Automated External Defibrillators Programs Research Articles

Attitudes of Law Enforcement Officers Regarding Automated External Defibrillators

Abstract Objective: To assess the knowledge and attitudes of law enforcement officers regarding treating out‐of‐hospital cardiac arrest (OHCA) and using automated external defibrillators (AEDs). Methods: This was a survey conducted among officers serving Marion County, Indiana. Results: Of 1,130 surveys distributed, 929 (82.2%) were returned. Among these officers, 603 (66.4%) were certified in cardiopulmonary resuscitation (CPR) and 103 (11.3%) had received AED training. Most officers had limited knowledge regarding OHCA. A 100‐point knowledge score (mean ± SD: 31.9 ± 14.3) was higher in officers who had performed CPR while on duty [35.0, 95% confidence interval (95% CI) = 32.9 to 37.2, p = 0.005] and who were AED‐trained (40.8, 95% CI = 38.0 to 43.6, p < 0.001). Of the respondents, 367 (40.1%) believed that AED usage by local law enforcement was needed, and 323 (35.6%) stated that they would feel comfortable using an AED if trained. A 100‐point attitude score (mean ± SD: 32.1 ± 21.0) was higher in officers who had CPR certification (38.2, 95% CI = 35.6 to 40.8), who had performed CPR while on duty (40.6, 95% CI = 37.7 to 43.5), who were AED‐trained (39.5, 95% CI = 35.6 to 43.4), and who had improved OHCA knowledge (+3.8 per 10 points knowledge score, 95% CI = 3.0 to 4.7), p < 0.001, all significant factors. Conclusions: Limited knowledge and negative attitudes of law enforcement officers regarding their involvement in treating OHCA and using AEDs are commonly present. These factors could result in barriers that negatively impact law enforcement AED programs.

Event and sideline management of sudden cardiac death.

The increasing use of automated external defibrillators (AEDs), coupled with methods to improve cardiopulmonary resuscitation 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.

Police AED Programs Are Cost-Effective

Although some police automated-external-defibrillator (AED) programs have demonstrated remarkable success, others have not. These investigators

MD1: COST-EFFECTIVENESS OF AIRLINE DEFIBRILLATORS: IS PEACE OF MIND MORE IMPORTANT THAN SAVING LIVES?

OBJECTIVES: Airline passengers are particularly vulnerable to the effects of cardiac arrest due to a lack of access to emergency medical services. To offset this isolation, airlines are installing automated external defibrillators (AEDs) on aircraft. Our objective was to measure the cost-effectiveness of airline AED programs and estimate their value to the flying public. METHODS: A decision analytic model was constructed to estimate the clinical and economic effects of airline AEDs. Inputs were obtained from published data and the FAA. Utility estimates were derived from cardiac arrest survivors. Sensitivity analyses evaluated changes in AED cost and probability of cardiac arrest. Since AEDs may provide utility gains through “peace of mind” for passengers not experiencing a medical event, the impact of this added passenger confidence was also evaluated. RESULTS: AEDs on commercial aircraft cost an incremental $5.16 per flight. AED deployment resulted in an estimated additional $162,000 per QALY gained (16 quality-adjusted minutes per flight). Sensitivity analysis of event probabilities and cost inputs did not substantially change the results. However, the cost-effectiveness of AEDs was significantly enhanced by the inclusion of utility gain experienced by passengers from increased peace of mind. While the magnitude of this benefit is unknown, an incremental increase of .003 in utility over the flight duration would reduce the incremental cost-effectiveness of AEDs to less than $50,000 per QALY gained. CONCLUSIONS: Our model estimated that when the benefits of on-board AEDs are limited to patients experiencing medical events, the incremental cost-effectiveness is inferior to most recommended medical interventions. However, if passengers gain utility from knowing an AED is on the aircraft, then these incremental expenditures may be justified. Utility gains from “peace of mind” may have significant implications in determining the value of health care interventions. Further research should be conducted into this potentially important area.

Public access defibrillation: a shocking idea?

Currently, survival from out-of-hospital cardiac arrest in the United Kingdom is poor. Ambulance response standards require that an ambulance reach 75 per cent of cardiac arrests within 8 min. But a short time to defibrillation from the onset of collapse is a key predictor of outcome from out-of-hospital cardiac arrest. The Department of Health has recently implemented a lay responder defibrillation programme, with the aim of shortening this time interval for victims in public places. This initiative utilizes automated external defibrillators (AEDs), which provide written and recorded voice prompts to minimize training requirements and errors in use. Lay responder AED programmes with very short response times have reported survival to discharge rates of up to 53 per cent for patients presenting in ventricular fibrillation (VF). This compares well with the results of a meta-analysis that reported a survival rate of only 6.4 per cent for traditional defibrillator-equipped ambulance systems. The annual incidence of out-of-hospital cardiac arrest in England is 123 per 100,000 population. Approximately half of these present in VF, and could benefit from an AED programme. But only 16 per cent of cardiac arrests occur in a public place. It has been calculated that there are approximately 5,000 instances of VF in public places each year in England. If half of these patients can be reached and administered a first shock within 4 min of their collapse, an additional 400 victims may survive each year. Given the current investment by the DoH of 2 million pounds, this suggests a cost per life saved of approximately 505 pounds over a 10 year period.

Electrical defibrillation: new technologies

Two-thirds of deaths from coronary disease occur in the pre-hospital phase and are caused by ventricular fibrillation or pulseless ventricular tachycardia, for which electrical defibrillation is the only effective treatment. The time delay between the onset of ventricular fibrillation and the administration of the first defibrillatory shock is the most important determinant for survival. To achieve the earliest defibrillation possible, rescuers others than physicians need to be able to initiate this treatment. The international scientific community strongly supports the concept of early defibrillation in the setting of a strong chain of survival. New technological developments of automated external defibrillators (AEDs) allowed the implementation of defibrillation by the first responding professional rescuer. As a consequence of the technological evolution in implantable defibrillators, much research has also been done on new defibrillation waveforms and alternative energy levels in external defibrillators. After initial animal research, human clinical investigation has shown that initial low energy (150J) nonprogressive (150J-150J-150J) impedance-adjusted biphasic waveform defibrillatory shocks for patients in out-of-hospital ventricular fibrillation are safe, acceptable and clinically effective. Reporting on outcome from cardiac arrest must be as uniform as possible to allow conclusions on performance of emergency medical service systems. The 'Utstein Style' nomenclature is a glossary of terms and a reporting guideline for uniform description of cardiac arrest, resuscitation, the emergency medical service (EMS) system and the outcome. Reports on experiences with AED programmes by traditional and non-traditional professional rescuers support the view that AEDs should not be implemented in EMS systems as an isolated intervention, but that efforts are equally needed to strengthen the other links of the chain of survival. The international scientific community (American Heart Association, International Liaison Committee on Resuscitation and European Resuscitation Council) have issued guidelines for the use of AEDs by EMS providers and first responders, and a universal treatment algorithm is proposed.

Early defibrillation: lessons learned.

Recovery from nontraumatic cardiac arrest depends on the presence of all the elements in the chain of survival. Early defibrillation is critical because ventricular fibrillation is the most common initial dysrhythmia of sudden cardiac arrest, defibrillation is the only treatment, and survival from ventricular fibrillation is determined by time. Out-of-hospital studies have demonstrated that defibrillation provided by first responders improves survival. Technologic advances have simplified defibrillation delivery through the development of automated external defibrillators (AEDs). Early defibrillation programs with AEDs are quickly becoming a standard of care for emergency medical services systems throughout the United States. Improvement in in-hospital survival rates from cardiac arrest is not as evident as in the emergency medical services community. Medical centers need to assess response times to cardiac arrest and implement AED programs. All nurses should learn to use an AED as part of basic life support training.