Automated External Defibrillators Use Research Articles

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.

AEDs at Your Fingertips: Automated External Defibrillators on College Campuses and a Novel Approach for Increasing Accessibility

. The use of automated external defibrillators (AEDs) increases survival in cardiac arrest events. Due to the success of previous efforts and free, readily available mobile mapping software, the discussion is to emphasize the importance of the use of AEDs to prevent sudden cardiac arrest–related deaths on college campuses and abroad, while suggesting a novel approach to aiding in access and awareness issues. A user-friendly mobile application (a low-cost iOS map) was developed at Florida State University to decrease AED retrieval distance and time. The development of mobile AED maps is feasible for a variety of universities and other entities, with the potential to save lives. Just having AEDs installed is not enough—they need to be easily locatable. Society increasingly relies on phones to provide information, and there are opportunities to use mobile technology to locate and share information about relevant emergency devices; these should be incorporated into the chain of survival.

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.

Public access defibrillation—Results from the Victorian Ambulance Cardiac Arrest Registry

AimTo assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). MethodsWe analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. ResultsOf 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p<0.001). First defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0min, p<0.001). Unadjusted survival to hospital discharge for bystander defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p<0.05). Multivariable logistic regression analysis showed that first defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p=0.010) compared to first defibrillation by EMS. ConclusionSurvival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.

Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers.

Although increased dissemination of automated external defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affected public cardiac arrest coverage in high- and low-risk areas. All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High-risk areas were defined as those with ≥1 arrest every 2 years and accounted for 1.0% of the total city area. Of 1864 cardiac arrests, 18.0% (n=335) occurred in high-risk areas throughout the study period. From 2007 to 2011, the number of AEDs and the corresponding coverage of cardiac arrests increased from 36 to 552 and from 2.7% to 32.6%, respectively. The corresponding increase for high-risk areas was from 1 to 30 AEDs and coverage from 5.7% to 51.3%, respectively. Since the establishment of the AED network (2007-2011), few arrests (n=55) have occurred ≤100 m from an AED with only 14.5% (n=8) being defibrillated before the arrival of emergency medical services. Despite the lack of a coordinated public access defibrillation program, the number of AEDs increased 15-fold with a corresponding increase in cardiac arrest coverage from 2.7% to 32.6% over a 5-year period. The highest increase in coverage was observed in high-risk areas (from 5.7% to 51.3%). AED networks can be used as useful tools to optimize AED placement in community settings.

Care for Cardiac Arrest on Golf Courses: Still Not up to Par?

Introduction. Early CPR and use of automated external defibrillators (AEDs) have been shown to improve cardiac arrest (CA) outcomes. Placement of AEDs on golf courses has been advocated for more than a decade, with many trade golf publications calling for their use. Objective. To describe the incidence and treatment of CAs at Michigan golf courses and assess the response readiness of their staff. Methods. We performed a retrospective study of CA on Michigan golf courses from 2010 to 2012. Cases were identified from the Michigan EMS Information (MI-EMSIS) database. Cases with “golf” or “country club” were manually reviewed and location type was confirmed using Google Maps. We conducted a structured telephone survey capturing demographics, course preparedness, including CPR training and AED placement, and a description of events, including whether CPR was performed and if an AED was used. Our primary area of interest was the process of care. We also recorded return of spontaneous circulation (ROSC) as an outcome measure. EMS Utstein data were collected from MI-EMSIS. Descriptive data are presented. Results. During the study period, there were 14,666 CAs, of which 40 (0.18%) occurred on 39 golf courses (1 arrest/64 courses/year). Of these, 38 occurred between May and October, yielding a rate of 1 arrest/33.5 courses/golf season. Almost all (96.2%) patients were male, mean age 66.3 (range 45–85), 68% had VT/VF, and 7 arrested after EMS arrival. Mean interval from 9-1-1 call to EMS arrival at the patient was 9:45 minutes (range 3–20). Of all cases, 24 (72.3%) patients received CPR with 2 patients having CPR performed by course staff. Although AEDs were available at 9 (22.5%) courses, they were only placed on 2 patients prior to EMS arrival. Sustained ROSC was obtained in 12 (30.0%) patients. Only 7, (17.9%) courses required CPR/AED training of staff. Conclusion. When seasonally adjusted, the rate of cardiac arrest on Michigan golf courses is similar to that of other public locations. AED use was rare even when available. Preparedness for and response during a CA is suboptimal. Despite more than a decade of advocacy, response to golf course cardiac arrest is still not up to par.

European Restart a Heart Day.

October 16th is European Restart a Heart Day (http://www.restartaheart.eu). This initiative, spearheaded by the European Resuscitation Council (ERC), is aimed at increasing survival rates from out-of-hospital cardiorespiratory arrest (OHCA). It was instigated in 2013 following a successful campaign by the ERC to pass a written declaration in the European Parliament, which called upon member states to improve awareness and provide cardiopulmonary resuscitation (CPR) education to the public as well as healthcare professionals. The 2010 ERC Guidelines had already endorsed the recommendation that all citizens should be taught CPR.1 Every year, approximately 350 000 Europeans suffer OHCA.2 In the UK alone, the figure is estimated to be 60 000.3 Average survival rates are, at best, 12% overall with higher rates (23%) seen in the subgroup of those who are fortunate to arrest in a ‘shockable’ rhythm (ventricular fibrillation or tachycardia).4 Factors that have been proven to improve survival include rapid access to defibrillation and swift onset of CPR in the meantime. For every minute that passes without CPR, survival decreases by 10%. With bystander CPR, this rate drops to 2–3% per minute thus buying extra time for a defibrillator to arrive and be used successfully.1 As Deakin and Gray5 have shown however, the presence of a nearby automated external defibrillator (AED) does not guarantee its use. We therefore need to increase awareness in the use of public access AEDs as well as train our population to perform CPR when needed. The theme of last year's Restart a Heart Day was ‘Children Save Lives’. Events were held throughout Europe to increase awareness of the problem. In the UK, the Resuscitation Council (UK) distributed a free copy of the award winning Lifesaver programme (http://www.life-saver.org.uk) to every …

Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?

Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population.

Effectiveness of a simplified cardiopulmonary resuscitation training program for the non-medical staff of a university hospital.

BackgroundThe 2010 Consensus on Science and Treatment Recommendations Statement recommended that short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered an effective alternative to instructor-led basic life support courses. The purpose of this study was to examine the effectiveness of a simplified cardiopulmonary resuscitation (CPR) training program for non-medical staff working at a university hospital.MethodsBefore and immediately after a 45-min CPR training program consisting of instruction on chest compression and automated external defibrillator (AED) use with a personal training manikin, CPR skills were automatically recorded and evaluated. Participants’ attitudes towards CPR were evaluated by a questionnaire survey.ResultsFrom September 2011 through March 2013, 161 participants attended the program. We evaluated chest compression technique in 109 of these participants. The number of chest compressions delivered after the program versus that before was significantly greater (110.8 ± 13.0/min vs 94.2 ± 27.4/min, p < 0.0001), interruption of chest compressions was significantly shorter (0.05 ± 0.34 sec/30 sec vs 0.89 ± 3.52 sec/30 sec, p < 0.05), mean depth of chest compressions was significantly greater (57.6 ± 6.8 mm vs 52.2 ± 9.4 mm, p < 0.0001), and the proportion of incomplete chest compressions of <5 cm among all chest compressions was significantly decreased (8.9 ± 23.2% vs 38.6 ± 42.9%, p < 0.0001). Of the 159 participants who responded to the questionnaire survey after the program, the proportion of participants who answered ‘I can check for a response,’ ‘I can perform chest compressions,’ and ‘I can absolutely or I think I can use an AED’ increased versus that before the program (81.8% vs 19.5%, 77.4% vs 10.1%, 84.3% vs 23.3%, respectively).ConclusionsA 45-min simplified CPR training program on chest compression and AED use improved CPR quality and the attitude towards CPR and AED use of non-medical staff of a university hospital.

Achieving an out of hospital cardiac arrest survival rate of over 79%

Aim: The study reviewed out of hospital cardiac arrests that occurred within a Health & Fitness chain over a 3 year period form 1st January 2011 to 31st December 2013. All branches of the chain have an Automated External Defibrillator (AED), lay rescuers trained in CPR and the use of AEDs and a robust AED policy to ensure that the AED arrives at all incidents rapidly.

Is there a need for automated external defibrillators in supermarkets?

The government white paper Saving lives: Our Healthier Nation ( Department of Health (DH), 1999 ) was the first of its kind to set the standard for decreasing social inequalities in health care. In particular it placed emphasis on reducing the number of deaths in England from coronary heart disease (CHD). Sudden cardiac arrest accounts for 60% of adult deaths from CHD in Europe ( Resuscitation Council (UK) 2011 ). It is estimated that 60 000 out-of-hospital cardiac arrests (OHCA) occur in the UK each year and the outcome remains poor ( Resuscitation Council (UK), 2011 ). In order to reduce the number of deaths from OHCA in the UK, the government implemented a national defibrillator programme ( Davies et al, 2002 ). Its success was such that many workplaces in the UK are considering having public-access automated external defibrillators (AED) on site. Currently, no research exists regarding the use of AEDs in supermarkets but studies have been carried out in areas which have a similar footfall on a daily basis and a clientele and workforce of various ages. Despite the lack of research, many large supermarket chains have carried out individual risk assessments and have consequently began to install AEDs on site. This article aims to explore this requirement further, taking into consideration cost-effectiveness and training requirements, as well as the legal aspects of having an AED in the workplace.

Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era.

BackgroundThe strategy to place public‐access automated external defibrillators (AEDs) has not yet been established in real settings.Methods and ResultsThis, prospective, population‐based observational study in Osaka, Japan, included consecutive out‐of‐hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public‐access AED use and 1‐month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander‐witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public‐access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public‐access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1‐minute increment, 0.89; 95% confidence interval, 0.87 to 0.92).ConclusionsThis large, population‐based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public‐access defibrillation program was successfully implemented so that shocks with public‐access AEDs were delivered to over 40% of bystander‐witnessed OHCAs and time to shock was shortened in some kinds of public places.

Most Important Outcomes Research Papers on Cardiac Arrest and Cardiopulmonary Resuscitation

Cardiac arrest is a common and treatable cause of death and disability. Each year ≈424 000 people experience emergency medical services (EMS)-assessed out-of-hospital cardiac arrest (OHCA) in the United States.1 The actual burden of OHCA is likely significantly higher because a substantial number go unassessed. In a prospective analysis of deaths in a US county, 5.6% of annual mortality was attributable to cardiac arrest.2 Many patients who suffer OHCA do not receive prompt cardiopulmonary resuscitation (CPR). Among those who receive CPR, a large number do not survive because of an inability to restore spontaneous circulation, or anoxic cerebral injury even after restoration of circulation. Nevertheless, when timely interventions are provided, a small proportion of patients (10.4% of all EMS-treated OHCA) recover to resume normal lives. The key therapeutic interventions that make the difference between life and death, metaphorically characterized as the 5 links in a chain of survival by the American Heart Association, include: (1) immediate recognition of cardiac arrest and activation of the EMS, (2) early CPR with emphasis on chest compression, (3) rapid defibrillation, (4) effective advanced life support, and (5) integrated postcardiac arrest care.3 Resuscitation science has undergone major advances since the origins of modern CPR >50 years ago.4 The field continues to be dynamic with emergence of new therapies such as therapeutic hypothermia5 and improvements in systems of care. However, many questions remain on issues such as optimum compression rate, efficacy of chest compression only CPR (CCCPR), dispatcher-assisted CPR, and benefits of postresuscitation measures such as hypothermia. A critical challenge also lies in the translation of resuscitation science into practice. To improve outcomes, each of the links in the chain of survival needs to be executed promptly and effectively. There remain several lacunae, which need to be overcome to develop an …

Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo

Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed; CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms; the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%; 7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.

Long‐term Retention of Cardiopulmonary Resuscitation Skills After Shortened Chest Compression–only Training and Conventional Training: A Randomized Controlled Trial

It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training. Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, rescue breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. UMIN-CTR UMIN000001675.

병원직원의 심폐소생술 수행능력에 영향을 미치는 요인

Purpose: The purpose of this study was to identify the factors influencing hospital staffs' performance ability of Cardiopulmonary resuscitation (CPR). Methods: The study was conducted with 250 hospital staffs in B hospital located in Busan. The survey data were collected from August 1 to September 15, 2012 and were analyzed using frequencies, percentages, means, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression with the SPSS WIN 19.0 program. Results: There were statistically significant differences in performance ability of CPR depending on occupations, CPR experience, CPR situations, identification of Automated external defibrillator (AED) location within the hospital, AED use experience, CPR training experience and AED training experience. A significant positive correlation was found between CPR knowledge and performance ability in addition to a significant positive correlation between CPR attitude and to performance ability. The significant factors influencing performance ability of CPR were CPR attitude, occupations, CPR training experience, knowledge and identification of AED location within the hospital. Those factors explained about 40.1% of the variance. Conclusion: It is necessary to develop a strategy for hospital staff to improve the levels of performance ability of CPR.

Abstract 311: Defibrillation in Public Places. Who is Shocking the Patients?

Background: In 2003, survival from Out of Hospital Cardiac Arrest (OHCA) was 2,5 % in Stockholm county. To increase survival, a first responder system was implemented in 2005 in parallel with a structured Public Access Defibrillation (PAD) program. In addition, the number of “wild” public Automated External Defibrillators (AEDs) has rapidly increased over time. Aim: To evaluate the impact on survival from three different defibrillation strategies (EMS, first responders and PAD) in OHCA patients available for PAD in Stockholm County, Sweden. Methods: All witnessed cases of OHCA outside home of cardiac origin with shockable rhythm in Stockholm County 2006-2012 were considered subjects for PAD and were included in the study. 60 high incidence sites were initially selected for the PAD program, and security officers and lay responders were trained to respond to “on site” emergencies. The number of sites in the PAD program increased to 120 at the end of the study. 35 fire stations throughout the county were available for simultaneously dispatch to suspected OHCAs. By approximations based on wholesale numbers, around 1000 public AEDs were present outside the PAD program. Results: 469 OHCA cases were included in the study. Out of these, 66 % (n=311) were defibrillated by the EMS, 16% (n=77) by a first responder and in 17% (n=81) the first shock was delivered by a public AED. In 33% (n=27) the public AED was a part of the PAD program. Survival to 1-month was 33 % in cases were defibrillation was performed by the EMS (n=103), 33% if defibrillation was performed by a first responder (n=25) and 66 % (n=55) if a public AED was used. Defibrillation by EMS and first responders in patients suitable for PAD decreased over time[[Unable to Display Character: ]]from 93% to 73 %. Concurrently, defibrillation by public AEDs increased from 7% to 27% during the study period. Conclusion: [[Unable to Display Character: ]]Public AEDs significantly contributes to survival in OHCAs suitable for PAD in Stockholm County, demonstrated by a 1-month survival of 66%. In this patient population, a public AED is used in 30% of all cases and with increased use of AEDs, PAD might challenge the potential gain from EMS and first responder systems.

Abstract 86: AED Allocation: Creating Rules for AED Placement Based on Urban Risk Maps

Background: Although the prompt use of automatic external defibrillators (AEDs) in out of hospital cardiac arrest (OHCA) can be lifesaving, policies to guide placement of publicly accessible AEDs are not clearly defined. Objectives: To use location-based risk, location density, and presence of a designated responder to create a risk-based mapping framework to guide urban AED placement. Methods: Literature reporting frequency of OHCA by location type in urban areas was used to create a list of candidate sites in downtown Philadelphia, PA. Location-based risk areas were plotted using ArcGIS with a kernel density surface that reflected walking time of approximately 1.5 minutes. Locations were identified through available public records and the Google search engine. Designated responder status was assigned by location type. Sites were weighted by risk of arrest and multiplied by density of designated responders to create a composite “opportunity” layer. Hypothetical sites for 20 new AEDs were then mapped by selecting the point with the highest opportunity score, “placing” an AED, and recalculating opportunity scores for the entire study area. This process was iterated until 20 hypothetical AEDs were sited. Results: Thirty types of locations with previously-studied frequency of OHCA were identified. Figure 1 identifies several high-risk areas for OHCAs with AED caretakers present to use devices in an emergency that could benefit from close proximity to an AED. Conclusions: A location-based risk map for OHCA identifies specific higher-risk locations to locate AEDs in an urban area. The metrics to build this theoretical framework for device allocation can be used by cities to guide more strategic AED placement based on their unique cardiac arrest data and current AED placement. Figure 1:

Prepared for sudden cardiac arrest? A cross-sectional study of automated external defibrillators in amateur sport

IntroductionSudden cardiac arrest (SCA) is a rare but tragic part of professional and amateur sport. Following multiple high profile deaths in professional sport over the past two decades, there has...