Automated External Defibrillators Use Research Articles

Abstract 53: Aerial Drone versus Ground Search for Delivery of an Automated External Defibrillator (AED) for Out-of-hospital Cardiac Arrest: A Comparison of Elapsed Time and Bystander Experience in a Community Setting

Background: An estimated 350,000 individuals experience out-of-hospital cardiac arrest (OHCA) in the United States (US) annually; only approximately 10% survive. The probability of survival after OHCA doubles when a bystander uses an automated external defibrillator (AED) before emergency management services arrives; however, bystander AED use is less than 2% in the US. We conducted a series of randomized trials in a community setting comparing the delivery of an AED by aerial drone to that of a bystander searching for and retrieving an AED from fixed locations in the area. Methods: We conducted 35 simulation trials of an OHCA using a life-sized manikin accompanied by two participants, paired by gender and age (18-34, 35-49, 50-65 years), in a community setting, with seven trials per zone in five distinct zones. Zones represented different environmental challenges to drone navigation and pedestrian acquisition of an AED and varied in number of fixed AEDs in the area (range 1-8 AEDs in a 600 ft radius from the OHCA site). We used a DJI Matrice 600 Pro drone, modified to carry a standard AED, flying autonomously from a preprogrammed flight path to the OHCA site. Drone launch sites varied by zone and ranged from 800 to 1300 ft from the OHCA site. We randomized participants either to call a mock 9-1-1 telecommunicator who would initiate the drone’s flight sequence, or to conduct a ground search to locate and retrieve an AED from a fixed location. We compared the delivery time of an AED by drone to that of an AED acquired by ground search. We conducted pre- and post-trial interviews with each participant to query perceptions. Results: We conducted 18 trials with women and 17 with men. These included 15, 11, and 9 trials across the three age strata, respectively. The average time (minutes: seconds) from onset of the simulated OHCA to AED delivery was 1:21 faster by drone (4:45, standard deviation (SD) = 0.34) compared to ground search (6:06, SD = 3:21). In 71% of trials (n=25 of 35), the drone delivered the AED to the event site within 5 minutes, compared to 51% (n=18 of 35) of ground searches (p=0.09). Median AED delivery time was faster by drone than by ground search in four of the five zones (range 0:17 to 2:56). Ground search was faster than the drone in one zone with 7 AEDs within 600 ft of the simulated OHCA event site and the shortest average distance to an AED (254 ft) of all the five zones. Among participants randomized to call for the drone, 89% reported that they felt comfortable as the drone approached, and 72% reported having no safety concerns. Nearly half of participants randomized to conduct a ground search reported difficulty finding an AED. Conclusion: Our study suggests that drone delivery of an AED to the site of an OHCA is feasible and acceptable in a community setting. Drones may provide more timely access to early defibrillation compared to bystander search and acquisition of an AED from the surrounding area.

Transfer of essential AED information to treating hospital (TREAT)

BackgroundDefibrillation in out-of-hospital cardiac arrest (OHCA) is increasingly performed by using an Automated External Defibrillator (AED). Therefore presence of a shockable rhythm is recurrently only documented by the AED. However, AED-information is rarely available to the treating physician. PurposeTo determine (1) how often a shockable rhythm was recorded only in the AED; (2) if so, how often information that a shockable rhythm had been present reached the physician. MethodsData on OHCA patients with (presumed) cardiac cause with an AED connected in the years 2012–2014 (Study period 1) and 2016 (Study period 2) in the Amsterdam Resuscitation Study (ARREST) database were collected. We determined how often only the AED had defibrillated. In these patients, we retrospectively analyzed EMS run sheets and hospital discharge letters to determine if a shockable rhythm and/or AED use was correctly noted. In Study period 2, we prospectively contacted the physicians to study whether AED defibrillation was known. ResultsIn Study period 1, of 2840 OHCA CPR attempts with (presumed) cardiac cause, 1521 (54%) patients had a shockable rhythm, with 356 patients (13%) receiving AED defibrillation only. Of these patients, 11 hospital discharge letters (4%) contained no information about a shockable rhythm. In Study period 2, 125/1128 patients (11%) received AED defibrillation only; of these, in two cases the shockable rhythm was unknown by the physician. ConclusionIn 11–13% of OHCAs, a shockable rhythm is only seen on the AED-ECG. Adequate transfer to the physician of vital AED-information is essential but not always accomplished.

Assessment of Knowledge of Polish University Technical Students on Using an Automated External Defibrillator (AED) – Survey Results

Aim: The article presents the results of a survey, which assessed the knowledge of technical university studentson the use of AED (Automated External Defibrillator). The authors put forward two research hypotheses. The first one assumes that the respondents do not have sufficient knowledge about the use of AED. According to the second, the respondents assess their knowledge on using AED at a higher level than it actually is. Project and methods: The survey method was used to assess the knowledge about the location and proper use of the AED. Authors have conducted surveys with 133 respondents (42% women and 58% men) aged 20-24 (average 21.56 ± 0.95 years). Of all subjects, 91% had not previously performed any basic life support before. The questionnaire contained a number of questions that verify both the theoretical knowledge of the respondents and detailed practical knowledge regarding the proper use of the defibrillator. Results: The research results indicate that the level of knowledge about cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) among the surveyed students of technical universities is limited. As many as 92% of respondents declared that they know what a defibrillator is used, but only 5% of respondents actually know what defibrillation is. Only 23% of respondents claimed to know the location of the defibrillator at their university, but in fact only 7% of them were able to pinpoint it. As many as 87% of students were not familiar with the location of the defibrillator in their area of residence. Furthermore, only 32% of the respondents answered the question correctly when the defibrillator should be used. Conclusions: The results of the survey indicate an important need for education – not only in terms of general knowledge and skills related to CPR and AED, but especially in practical information about the location of the nearest AED in the workplace, as well as place of residence. Information on the AED location should be included in the first aid training program. It is also important to instruct the audience where such data can be obtained. The authors would like to emphasize that efforts to increase the level of knowledge of lay people are necessary to improve the effectiveness of CPR and AED, and thus the survival of people during sudden life-threatening situations.

A follow‐up report on the effect of a simplified basic life support training program for non‐medical staff working at a university hospital: changes in attitude toward cardiopulmonary resuscitation and automated external defibrillator use through repeat training

This study aimed to investigate the effect of repeat training and the interval of reattending a simplified basic life support (BLS) training course. We administered a questionnaire on the attitude toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use (check for response, chest compression, and using an AED) before and immediately after a 45-min BLS training program provided for non-medical staff working at a university hospital from September 2010 to November 2018. The main outcome was positive willingness of the participants toward CPR and AED use. The effect of repeat training was assessed with McNemar's test and multivariable logistic regression analysis. Differences in the interval of reattending the simplified BLS training course were assessed with Fisher's exact test. Fifty-nine training courses were held. Among the total participant count of 1,025, 760 individuals attended, of whom 126 attended the training multiple times. The proportion of participants showing a positive attitude toward chest compression before the course increased as the number of attendances increased (adjusted odds ratio 1.62: 9.8% at first training to 58.8% at sixth training). The positive attitude of participants before the course was significantly greater when the training interval was <1year (36.1% versus 18.7%). There was no significant difference for a 6-month interval (40% versus 23.2%). Repeat training for non-medical staff in a chest compression-only CPR training course showed a cumulative effect of repeat attendance. A course interval of <1year from the previous attendance would be important for maintaining a positive attitude toward CPR and AED use.

The use of an automatic defibrillator by non-sanitary personnel in sport areas: an Observational Study.

Introduction:In industrialized countries, sudden cardiac death is a serious public health problem that accounts for about 15% to 20% of all deaths, with an incidence of 0.5 to 3 deaths per 100,000 athletes. In recent years, although both first aid prevention programs and the availability of External Automatic Defibrillator (AED) in public places have increased, few data are available with respect to real knowledge about the use of such devices. The aim of this study is to detect the level of knowledge and skills in the use of automatic external defibrillators among sports and management staff in sports facilities.Materials and Methods:A cross-sectional, multicentre study conducted in 16 sports facilities in the Province of Lecce, Italy, and targeted to all the athletic and managerial staff of these sports facilities. Information was obtained through a validated questionnaire consisting of 27 items.Results:339 participants of which 59.3% male (n=201) (average=33.6; SD=13.1). 51.6% (n=175) were informed about the presence of the defibrillator, only 38.1% (n=129) declared to know where it was placed and 43.7% (n=96) considered it to be quite or very accessible. The majority of them (78.8%; n=267) were never involved in a training course and declared limited knowledge about the use of this device.Conclusions:Respondents stated that they have poor knowledge and skills in the use of the defibrillator, its operation and maintenance, which could reduce the positive outcomes of early treatment. Further studies should be conducted, although it may be appropriate to implement specific training courses for personnel working in sports centres. (www.actabiomedica.it)

Use of a Motorlance to Deliver Emergency Medical Services; a Prospective Cross Sectional Study.

Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance. This prospective cross sectional study was conducted on all users of emergency call, Srinagarind Hospital, Thailand, from June to December 2018, who received a registration number from the command center. 504 emergency-service operations were examined over a six-month period, 252 (50%) of which were carried out by motorlance. The mean activation time for motorlance and ambulance were 0.57 ± 0.22 minutes and 1.11 ± 0.18 minutes, respectively (p<0.001). Mean response time for motorlance was significantly lower (5.57 ± 1.21 versus 7.29 ± 1.32 minutes; p < 0.001). The response times during 6 a.m. to 6 p.m. were 5.26 ± 1.11 minutes for motorlance and 7.15 ± 1.39 minutes for ambulance (p < 0.001). These measures for night time (6 p.m. to 6 a.m.) were 5.58 ± 1.21 minutes and 8.01 ± 1.30 minutes, respectively (p < 0.001). The mean automated external defibrillator (AED) waiting time for motorlance and ambulance were 5.26 ± 2.36 minutes and 9.24 ± 3.30 minutes, respectively (p = 0.012). The survival rate of patients after AED use in motorlance and ambulance was 80% versus 37.5%; p<0.001. Emergency service delivery by motorlance had lower mean activation time, response time, AED time, and mortality rate of cardiac arrest patients compared to ambulance. It seems that motorlance could be considered as an effective and applicable device in emergency medical service delivery, especially in crowded cities with heavy traffic.

Public-access automated external defibrillator pad application and favorable neurological outcome after out-of-hospital cardiac arrest in public locations: A prospective population-based propensity score-matched study

BackgroundRandomized controlled trials or observational studies showed that the use of public-access automated external defibrillator (AED) was effective for patients with out-of-hospital cardiac arrest (OHCA). However, it is unclear whether public-access AED use is effective for all patients with OHCA irrespective of first documented rhythm. We aimed to evaluate the effect of public-access AED use for OHCA patients considering first documented rhythm (shockable or non-shockable) in public locations. MethodsFrom the Utstein-style registry in Osaka City, Japan, we obtained information on adult patients with OHCA of medical origin in public locations before emergency-medical-service personnel arrival between 2011 and 2015. Primary outcome was 1-month survival with favorable neurological outcome. Multivariable logistic regression analysis was performed to assess the association between the public-access AED pad application and favorable neurological outcome after OHCA by using one-to-one propensity score matching analysis. ResultsAmong 1743 eligible patients, a total of 336 (19.3%) patients received public-access AED pad application. The proportion of patients who survived 1-month with favorable neurological outcome was significantly higher in the pad application group than in the non-pad application group (29.8% vs. 9.7%; adjusted odds ratio [AOR], 2.85; 95% confidence interval [CI], 1.73–4.68, AOR after propensity score matching, 2.46; 95% CI, 1.29–4.68). In a subgroup analysis, the AORs of patients with shockable or non-shockable rhythms were 3.36 (95% CI, 1.78–6.35) and 2.38 (95% CI, 0.89–6.34), respectively. ConclusionsPublic-access AED pad application was associated with better outcome among patients with OHCA of medical origin in public locations irrespective of first documented rhythm.

The Case for Drone-assisted Emergency Response to Cardiac Arrest: An Optimized Statewide Deployment Approach.

BACKGROUND Despite evidence linking rapid defibrillation to out-of-hospital cardiac arrest (OHCA) survival, bystander use of automatic external defibrillators (AEDs) remains low, due in part to AED placement and accessibility. AED-equipped drones may improve time-to-defibrillation, yet the benefits and costs are unknown.METHODS We designed drone deployment networks for the state of North Carolina using mathematical optimization models to select drone stations from existing infrastructure by specifying the number of stations and the targeted AED arrival time. Expected outcomes were evaluated over the drone's lifespan (4 years). We estimated the following parameters: proportion of OHCAs within a targeted AED delivery time, bystander utilization of AEDs, survival/neurological status, and incremental cost per quality-adjusted life year (QALY).RESULTS Statewide, 16,503 adults aged 18 or older were expected to experience OHCA with an attempted resuscitation over 4 years. Compared to no drone network, all proposed drone networks were expected to improve survival outcomes. For example, assuming 46% of OHCAs have bystanders willing to use an AED, a 500-drone network decreased the median time of defibrillator arrival from 7.7 to 2.7 minutes compared to no drone network. Expected survival rates doubled (24.5% versus 12.3%), resulting in an additional 30,267 QALYs ($858/incremental QALY). If just 4.5% of OHCAs had willing bystanders, 13.8% of victims would have survived. Sensitivity analysis demonstrated that an AED drone network remained cost-effective over a wide range of assumptions.CONCLUSIONS With proper integration into existing systems, large-scale networks for drone AED delivery have the potential to substantially improve OHCA survival rates while remaining cost-effective. Public health researchers should consider advocating for feasibility studies and policy development surrounding drones.

"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.

Actual resuscitation actions after the training of chest compression-only CPR and AED use among new university students

BackgroundAlthough cardiopulmonary resuscitation (CPR) training is recommended in schools, there are few attempts to train all students at universities and no reports showing actual resuscitation actions at emergency settings after the training. We surveyed how many students encountered a collapsed person, whether they performed any resuscitation actions, and any reasons why they could not do any resuscitation actions. MethodsWe have provided chest compression-only CPR and automated external defibrillator (AED) use training for 3000 new university students every April since 2015 and followed up on their subsequent emergency actions to collapsed persons in the real world. We carried out a questionnaire survey for 2nd through 4th-year students during the annual student health checkup period in 2018. ResultsA total of 7595 students underwent the annual health checkup and 5549 of them (73.1%) responded to the survey. The rates of encountering collapsed persons and out-of-hospital cardiac arrest (OHCA) patients were 2.5 and 1.1 per 100 person-years, respectively. Of the 264 students who encountered a collapsed person, 82 (53.6%) who encountered non-OHCA collapsed persons and 54 (48.6%) who encountered OHCA persons performed at least one resuscitation action including either chest compression, AED use, or any other various resuscitation actions. ConclusionsThe incidence rate of encountering OHCA patients was 1.1 per 100 person-years and half of them who encountered a collapsed person performed at least one resuscitation action. Hands-on mass training would encourage university students to perform any resuscitation actions on the emergency scene.

Implementing automated external defibrillators into community sports clubs/facilities: a cross-sectional survey of community club member preparedness for medical emergencies

ObjectiveThere is a growing focus on ensuring the availability of automated external defibrillators (AED) in sport settings to assist in preventing sudden cardiac death. For the AED to be most...

Effectiveness of a network of automatically activated trained volunteers on the reduction of cardiopulmonary resuscitation manoueuvers initiation time: study protocol

BackgroundCardiorespiratory arrest (CRA) is a health emergency with high mortality. Mortality depends on time of initiation and quality of cardiopulmonary resuscitation (CPR) manoeuvres and the use of the automated external defibrillator (AED).MethodsThe aim of the study is to determine the effectiveness of an automatically activated network of volunteers using smartwatch and smartphone applications on the reduction of time of initiation of cardiopulmonary resuscitation manoeuvres. The protocol will be developed in four phases: 1) validation of an application (App) for smartwatch that automatically generates a health alert in case of out-of-hospital cardiorespiratory arrest (OHCA); 2) training course for laypersons on CPR manoeuvres and AED use; 3) creation of a network of volunteers trained in CPR and AED use that covers our city; and 4) simulation in which the network of volunteers is automatically activated via smartphone to attend simulated OHCAs. A total of 134 health alerts will be generated; on 67 occasions the alert will be directed to the emergency health services and to the network of trained volunteers (Intervention Group) and on 67 occasions the alert will be solely directed to the emergency health services (Control Group). The arrival time of the first rescuer, category of first rescuer (emergency services versus network of volunteers), initiation time of manoeuvres and competence will be recorded.DiscussionCPR training for laypersons is advised, especially for relatives and people close to patients with heart disease, to reduce time of initiation of CPR and to improve OHCA survival rates. This study aims to verify that the initiation time of CPR manoeuvres and AED use is shorter in the intervention than in the control group.Trial registrationClinicaltrials.gov ID NCT03828305. Trial registered on February 1, 2019 (retrospective register).

P083: Innovative use of AED by RNs and RTs during in-hospital cardiac arrest (Phase III)

Introduction: In-hospital cardiac arrest (IHCA) most commonly occurs in non-monitored areas, where we observed a 10min delay before defibrillation (Phase I). Nurses (RNs) and respiratory therapists (RTs) cannot legally use Automated External Defibrillators (AEDs) during IHCA without a medical directive. We sought to evaluate IHCA outcomes following usual implementation (Phase II) vs. a Theory-Based educational program (Phase III) allowing RNs and RTs to use AEDs during IHCA. Methods: We completed a pragmatic before-after study of consecutive IHCA. We used ICD-10 codes to identify potentially eligible cases and included IHCA cases for which resuscitation was attempted. We obtained consensus on all data definitions before initiation of standardized-piloted data extraction by trained investigators. Phase I (Jan.2012-Aug.2013) consisted of baseline data. We implemented the AED medical directive in Phase II (Sept.2013-Aug.2016) using usual implementation strategies. In Phase III (Sept.2016-Dec.2017) we added an educational video informed by key constructs from a Theory of Planned Behavior survey. We report univariate comparisons of Utstein IHCA outcomes using 95% confidence intervals (CI). Results: There were 753 IHCA for which resuscitation was attempted with the following similar characteristics (Phase I n = 195; II n = 372; III n = 186): median age 68, 60.0% male, 79.3% witnessed, 29.7% non-monitored medical ward, 23.9% cardiac cause, 47.9% initial rhythm of pulseless electrical activity and 27.2% ventricular fibrillation/tachycardia (VF/VT). Comparing Phases I, II and III: an AED was used 0 times (0.0%), 21 times (5.6%), 15 times (8.1%); time to 1st rhythm analysis was 6min, 3min, 1min; and time to 1st shock was 10min, 10min and 7min. Comparing Phases I and III: time to 1st shock decreased by 3min (95%CI -7; 1), sustained ROSC increased from 29.7% to 33.3% (AD3.6%; 95%CI -10.8; 17.8), and survival to discharge increased from 24.6% to 25.8% (AD1.2%; 95%CI -7.5; 9.9). In the VF/VT subgroup, time to first shock decreased from 9 to 3 min (AD-6min; 95%CI -12; 0) and survival increased from 23.1% to 38.7% (AD15.6%; 95%CI -4.3; 35.4). Conclusion: The implementation of a medical directive allowing for AED use by RNs and RRTs successfully improved key outcomes for IHCA victims, particularly following the Theory-Based education video. The expansion of this project to other hospitals and health care professionals could significantly impact survival for VF/VT patients.

Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.

BackgroundThe chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.MethodsData from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.Results3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).ConclusionThe prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

The evaluation of laypersons awareness of basic life support at the university in Izmir

ObjectivesBasic Life Support (BLS) is the application of cardiopulmonary resuscitation (CPR) in order to save the lives of cardiac arrest victims by members of the public pending the arrival of the Emergency Medical Service (EMS). The aim of this study was to evaluate the effectiveness of training in order to ensure society understands the importance of early initiation of BLS, and to provide information concerning BLS and automated external defibrillators (AED). MethodsThis study consisted of 150 participants, of whom none were healthcare professionals. The research data were collected from 150 pre-tests and 100 post-tests. A Comparison of nominal data was analyzed by both McNemar's test and Pearson's chi-square exact test. ResultsOf the participants, 39% had received the BLS training prior to the study. It was observed that the participants’ desire for applying BLS increased from 43% to 78% post training, and the ratio of ability to distinguish the need for BLS increased from 54% to 79%. Our results also indicated that the knowledge level of the CPR application increased after the study. The proportion of participants who knew the purpose of using AED increased from 79.8% to 95.7%. ConclusionsIt was concluded that the BLS Awareness training increased in relation to the application of BLS, improved the BLS knowledge and increased awareness of the use of AED.

Abstract 121: The Influence of Age, Race, and Ethnicity on Public Automated External Defibrillator Use and Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival (CARES)

Introduction: Automated external defibrillators (AEDs) are an important link in the chain of survival following out-of-hospital cardiac arrest (OHCA). While the use of AEDs are clearly beneficial for OHCA in adults, there are few data on the overall use and outcomes of public AED use in children. Hypothesis: AED use is uncommon in children and associated with neurologically favorable survival. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years of age, public arrests, and non-traumatic OHCA from January 1, 2013 through December 31, 2017. Neurologically favorable survival was defined as a Cerebral Performance Category Scale of 1 or 2 at hospital discharge. Results: Of 971 public pediatric OHCA (66% male, 32% white), AEDs were used by bystanders in 117 (10.3%). AEDs were used among 2.3% of children aged ≤ 1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p&lt;0.001). AED use was similar among white (11.1%), black (9.1%), and Hispanic children (8.1%) (p=0.84). AED use was more common with the provision of bystander CPR (19.1%) vs no bystander CPR (0.9%), witnessed arrests (16.0%) vs unwitnessed arrests (4.7%), and arrests with a shockable rhythm (23.6%) vs a nonshockable rhythm (6.3%) (p&lt;0.001 for all). Overall, adjusted neurologically favorable survival was 29.1% (95% CI 22.7%, 35.5%) when a bystander used an AED compared to 23.7% (95% confidence interval [CI] 21.1%, 26.3%) for no bystander AED use (p=0.11). There was a significant interaction with age and race/ethnicity. AEDs were associated with neurologically favorable survival among children aged 12-18 years (p=0.04) but not associated with neurologically favorable survival in children ≤ 1 year (p=0.43), 1-5 years (p=0.16) or 6-11 years (0.41). AEDs were also associated with neurologically favorable survival in white children (p=0.01) but not with black (p=0.97) or Hispanic children (p=0.06). Conclusions: AED use is uncommon in children suffering OHCA but is associated with improved neurologically favorable survival. The benefit of AEDs was evident mostly for adolescents and white children. Further study is needed to understand these disparities in AED use and outcomes after AED use.

Abstract 197: What Limits the Use of AEDs by Bystanders?

Introduction: In Japan, the number of automated external defibrillators (AEDs) placed in public areas has climbed up to the estimated 530,000. We reported previously that a half of out-of-hospital cardiac arrests occurred within 100 m from a public AED in urban areas. However, shocks for defibrillation were given to less than 15% of those patients. The objectives of this study was to identify the limiting factors against the use of AEDs by bystanders. Methods: A prospective survey on out-of-hospital cardiac arrest was conducted in the city of Osaka (Dec 2016 through Mar 2017) and the city of Nagoya (Dec 2016 through Nov 2017) searching for patient demographics and AED settings including; absence/presence of a public AED on the scene, attachment of AED pads, delivery of shocks before the time of EMS arrival. Results: Of 558 cases of cardiac arrest registered during the survey period, an AED had already been delivered at the patient side by the time of EMS arrival in 92 case (16.5%). Of those, pads had been attached in 89 cased (96.7%). Shocks had been advised in 35 cases (39.3%) and to all but one of those cases at least 1 shock had been given by the bystanders. There were no statistically significant differences between the groups of cases with and without AEDs at the patient side regarding the patient age (65 years [IQR: 48-74] vs 63 years [IQR49-75], p=0.84), gender (p=0.68) and the time from call to EMS arrival (7 min [IQR: 6-9] vs 7 min [IQR: 6-9], p=0.74). Cases occurring indoors had more chances of AEDs being delivered on the patient side than cases occurring outdoors (24.0% vs 7.8%, p&lt;0.001). Conclusions: Our study indicates that once an AED is delivered at the patient side, pads are successfully attached and shocks are given if indicated in almost all cases. This suggests that finding and delivering an AED onto the patient side are the limiting factors against the use of AEDs by bystanders. In order to popularize the use of AEDs by bystanders, informing people with AED placement and clear direction to the AED location seem to be the key steps.

Abstract 183: Public-Access Automated External Defibrillator Pad Application and Favorable Neurological Outcome After Out-of-Hospital Cardiac Arrest in Public Locations; A Prospective Population-Based Propensity-Score Matched Study

Background: Randomized control trials or observational studies showed that the use of public-access automated external defibrillator (AED) was effective for patients with out-of-hospital cardiac arrest (OHCA). However, it is unclear whether public-access AED use is effective for all patients with OHCA irrespective of first documented rhythm. We aimed to evaluate the effect of public-access AED use for OHCA patients considering first documented rhythm (shockable or non-shockable) in public locations. Methods: From the Utstein-style registry in Osaka City, Japan, we obtained information on adult patients with OHCA of medical origin in public locations before emergency-medical-service personnel arrival between 2011 and 2015. The primary outcome was one-month survival with favorable neurological outcome. Multivariable logistic regression analysis was used to assess the association between the public-access AED pad application and favorable neurological outcome after OHCA by using one-to-one propensity score matching analysis. Results: Among 1743 eligible patients, a total of 336 (19.3%) victims received public-access AED pad application. The proportion of patients who survived one-month with favorable neurological outcome was significantly higher in the pad application group than in the non-pad application group (29.8% vs. 9.7%; adjusted odds ratio [AOR], 2.85; 95% confidence interval [CI], 1.73-4.68, AOR after propensity score matching, 2.83; 95% CI, 1.40-5.72). In a subgroup analysis, the AOR of patients with shockable or non-shockable rhythms was 3.36 (95% CI, 1.78-6.35) and 2.38 (95% CI, 0.89-6.34), respectively. Conclusions: Public-access AED pad application was associated with better outcome among OHCA patients with shockable rhythm and the trend was the same among those with non-shockable rhythm.

Abstract 25: Cost-Effectiveness of Public Automated External Defibrillators

Introduction: Despite a consistent association with improved outcomes, automated external defibrillators (AEDs) are used in only approximately 10% of public out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost. The objective of this study was to provide a contemporary cost-effectiveness analysis on the use of public AEDs in the United States (US) to inform guidelines and public health initiatives. Methods: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the US over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs (in 2017 US dollars) per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. It was assumed that AED use was associated with a 52% relative increase in survival to hospital discharge with a favorable neurological outcome in those with a shockable rhythm. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Consistent with recent guidelines from the American Heart Association, we used a willingness-to-pay threshold of $150,000 per QALY gained. Results: The no AED strategy resulted in 1.63 QALYs at a cost of $42,757. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. At an incidence of 1%, the incremental cost-effectiveness ratio was $101,040 per QALY gained. In sensitivity analyses across a plausible range of health-care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion: Public AEDs are a cost-effective public health intervention in the US. These findings support widespread dissemination of public AEDs.

Abstract 162: Major Differences in the Intended Operation and Default Energy Setting in Automated External Defibrillators in Pediatric Cardiac Arrest

Introduction: Automated external defibrillators (AEDs) should be easy to use to improve survival from cardiac arrest. In pediatric cardiac arrest, defibrillation is recommended to be delivered with less energy compared with adults. Consequently, many AED manufacturers provide the possibility of “converting” an AED from adult to pediatric use. Aim: To study how different AEDs are intended to be operated in case of pediatric cardiac arrest and to investigate the default pediatric defibrillation energy levels. Methods: This nationwide cross-sectional study included information on all commercially available AEDs sold to laypersons in Denmark. Technical specifications and information on AED use in pediatric cardiac arrest were extracted from user manuals, data sheets, and from contact with AED distributors in Denmark. Results: Overall, 28 different AEDs were available in Denmark. Data on pediatric use were available for all 28 (100%) devices. Separate pediatric electrodes were required for 19 (68%) AEDs which were sold as an accessory. Activation of “pediatric mode” was available in 10 (36%) AEDs leading to an automatic adjustment of shock energy level thereby making the use of adult electrodes in children possible. This feature consisted of a “pediatric button” in 8 (29%) devices and 1 (4%) device required insertion of an accessory “child key”. Data on default energy levels were available for 27 (96%) of devices. Median first shock energy level was 50J (Q1; 50J, Q3; 50J) with a range from 15-50J. Median third shock energy level was 50J (Q1; 50J, Q3; 83.5J) with a range from 50-140J. Conclusion: There are major differences in the intended operation and default energy settings in automated external defibrillators used in pediatric cardiac arrest. Standardizing how AEDs should be operated in pediatric cardiac arrest may reduce the risk of human errors and improve survival.