Automated External Defibrillators Use Research Articles

Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary Resuscitation

Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada. In the United States, each year ≈330 000 people die of coronary heart disease out of the hospital or in emergency departments. Of these, >150 000 SCAs occur out of the hospital.1,2 Despite the development of electrical defibrillation and the more recent implementation of lay rescuer defibrillation programs, the vast majority of these victims do not leave the hospital alive. In studies over the past 15 years, only 1.4% of patients with out-of-hospital arrest in Los Angeles, Calif, survived to hospital discharge3; in Chicago, Ill, the number was 2%,4 and in Detroit, Mich, it was <1%.5 Conversely, a few municipalities such as Seattle, Wash, report much higher survival rates from SCA—more than 15% in 1 study6—which suggests that survival rates need not remain so low. Recent work in Europe and elsewhere has confirmed that a higher survival-to-hospital discharge rate is indeed a realistic goal, with survival rates as high as 9% reported in Amsterdam7 and 21% in Maribor, Slovenia.8 The American Heart Association (AHA) uses 4 links in the “chain of survival” to illustrate the time-sensitive actions required for victims of SCA: (1) early recognition of the emergency and activation of emergency medical services (EMS), (2) early bystander cardiopulmonary resuscitation (CPR), (3) early delivery of shock(s) from a defibrillator if indicated, and (4) early advanced life support and postresuscitation care. Immediate bystander recognition of the emergency and EMS activation are critical. In many communities, however, these actions may be followed by significant delays, because the time interval from activation of EMS to arrival of these medical personnel may be 7 to 8 minutes or longer.4 Therefore, initial care in the first critical minutes after …

CrossRef Listing of Deleted DOIs

The increasing use of automated external defibrillators (AEDs), coupled with methods to improve cardiopulmonary resusitation and implementation of early defibrillation, have significantly improved survival from sudden cardiac death (SCD) in the prehospital setting. This article reviews the evidence and principles of management of SCD in the sports setting. It is noted that ventricular fibrillation is the most common arrhythmia causing SCD in athletes. When it occurs, survival is reduced by 7% to 10% per minute pending defibrillation. This statistic is true for athletes as well as nonathletes, and underscores the critical need for a rapid defibrillation response. Use of the AED in the sports setting and suggestions on whether to implement an AED program are reviewed. Despite increasing application of this technology, outcomes data on the use of AEDs in the sports arena are lacking, partly due to the relatively rare occurrence of SCD therein. New evidence on pharmacotherapy in SCD is also reviewed. Although drug administration in SCD is unlikely to be required in the sports setting, clinicians are updated on some of the newer considerations. Finally, selected articles from the recent literature on advanced cardiac life support are provided to guide the team physician in using the most current approach to the management of SCD.

The Prognosis of Patients who Received Automated External Defibrillator Treatment in Hospital

Introduction: Unlike cardiac arrest occurring out-of-hospital, the safety and efficacy of automated external defibrillators (AED) in the hospital has not been assessed. This study examined the conditions of AED use in hospital and the prognosis of these patients. Methods and Results: We examined the condition and prognosis of 32 patients who were given AED treatment while they were in an unconscious state in the hospital, between May 2004 and January 2007. During this period, AED was used only for patients, not for visitors or hospital personnel. Ventricular fibrillation (VF) or ventricular tachycardia (VT) was observed in 7 patients, and in the other 25 the initial rhythm of the patients did not require AED. Two patients survived with the help of AED, but it did not deliver shock in two patients with VF and VT. There was no significant difference in vital prognosis due to the presence or absence of shock delivery in the VF or VT patients. Conclusion: The situation of AED use may be different whether it is used in hospital or outof-hospital. This study suggests that using AED in the hospital may have limited effect when it is used for critically ill patients.

The Prognosis of Patients who Received Automated External Defibrillator Treatment in Hospital

Introduction: Unlike cardiac arrest occurring out‐of‐hospital, the safety and efficacy of automated external defibrillators (AED) in the hospital has not been assessed. This study examined the conditions of AED use in hospital and the prognosis of these patients.Methods and Results: We examined the condition and prognosis of 32 patients who were given AED treatment while they were in an unconscious state in the hospital, between May 2004 and January 2007. During this period, AED was used only for patients, not for visitors or hospital personnel.Ventricular fibrillation (VF) or ventricular tachycardia (VT) was observed in 7 patients, and in the other 25 the initial rhythm of the patients did not require AED. Two patients survived with the help of AED, but it did not deliver shock in two patients with VF and VT. There was no significant difference in vital prognosis due to the presence or absence of shock delivery in the VF or VT patients.Conclusion: The situation of AED use may be different whether it is used in hospital or outof‐hospital. This study suggests that using AED in the hospital may have limited effect when it is used for critically ill patients.

Automatic External Defibrillators: the Potential for Widespread Prevention of Sudden Cardiac Death in the Community

A B S T R A C T The vast majority of witnessed sudden cardiac death is due to the unpredictable occurrence of ventricular fibrillation, which is almost uniformly reversed by the immediate application of defibrillation. Thus, there is dire need for development of the appropriate conditions for early defibrillation in places where the likelihood of an unexpected sudden death event is deemed probable. In this setting, the automatic external defibrillators (AED) in the hands of even trained lay persons has been considered to have the potential to be the single greatest advance in the treatment of cardiac arrest due to ventricular fibrillation since the development of cardiopulmonary resuscitation. Several studies suggest that the use of publicly accessible AEDs by lay persons is feasible and that organized AED training should also focus on community and on-site responders. The potential for widespread prevention of sudden cardiac death in the community with the use of AEDs is discussed in this brief overview.

Legal Aspects of the Application of the Lay Rescuer Automatic External Defibrillator (AED) Program in South Korea

The American Heart Association has stated that the automatic external defibrillator (AED) is a promising method for achieving rapid defibrillation, and emphasized that AED training and use should be available in every community. The demonstrated safety and effectiveness of the AED make it ideally suited for the delivery of early defibrillation by trained laypersons, and the placement of AEDs in selected locations for immediate use by trained laypersons may enable critical intervention that can significantly increase survival from out-of-hospital cardiac arrest. The American Heart Association recommends the installation of AEDs in public locations such as airports, thus allowing laypersons to conduct defibrillation and cardiopulmonary resuscitation on the occasion of adverse cardiopulmonary events. In Korea, the Ministry of Health and Welfare officially prohibits the installation of AEDs in public locations on the grounds that cardiopulmonary resuscitation and defibrillation are understood as medical practices that can be conducted only by licensed medical practitioners. The purpose of this article is to discuss the necessity for AEDs and the appropriate process for their implementation in Korea, by examining the current pre-AED status of Korea and the relevant legal aspects.

Ventricular Fibrillation and the Use of Automated External Defibrillators on Children

The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.

Ventricular Fibrillation and the Use of Automated External Defibrillators on Children

The use of automated external defibrillators (AEDs) has been advocated in recent years as one part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they had not been tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from the use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, which has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use on children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of them on children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.

Abstract 82: Awareness of Guidelines of Automated External Defibrillator Use in Children within Emergency Medical Services

BACKGROUND . Ventricular fibrillation occurs in 10 –20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last five years, recommendations have been made for the use of automated external defibrillators(AED) in children 1– 8 years of age. OBJECTIVE . The goal of this study was to determine the awareness of American Heart Association (AHA) guidelines and statewide protocols concerning AED use in children ages 1– 8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. METHODS . Surveys were distributed to EMS providers in Iowa and Montana within one year of the AHA advisory statement in 2003 recommending use of AEDs in children ages 1– 8, and again approximately one year after the 2005 AHA guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. RESULTS . Awareness of AHA guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs 9% in Montana, p&lt; 0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60 %, p &lt; 0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs 37% in Montana, p &lt; 0.001). CONCLUSIONS . At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that awareness among providers and that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter should be developed.

Abstract 78: Cardiopulmonary and Automatic External Defibrillator handling skills evaluation in lay persons

Background: Since the public access of defibrillation law was approved in Sao Paulo city in 2005, it has been increasing the number of lay people who demand for cardiopulmonary resuscitation (CPR) and Automatic External Defibrillator (AED) training courses. According to the law, subway stations should have an AED and 30 per cent of the Agents should be trained in Heartsaver AED. The American Heart Association advises a Basic Life Support (BLS) refresh every two years. However, recent published papers demonstrated a significant decrease in CPR skills only 6 months following a BLS course. Hypothesis: we hypothesized that retention of skills in CPR and AED use considerably diminish after 8 month of training in Heartsaver AED course. Methods: This is an observational prospective study on the retention of CPR and AED handling skills. Twenty Subway Agents who were previously trained in these maneuvers were evaluated . The evaluation of the skills retention was performed 8 months after the success completion of the first Heartsaver AED course, consisting in a cardiopulmonary arrest simulation in a training mannequin. An experienced Heartsaver AED instructor evaluated the following performed skills: Check for response; Activate Emergency Response System and Get an AED; Open airway; Check breathing; Give two breaths; Perform compressions hard and fast in a correct hands position; AED operation Results: It was observed that the totality of the participants did not fill, at least, one of the requirements of the evaluation: 85% of the participants checked response, 55% asked for help after check response, 45% asked for help at another moment, 45% opened correctly the airway, 30% checked breathing, 50% gave two breathings, 80% performed 30 compressions, 35% performed compressions in a correct frequency and 60% had performed correct chest place CPR. Concerning the AED use, 30% powered the AED in an appropriated manner and 15% correctly attached the pads but 15% removed the pads after the chock. Conclusion: The results suggest a possible necessity of a continuous CPR and AED training in view of a significant decreasing in the performance of these skills 8 months following the first training course.

Cardiopulmonary resuscitation alone vs. cardiopulmonary resuscitation plus automated external defibrillator use by non-healthcare professionals: A meta-analysis on 1583 cases of out-of-hospital cardiac arrest

Out-of-hospital cardiac arrest (OHCA) accounts for 250.000-350.000 sudden cardiac deaths per year in the United States. The availability of automated external defibrillators (AEDs) promoted the implementation of public access defibrillation programs based on out-of-hospital early defibrillation by non-healthcare professionals. To perform a systematic review and a meta-analysis of the pooled effect of studies comparing the outcome of pts receiving cardiopulmonary resuscitation plus AED therapy (CPR+AED) vs. cardiopulmonary resuscitation (CPR) alone, both delivered by non-healthcare professionals, for the treatment of OHCA. We performed a search of the relevant literature exploring major scientific databases, carrying out a hand search of key journals, analysing conference proceedings and abstracts and discussing the topic with other researchers. Two analyses were planned to assess the outcomes of interest (survival to hospital admission and survival to hospital discharge). Three studies were selected for the meta-analysis. The first meta-analysis evidenced a RR of 1.22 (95% C.I.: 1.04-1.43) of surviving to hospital admission for people treated with CPR+AED as compared to CPR-only. The second meta-analysis showed a RR of 1.39 (95% C.I.: 1.06-1.83) of surviving to hospital discharge for people treated with CPR+AED as compared to CPR-only. The results of our meta-analysis demonstrate that programs based on CPR plus early defibrillation with AEDs by trained non-healthcare professionals offer a survival advantage over CPR-only in OHCA. The conclusions of our meta-analysis add to previous evidence in favour of developing public-health strategies based on AED use by trained layrescuers.

Ability of Citizens in a Senior Living Community to Perform Lifesaving Cardiac Skills and Appropriately Utilize AEDs

The objective of this study was to assess the ability of citizens in a senior living community (SLC) to perform adequate cardiopulmonary resuscitation (CPR) and appropriately utilize an automated external defibrillator (AED) in a simulated cardiac arrest scenario (SCAS). This study was a prospective, observational study; a convenience sample of SLC residents aged > 54 years was enrolled. Subjects were presented with a SCAS (adult mannequin, bystander available to assist, AED visible). Subjects’ skills were rated in standardized fashion. For statistical analysis, 95% confidence intervals (CIs) were calculated as appropriate. There were 51 subjects; 69% were female; mean age was 64 years; 86% were without disabilities. Pre-retirement professions included: medical (13.7%), office/sales (41.2%), and engineer/science (15.7%). Subjects had previous American Heart Association first-responder training (CPR and AED use) as follows: none (22%), within 0 to 6 months (47%), 7–12 months (4%), > 12 months (27%). During the SCAS, subjects performed inconsistently on the various links in the chain of survival. Although most subjects (94%; 95% CI 84–99%) checked for unresponsiveness, only 62.8% (95% CI 48–76%) also specified “call 911 and bring me the AED.” Most subjects (88%; 95% CI 76–96%) started chest compressions, however, only a minority provided high quality chest compressions (29%; 95% CI 17–44%). With respect to AED skill performance, we noted the following: 94% (95% CI 84–99%) of subjects removed the patient’s clothing, 90% (95% CI 79–97%) turned the device on, 94% delivered a shock as directed, and 82% continued CPR if “no shock indicated” by AED (95% CI 69–92%). Performance was less satisfactory for the following: only 39.2% (95% CI 26–54%) continued chest compressions after AED arrival, 60.8% (95% CI 46–74%) of subjects correctly attached electrodes, and 6% (95% CI 1–16%) verbalized “clear” in advance of shock. Although many members of our sample SLC had prior training, they frequently failed to adequately perform some key steps in the SCAS. Recent efforts to place AEDs in SLCs should be augmented by a plan to adequately train residents and other available individuals (e.g., staff) in CPR/AED use.

College Fitness Center Emergency Readiness

College Fitness Center Emergency Readiness

Attitudes of Ohio Dentists and Dental Hygienists on the Use of Automated External Defibrillators

The American Heart Association reports that approximately 220,000 people die each year of sudden cardiac arrest. In ventricular fibrillation (VF), the most common abnormal heart rhythm that causes cardiac arrest, the heart's electrical impulses suddenly become chaotic, often without warning. Death will follow within minutes if the victim is not treated appropriately, and the only known treatment is defibrillation. An automated external defibrillator (AED) can restore a victim's normal heart rhythm by providing defibrillation. The purpose of this study was to gather data from dentists and dental hygienists in Ohio on their use of and attitudes toward using AEDs in dental offices. Six percent of Ohio dentists and dental hygienists were randomly selected to receive a twenty-three question survey related to their use of and attitudes toward their use of AEDs in dental offices. Thirty-three percent (244) of the surveys were returned; 41 percent of the respondents were dentists, and 59 percent were dental hygienists. Six percent said they have had to administer nitroglycerin to a patient during a dental visit; 5 percent have performed CPR on a patient in the dental office; and 78 percent said their last CPR training course included training on an AED. Eleven percent said there was an AED at their dental office. With the increased likelihood of dealing with a cardiac emergency in the dental office setting and the willingness of dental professionals to use an AED, all dental offices should consider obtaining an AED. Dental educators should become familiar with current protocols for handling cardiac medical emergencies in the dental office and prepare dental and dental hygiene students with the skills necessary to manage patients with cardiac emergencies. Graduating dental students entering private practice may want to consider the AED as part of their medical emergency office protocol.

Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement

To assist high school and college athletic programs prepare for and respond to sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA. SCA is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes. Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishing an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of onsite responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.

Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement

To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA. Sudden cardiac arrest is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes. Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishing an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of onsite responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.

Automated external defibrillators in Washington State high schools

Background: The placement of automated external defibrillators (AEDs) in schools and public sporting venues is a growing national trend. Objective: To determine the prevalence and use of AEDs in Washington...

Why AMDA Is Still on Sidelines Over AEDs

Why AMDA Is Still on Sidelines Over AEDs

Home defibrillation: A feasibility study in myocardial infarction survivors at intermediate risk of sudden death

Background Out-of-hospital cardiac arrest occurs at home in 65-80% of cases and is often witnessed. We designed a study to explore the feasibility of a home defibrillation program (a) evaluating the retention of cardiopulmonary resuscitation and automated external defibrillators (AED) use skills (BLSD) (b) assessing the impact on anxiety, depression, and quality of life and (c) recording the critical issues emerging from program implementation. Methods Thirty-three post-myocardial infarction patients and their 56 relatives received BLSD training and an AED. Assessment of BLSD skills, levels of anxiety, and depression and quality of life were scheduled every 3 months for 1 year or until a common stopping date. Results Overall BLSD score was 26 ± 3 at baseline vs. 22 ± 5 at 3 months ( P < .0001), 21 ± 6 at 6 months ( P < .0001), 22 ± 4 at 9 months ( P < .0001) and 23 ± 5 at 12 months ( P = .001). Conversely, the BLSD component AED use” remained stable throughout the study. Quality of life, anxiety, and depression scores remained constant. Compliance to BLSD retraining sessions and AEDs checks decreased over time and was influenced by a concomitant clinical appoinment. Conclusions BLSD performance of families of post-myocardial infarction patients decreases over time, even though the ability to operate AEDs appears to be the least affected component. Compliance with retraining sessions and AED checks declines over time and is improved if they are combined with clinical appointments. The implementation of a home defibrillation program does not affect anxiety, depression, or the quality of life.

Eighth grade students become proficient at CPR and use of an AED following a condensed training programme

To evaluate a new, 1-h, condensed training programme to teach continuous chest compression cardiopulmonary resuscitation (CCC-CPR) and automated external defibrillator (AED) skills to a cohort of eight grade public school students. Thirty-three eligible subjects completed the programme; mean age 13.7 years; 48.5% female. Eight participants reported some prior training in CPR and AED use. Following initial training, 29/33 (87.8%) subjects demonstrated proficiency at CCC-CPR and AED application/operation in a mock adult cardiac arrest scenario. At four-weeks, 28/33 (84.8%) subjects demonstrated skill retention in similar scenario testing. Subjects also showed improvement in written knowledge regarding AED use as shown by scores on an AHA based written exam (60.9% versus 77.3%; p<0.001). With our focused, condensed training program, eighth grade public school students became proficient in CCC-CPR and AED use. This is the first study to document the ability of middle school students to learn and retain CCC-CPR and AED skills for adult sudden cardiac arrest victims with such a curriculum.