsThe Swedish AED Registry (SAEDREG) was initiated in 2009 with the purpose of gathering the data of all public AEDs in Sweden. Data on all AEDs between 2013 and 2016 were included in the study. Additionally, data of non-registered AEDs was collected in one region using a survey to AED owners focusing on AED functionality. ResultsThe number of AEDs doubled between 2013–2016. A total of 6703 AEDs (30%) were removed due to unavailability of validation. At the end of 2016, AEDs were most frequently registered in offices and workplaces, 45% (n = 7241) followed by shops, 7% (n = 1200). In the Gotland region, 218 AEDs, 57% (n = 124) were registered in the SAEDREG. Of n = 94 Non-registered AED functionality was high, the main reason not to register was unawareness of the SAEDREG, 74.5%. Of those aware of the register but not having registered, 25% stated “hard to register” as cause. ConclusionsA national AED registry may gather information of AEDs on a national level. Although numbers have doubled between 2013–2016 in Sweden, a large proportion is still non-registered. More awareness of the registry and easier registration process is needed. General AED functionality seems high regardless of registered or non-registered AEDs. A key area for future research may be to use AED-registers to ascertain effectiveness of AED programs in terms of actual patient outcome.

PUBLIC KNOWLEDGE CONCERNING CARDIOPULMONARY RESUSCITATION AND AUTOMATED EXTERNAL DEFIBRILLATOR SKILLS IN LITHUANIA

Introduction: Cardiovascular diseases (CVD) are the leading cause of mortality worldwide. Even in 65% of cases the first registered rhythm after cardiac arrest is ventricular fibrillation (VF) which can be restored to sinus rhythm by defibrillation. European Resuscitation Council guidelines (2010) highlight the importance of automated external defibrillator (AED) and encourage further AED program development and device installation in public places. The aim and methods: To assess public knowledge about cardiopulmonary resuscitation (CPR) and capability of using AED in five largest cities of Lithuania. The anonymous survey was conducted in public areas (shopping malls, stations, city squares). Only adults (aged 18-65 years) who claimed to have knowledge about CPR were interviewed. Results: 130 (76.9%) of respondents described their knowledge about CPR as inadequate. In a hypothetical 3-step situation, where a person clenches fists over his chest and falls, only 16.6% of respondents would act correctly according to the guidelines. Only 29% (49) knew what AED was, those aware of AED – almost all correctly stated the principle of managing the device and indications of its usage. The main sources of information regarding AED: training at the office 28.6% (14), television 28.6% (14), driving courses 22.4% (11); about CPR – driving courses 70.4% (119), school 46.7% (79), television 26% (44) and training at the office 24.9% (42). 81.6% of respondents would participate in CPR and AED courses, if they were free of charge. Conclusions: Lithuanian‘s knowledge about CPR is insufficient, only every third person knows what AEDs are. Community education and training on CPR and AEDs use are needed. The majority of respondents would attend CPR and AED training if it was free of charge.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 12: Emergency Action Plans, Resuscitation, Cardiopulmonary Resuscitation, and Automated External Defibrillators: A Scientific Statement From the American Heart Association and American College of Cardiology.

Survival after Public Access Defibrillation in Stockholm, Sweden – A striking success

BackgroundIn Stockholm, a first responder system and a Public Access Defibrillation (PAD) program has been implemented. Additionally, the number of “unregulated” public Automated External Defibrillators (AEDs) sold “over-the-counter” has increased. The aim of this study was to evaluate the impact on survival from different defibrillation strategies in cases of out-of-hospital cardiac arrest (OHCA) available for PAD. Methods and ResultsDesign: Retrospective study of all OHCAs in Stockholm, 2006–2012. Witnessed OHCAs occurring outside home with cardiac origin and ventricular fibrillation were considered subjects for PAD. The sites within the PAD program increased from 60 to 135 while the number of unregulated AEDs outside the PAD program increased from 178 to 5016.Of 6532 OHCAs, 7% (n=474) were defined as subjects for PAD. Of these, 69% (n=326) were defibrillated by the EMS, 11% (n=53) by first responders and 16% (n=74) by public AEDs. Survival to one month was 31% (n=101) for cases defibrillated by the EMS, 42% (n=22) when defibrillated by first responders and 70% (n=52) when defibrillated by a public AED. The AEDs within the PAD program constituted 2.6% of all public AEDs and were used in 28% (n=21) of cases when a public AED was used. ConclusionsIn OHCAs available for PAD, 70% of patients survived if a public AED was used. Both the structured AED program as well as the spread of unregulated AEDs was associated with very high survival rates, but the structured approach was more efficient in relation to the number of AEDs used.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators.

In recent years, a wider use of automated external defibrillators (AEDs) to treat out-of-hospital cardiac arrest was advocated in The Netherlands. We aimed to establish whether survival with favorable neurologic outcome after out-of-hospital cardiac arrest has significantly increased, and, if so, whether this is attributable to AED use. We performed a population-based cohort study, including patients with out-of-hospital cardiac arrest from cardiac causes between 2006 and 2012, excluding emergency medical service-witnessed arrests. We determined survival status at each stage (to emergency department, to admission, and to discharge) and examined temporal trends using logistic regression analysis with year of resuscitation as an independent variable. By adding each covariable subsequently to the regression model, we investigated their impact on the odds ratio of year of resuscitation. Analyses were performed according to initial rhythm (shockable versus nonshockable) and AED use. Rates of survival with favorable neurologic outcome after out-of-hospital cardiac arrest increased significantly (N=6133, 16.2% to 19.7%; P for trend=0.021), although solely in patients presenting with a shockable initial rhythm (N=2823; 29.1% to 41.4%; P for trend<0.001). In this group, survival increased at each stage but was strongest in the prehospital phase (odds ratio, 1.11 [95% CI, 1.06-1.16]). Rates of AED use almost tripled during the study period (21.4% to 59.3%; P for trend <0.001), thereby decreasing time from emergency call to defibrillation-device connection (median, 9.9 to 8.0 minutes; P<0.001). AED use statistically explained increased survival with favorable neurologic outcome by decreasing the odds ratio of year of resuscitation to a nonsignificant 1.04. Increased AED use is associated with increased survival in patients with a shockable initial rhythm. We recommend continuous efforts to introduce or extend AED programs.

Ten years of early defibrillation: "Bochum against sudden cardiac death". Acceptance and critical analysis of using automated external defibrillators

There is a comprehensive early defibrillation program in Bochum (Germany); since 2003 a total of 175 automated external defibrillators (AEDs) have been installed in urban areas by the city of Bochum and private companies. These were preferably installed in places with high foot traffic, e.g., public buildings, companies, and event/shopping centers. Approximately 15,000 laypeople who work in the vicinity of the AED locations were trained in the use of defibrillators and in basic resuscitation. In addition, rescue workers on fire trucks and medically trained personnel in physicians' medical practices were equipped as "first responders" with AEDs. After an initiation phase, all available information after each AED use since August 2004 has been collected by the project coordinator. During the period of data collection (August 2004 to August 2013), an AED was used in a total of 17 patients who had suffered sudden cardiac death (SCD) under the project in Bochum. Eleven patients had primary ventricular fibrillation (VF). Six of these survived without neurological deficit. In another 6 patients, a nondefibrillatable rhythm disorder was diagnosed. The AEDs are reliable and showed impeccable rhythm analysis before the instructions to provide any necessary shock. Compared to the number of existing units and an estimated number of 37-100 SCD/100,000, the use of the AEDs only 17 times appears relatively small. To improve the effectiveness of the AED program in Bochum, an analysis of the emergency service responses, which were necessary because of sudden circulatory collapse, is currently being performed. This will allow areas with an increased incidence of SCD to be identified and a plan for the strategic placement of AED and emergency services can be made.

Implementação do Programa Nacional de Desfibrilhação Automática Externa em Portugal

AimTo describe the stages of development and implementation of an automated external defibrillator (AED) program within the Emergency Medical Service System and in public places in Portugal. MethodsDescription of the implementation process in terms of logistics, training and supervision of activity. ResultsBy the end of 2012 there were 442 emergency ambulances equipped with AEDs included in the AED program of the National Institute for Medical Emergencies (INEM). Between 2010 and 2012, 2130 emergency medical technicians were trained and considered qualified to use AEDs. With regard to AED programs in public places, by the end of 2012 there were 207 licensed programs, covering 302 public places, 66 patient transport ambulances, 463 AEDs and 6133 AED operators. Between 2010 and 2012, 19 organizations were licensed to provide training in basic life support and AEDs. In INEM's AED program in 2012, AEDs were used 3250 times, with shockable rhythms in 12.5% of cases (407). Of these, a pulse was restored in 38.6% (157) after a shock, with recovery of spontaneous circulation in 45.9% of these (72). Survival to hospital discharge was 26% (19 cases). ConclusionsImplementation of the program followed recommended scientific criteria, and the results obtained, following significant growth in early access to AEDs, are satisfactory and in line with those in other countries. Strengthening the chain of survival requires the involvement of the community in general and in particular the widespread learning of basic life support measures, which must be the next step for all partners in the Emergency Medical Service System.

Implementation of a national automated external defibrillator program in Portugal

AimTo describe the stages of development and implementation of an automated external defibrillator (AED) program within the Emergency Medical Service System and in public places in Portugal. MethodsDescription of the implementation process in terms of logistics, training and supervision of activity. ResultsBy the end of 2012 there were 442 emergency ambulances equipped with AEDs included in the AED program of the National Institute for Medical Emergencies (INEM). Between 2010 and 2012, 2130 emergency medical technicians were trained and considered qualified to use AEDs. With regard to AED programs in public places, by the end of 2012 there were 207 licensed programs, covering 322 public places, 66 patient transport ambulances, 463 AEDs and 6133 AED operators. Between 2010 and 2012, 19 organizations were licensed to provide training in basic life support and AEDs. In INEM's AED program in 2012, AEDs were used 3250 times, with shockable rhythms in 12.5% of cases (407). Of these, a pulse was restored in 38.6% (157) after a shock, with recovery of spontaneous circulation in 45.9% of these (72). Survival to hospital discharge was 26% (19 cases). ConclusionsImplementation of the program followed recommended scientific criteria, and the results obtained, following significant growth in early access to AEDs, are satisfactory and in line with those in other countries. Strengthening the chain of survival requires the involvement of the community in general and in particular the widespread learning of basic life support measures, which must be the next step for all partners in the Emergency Medical Service System.

High School Automated External Defibrillator Programs as Markers of Emergency Preparedness for Sudden Cardiac Arrest

School-based automated external defibrillator (AED) programs have demonstrated a high survival rate for individuals suffering sudden cardiac arrest (SCA) in US high schools. To examine the relationship between high schools having an AED on campus and other measures of emergency preparedness for SCA. Cross-sectional study. United States high schools, December 2006 to September 2009. Principals, athletic directors, school nurses, and certified athletic trainers represented 3371 high schools. Comprehensive surveys on emergency planning for SCA submitted by high school representatives to the National Registry for AED Use in Sports from December 2006 to September 2009. Schools with and without AEDs were compared to assess other elements of emergency preparedness for SCA. A total of 2784 schools (82.6%) reported having 1 or more AEDs on campus, with an average of 2.8 AEDs per school; 587 schools (17.4%) had no AEDs. Schools with an enrollment of more than 500 students were more likely to have an AED (relative risk [RR] = 1.12, 95% confidence interval [CI] = 1.08, 1.16, P < .01). Suburban schools were more likely to have an AED than were rural (RR = 1.08, 95% CI = 1.04, 1.11, P < .01), urban (RR = 1.13, 95% CI = 1.04, 1.16, P < .01), or inner-city schools (RR = 1.10, 95% CI = 1.04, 1.23, P < .01). Schools with 1 or more AEDs were more likely to ensure access to early defibrillation (RR = 3.45, 95% CI = 2.97, 3.99, P < .01), establish an emergency action plan for SCA (RR = 1.83, 95% CI = 1.67, 2.00, P < .01), review the emergency action plan at least annually (RR = 1.99, 95% CI = 1.58, 2.50, P < .01), consult emergency medical services to develop the emergency action plan (RR = 1.18, 95% CI = 1.05, 1.32, P < .01), and establish a communication system to activate emergency responders (RR = 1.06, 95% CI = 1.01, 1.08, P < .01). High schools with AED programs were more likely to establish a comprehensive emergency response plan for SCA. Implementing school-based AED programs is a key step associated with emergency planning for young athletes with SCA.

First Responder for In-Hospital Resuscitation: 5-Year Experience with an Automated External Defibrillator-Based Program

BackgroundThe survival of in-hospital cardiac arrest (8–25%) has not changed substantially in the past. Until now, most hospitals in Germany had no standardized protocols available for a course of action in case of emergency, and there are no continuous registry data for in-hospital cardiac arrest and survival. ObjectiveOur aim was to improve survival and receive outcomes data, so we implemented a structured hospital-wide automated first-responder system in the hospital. Here our 5-year experience with 443 emergency calls is outlined. MethodsThroughout the hospital, 15 automated external defibrillator (AED) “access spots,” which can be easily reached within 30 s, were identified. AEDs were then installed at these locations (Lifepak 500 and Lifepak 1000, Medtronic equipped with a Biolog 3000i portable ECG monitor). At the same time, a training program was initiated in which the employees of the hospital participated once a year. Participants learned how to apply and activate an AED in case of cardiac arrest even before the designated Cardiac Arrest Team arrived at the scene. ResultsA witnessed cardiac arrest event was confirmed in 126 cases. In 56 of the 126 cases, the primary arrest rhythm was either ventricular tachycardia or ventricular fibrillation and the AED delivered a shock. In this group, spontaneous circulation was reached in 44 cases (79%) and 23 patients (41%) were discharged. In 44% (24 from 55 patients) of the cases, a shock was recommended by AED and delivered by the first responders before the rescue team arrived. ConclusionsThe first-responder AED program successfully gave training lessons to the hospital staff. The training included how to initiate the cardiac arrest call, how to use the AED, and how to start immediate resuscitation. As a result, a higher survival rate after in-hospital cardiac arrest can be accomplished.

The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved. A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences. AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program. The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

Use of Automated External Defibrillators in the Occupational Setting in Germany

Automated external defibrillators (AEDs) are widely used to increase survival of patients with sudden cardiac arrest (SCA). Despite these experiences only few data exist dealing with SCA at the workplace or AED usage in the occupational setting. In a pilot study, occupational physicians throughout Germany were contacted and queried about the utilization of AED and the primary success rate (return of spontaneous circulation; ROSC). Of 232 occupational physicians, 155 (67%) stated that the enterprise provided at least one AED. Overall, 63 AED utilizations were analyzed. An ROSC was reported in 42 patients (67%). In 48% (n = 20) ROSC was established before the arrival of the EMS. Our study showed a high proportion of patients with ROSC after SCA. Increased attention should be turned to workplace SCA and AED programs.

Reply

Authors Reply: I appreciate the thoughtful comments of McGuire-Wolfe. Excellent public-access automated external defibrillator (AED) programs exist all over the world, and it sounds as if there is such a program in Pasco County. We did not mean to imply that the money to fund such programs comes from the traditional healthcare sources; however, the money must come from somewhere. Local communities often choose to fund public-health projects, and AED programs are an example of that. If cost-effectiveness is a factor in funding, then communities need to know if their money provides greater returns in an AED program as compared with programs such as hypertension awareness or drug-prevention education in teens. Unfortunately for AED therapy, all of the available cost-effectiveness data comes from models that make a lot of assumptions and could be grossly inaccurate. It sounds as if Pasco County would be an ideal location to track all of the actual costs of a public-access AED program, including the cost of the AEDs and their ongoing maintenance, training of personnel, and all of the administrative costs. Such real-world data of actual costs and number of lives saved would be very important to determine the cost-effectiveness of public-access defibrillation.

Part 6: Electrical Therapies

The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF. Further data are needed to refine recommendations for energy levels for defibrillation and cardioversion using biphasic waveforms.