Automated External Defibrillator Application Research Articles

Einflüsse medizinischer Aufklärungsarbeit auf Erste-Hilfe- und AED-Kenntnisse in der Allgemeinbevölkerung

Although most laypersons have incomplete knowledge of first aid, the placement of automated external defibrillators (AED) on public places suggests AED application by laypersons. Unfortunately, previous results are disappointing; many people don't even recognize AED. Therefore, most authors suggest to force medical education about sudden cardiac death and AED use among laypersons. We wanted to find out whether intensive medical education can improve the recognition of AED at public places and the attendance to acquire knowledge in first aid. In 2001 eight AED were placed in the amusement swimming park "LAGO - die Therme". Contemporaneously, we started public education regarding sudden cardiac death, resuscitation and AED among layperson visiting the LAGO. After 10 years we interviewed the visitors with special regard to their knowledge of first aid and AED use. 531 persons (260 men, age 48,4 ± 21,9 [range 8-95] years) fulfilled the questionnaire. 59 (11,1%) stated heart disorder, 219 (41,2%) at least one cardiovascular risk factor. As ten years ago, knowledge of first-aid (59,1%) and AED use (45,2%) was poor, especially among persons younger than 17 years or older than 67 years. 398 (75%) of the interviewed visitors recognized the installed AED, 511 (96,2%) supported the placement of AED. The placement of AED on public places in combination with an intensive medical education results in a high acceptance and recognition of AED. Nevertheless, following our date it seems to be doubtful that this results automatically in a higher attendance to acquire knowledge in first-aid and AED use.

Cardiac arrests in schools: Assessing use of automated external defibrillators (AED) on school campuses

BackgroundSudden cardiac arrest in schools are infrequent, but emotionally charged events. The purpose of our study was to: (1) describe characteristics and outcomes of school cardiac arrests; and (2) assess the feasibility of conducting school bystander interviews to describe the events surrounding cardiac arrests, assess AED availability and use, and identify barriers to AED use. MethodsWe performed a telephone survey of bystanders to cardiac arrests occurring in K-12 schools in communities participating in the Cardiac Arrest Registry to Enhance Survival (CARES) database and a local cardiac arrest database. The study period was from 8/2005 to 8/2011 and continued in one community through 2011. Utstein style descriptive data and outcomes were collected. A structured telephone interview of a bystander or administrative personnel was conducted for each cardiac arrest event. We collected a descriptive event summary, including provision of bystander CPR, presence of an AED and information regarding AED deployment, training, and use and perceived barriers to AED use. Descriptive data are reported. ResultsDuring the study period there were 30,603 cardiac arrests identified at study communities, of which 47 (0.15%) events were at K-12 schools. Of these, 21 (45.7%) were at high schools, a minority (16, 34.0%) were children (<age 19), most (39, 83.0%) were witnessed arrests, a majority (36, 76.6%) received bystander CPR, and 27 (57.4%) were initially in ventricular fibrillation (VF). Most arrests (28/40, 70%) occurred during the school day (7a–5p). From this population, 15 (31.9%) survived to hospital discharge. A telephone interview was completed for 30 of 47 K-12 events. Nineteen schools had an AED on site. Most schools (84.2%) with AEDs reported that they had a training program, and personnel identified for its use. An AED was applied in 11 of 19 patients, of these 8 were in VF and 4 (all VF) survived to hospital discharge. Bystanders identified multiple reasons for non-use of the AED in the other eight patients. ConclusionsCardiac arrests in schools are rare events, most patients are adults and receive bystander CPR. AED application by laypersons was infrequent but resulted in excellent (4/11) survival. AEDs were not used in a substantial proportion of incidents and further attention must be paid to planning for emergency response on school campuses. We also identified the difficulty in assessing school emergency care and advocate for the development of methods to evaluate the provision of emergency care on school campuses.

In-Flight Automated External Defibrillator Use and Consultation Patterns

Background. Limited information exists about the in-flight use and outcomes associated with automated external defibrillators (AEDs) on commercial airlines. Objective. To describe the characteristics and outcomes of AED use during in-flight emergencies including in-flight cardiac arrest and the associated ground medical consultation patterns. Methods. We collected cases of AED use that were self-reported to an airline consultation service from three U.S. airlines between May 2004 and March 2009. We reviewed all available data files, related consultation forms, and recordings. For each case, demographics, initial rhythm, shock delivery/success, survival to admission, and ground medical consultation use were obtained. Success was defined as the return of a perfusing rhythm. Initial rhythms were classified as sinus, heart block, supraventricular tachycardia (SVT), atrial fibrillation/flutter, asystole, pulseless electrical activity (PEA), and ventricular fibrillation (VF)/ventricular tachycardia (VT). Results. There were a total of 169 AED applications with 40 cardiac arrests. The mean patient ages were 58 years (standard deviation [SD] 15) and 63 years (SD 12), respectively; both populations were 64%% male. AEDs were applied for monitoring in 129 (76%%) cases with the following initial rhythms: sinus, 114 (88%%); atrial fibrillation/flutter, seven (5%%); complete heart block, four (3%%); and SVT, four (3%%). Presenting rhythms among the cardiac arrest population were as follows: asystole, 16 (40%%); VF/VT, 10 (25%%); and PEA, 14 (35%%). Fourteen patients were defibrillated, including nine of the 10 patients with initial VF/VT and five for the presence of VF/VT after resuscitation for initial PEA/asystole. Defibrillation was advised but not performed in the remaining case of initial VF/VT, and no medical consultation was obtained. All five successful defibrillations occurred in patients with initial VF/VT. There were six (15%%; 95%% confidence interval [CI] 3–27%%) survivors, with five survivals occurring after successful defibrillation for initial VF/VT and one with return of a perfusing rhythm after cardiopulmonary resuscitation (CPR) for a junctional rhythm. Survival in those with VF/VT was five of 10 (50%%; 95%% CI 14–86%%). Medications were delivered in two cases. The median time to first shock was 19 seconds (interquartile range [IQR] 12–24 seconds) after AED application. Medical consultation was obtained in 42 (33%%) of the 129 AED monitoring cases and 14 (35%%) of the 40 cardiac arrest cases. Conclusion. Use of AEDs resulted in 50%% survival among those with VF/VT in flight and 15%% overall survival for cardiac arrest. Survival is poor among patients presenting with nonshockable rhythms. AEDs are used extensively for in-flight monitoring, with significant rhythms identified. Ground medical consultation is sought in only one-third of AED uses and cardiac arrests.

Public access defibrillation in out-of-hospital cardiac arrest: a community-based study.

The dissemination and use of automated external defibrillators (AEDs) beyond traditional emergency medical services (EMS) into the community has not been fully evaluated. We evaluated the frequency and outcome of non-EMS AED use in a community experience. The investigation was a cohort study of out-of-hospital cardiac arrest cases due to underlying heart disease treated by public access defibrillation (PAD) between January 1, 1999, and December 31, 2002, in Seattle and surrounding King County, Washington. Public access defibrillation was defined as out-of-hospital cardiac arrest treated with AED application by persons outside traditional emergency medical services. The EMS of Seattle and King County developed a voluntary Community Responder AED Program and registry of PAD AEDs. During the 4 years, 475 AEDs were placed in a variety of settings, and more than 4000 persons were trained in cardiopulmonary resuscitation and AED operation. A total of 50 cases of out-of-hospital cardiac arrest were treated by PAD before EMS arrival, which represented 1.33% (50/3754) of all EMS-treated cardiac arrests. The proportion treated by PAD AED increased each year, from 0.82% in 1999 to 1.12% in 2000, 1.41% in 2001, and 2.05% in 2002 (P=0.019, test for trend). Half of the 50 persons treated with PAD survived to hospital discharge, with similar survival for nonmedical settings (45% [14/31]) and out-of-hospital medical settings (58% [11/19]). PAD was involved in only a small but increasing proportion of out-of-hospital cardiac arrests.

A comparison of first-responder automated external defibrillator (AED) application rates and characteristics of AED training

Objective To determine whether there were associations between the characteristics of first-responder automated external defibrillator (AED) training and AED application rates. Methods This multicenter retrospective cohort study analyzed data from ten emergency medical services systems where first responders were trained and equipped with AEDs. Data were provided for all out-of-hospital cardiac arrests (OHCAs) occurring over two years, including whether the first-responder AED was applied (pads attached to patient). Systems were surveyed to determine the characteristics of their initial and continuing AED training. Data were analyzed using odds ratios (ORs) with 95% confidence intervals (95% CIs). Results Overall, the first-responder AED was applied to 53% of 2,181 OHCAs. First responders applied AEDs to 60% of OHCAs when a national AED training curriculum was used and to 49% of OHCAs when a locally created curriculum was used (OR = 1.58; 95% CI = 1.32–1.88). First responders applied AEDs to 61% of OHCAs when they were trained to the level of Certified First Responder or higher and to 28% of OHCAs when they were trained only in cardiopulmonary resuscitation (OR = 3.97; 95% CI = 3.20–4.93). First responders applied AEDs to 66% of OHCAs when they each had an opportunity to apply the AED during continuing training and to 17% of OHCAs when they did not have this opportunity (OR = 9.04; 95% CI = 7.15–11.42). First responders applied AEDs to 59% of OHCAs when they had not received continuing training within one year of their initial training and to 42% of OHCAs when they had received continuing training in the first year (OR = 2.00; 95% CI = 1.67–2.40). Conclusion Use of a national AED training curriculum, training to the level of Certified First Responder or higher, and the ability for each first responder to apply the AED during continuing training were associated with higher AED application rates. Continuing training within the first year did not appear to be as important as actually using the AED during the training.

A C OMPARISON OF F IRST - RESPONDER A UTOMATED E XTERNAL D EFIBRILLATOR (AED) A PPLICATION R ATES AND C HARACTERISTICS OF AED T RAINING

Objective. To determine whether there were associations between the characteristics of first-responder automated external defibrillator (AED) training and AED application rates. Methods. This multicenter retrospective cohort study analyzed data from ten emergency medical services systems where first responders were trained and equipped with AEDs. Data were provided for all out-of-hospital cardiac arrests (OHCAs) occurring over two years, including whether the first-responder AED was applied (pads attached to patient). Systems were surveyed to determine the characteristics of their initial and continuing AED training. Data were analyzed using odds ratios (ORs) with 95% confidence intervals (95% CIs). Results. Overall, the first-responder AED was applied to 53% of 2,181 OHCAs. First responders applied AEDs to 60% of OHCAs when a national AED training curriculum was used and to 49% of OHCAs when a locally created curriculum was used (OR = 1.58; 95% CI = 1.32−1.88). First responders applied AEDs to 61% of OHCAs when they were trained to the level of Certified First Responder or higher and to 28% of OHCAs when they were trained only in cardiopulmonary resuscitation (OR = 3.97; 95% CI = 3.20−4.93). First responders applied AEDs to 66% of OHCAs when they each had an opportunity to apply the AED during continuing training and to 17% of OHCAs when they did not have this opportunity (OR = 9.04; 95% CI = 7.15−11.42). First responders applied AEDs to 59% of OHCAs when they had not received continuing training within one year of their initial training and to 42% of OHCAs when they had received continuing training in the first year (OR = 2.00; 95% CI = 1.67−2.40). Conclusion. Use of a national AED training curriculum, training to the level of Certified First Responder or higher, and the ability for each first responder to apply the AED during continuing training were associated with higher AED application rates. Continuing training within the first year did not appear to be as important as actually using the AED during the training.

T IME TO F IRST S HOCK BY E MERGENCY M EDICAL T ECHNICIANS WITH A UTOMATED E XTERNAL D EFIBRILLATORS

The interval from collapse to electrical rescue shock is a critical determinant of successful defibrillation in cardiac arrest. In order to achieve the earliest possible defibrillation, many emergency medical services (EMS) systems equip first-responding units with an automated external defibrillator (AED). Objective. To measure the time from on-scene emergency medical technician (EMT) recognition of cardiac arrest to AED application and shock in ventricular fibrillation (VF) arrest. In addition, the authors sought to understand the reasons for delays. Methods. Using the AED recordings and written EMS reports, the authors conducted a retrospective cohort study of all persons who experienced an EMS-attended VF cardiac arrest in which an AED was applied and a shock delivered by an EMT, from January 1999 through December 2000 (n = 177). Based on the bimodal distribution of times, two groups were assembled: no delay (time to shock ≤ 90 seconds) and delayed (time to shock > 90 seconds). Patient and event characteristics associated with delay status were determined using Mantel-Haenszel methods. Results. The median (25th, 75th percentile) time from cardiac arrest recognition to shock was 51 (43, 64) seconds. Ninety-four percent (n = 166) of the cohort received a shock within 90 seconds. Delayed shock was associated with unwitnessed arrest status (odds ratio = 9.3, 95% confidence interval = 2.3, 36.8) and nursing home location (odds ratio = 10.0, 95% confidence interval = 2.1, 47.5). Conclusion. The findings suggest that a 1-minute goal and a 90-second minimum standard for time to first shock are appropriate for EMT AED defibrillation in the field.

Outcomes of cardiac arrest in the nursing home: Destiny or futility?

Objective. To compare EMS system characteristics and outcomes between nursing home (NH) patients and out-of-hospital cardiac arrest (OHCA) patients whose arrests occurred in a residence (home).Design. Prospective cohort study reviewing OHCA from July 1989 to December 1993. Variables were age, witnessed arrest, response intervals, automated external defibrillator (AED) use, and arrest rhythms. Outcomes were hospital admission and discharge. Pearson chi-square was used for analysis.Setting. Suburban EMS system.Subjects. Patients ≥ 19 years old with arrest of presumed cardiac cause, with locations at home or at a NH.Results. 2,348 total arrests were complete for analysis, 182 at a NH and 2,166 at home. BLS and ALS response intervals were shorter for the NH patients. The NH patients were more likely to receive CPR on collapse, were older (73.1 vs 67.5 years, p < 0.001), were less likely to have had an AED used (9.9% vs 30.0%, p < 0.001), and were more likely to have an arrest bradyasystolic rhythm (74.7% vs 51.5%, p < 0.001). They were less likely to survive to hospital admission (10.4% vs 18.5%, p < 0.006) and discharge (0.0% vs 5.6%, p < 0.001).Conclusion. During this four-and-a-half-year study period, no NH patient survived, even though % CPR was increased. Arrest rhythm is an important factor in this finding. EMS initial care for ventricular tachycardia/fibrillation NH patients, with less application of AEDs, was identified. This different response may adversely contribute to dismal NH outcome.