Automated External Defibrillators Use Research Articles

Проект унифицированного Порядка оказания первой помощи в Российской Федерации: проблемные и дискуссионные вопросы

Summary. The purpose of the study is to develop proposals to improve the regulation of relations in the sphere of first aid in the basic and expanded scope between the participants of these relations to protect their legitimate rights and interests. Materials and research methods. Materials of the study are normative legal acts in the field of health care, regulating the issues of first aid: the Federal Law “On the basis of health protection of citizens in the Russian Federation” from November 21, 2011 № 323-FZ; Order of the Ministry of Health and Social Development of Russia “On approval of the list of conditions in which first aid is provided, and the list of measures to provide first aid” from May 4, 2012 № 477n; qualification specifications of positions of employees in the field of health care; professional standards of health care professionals. Research methods were analytical, logical methods and information modeling. The following sources were used in the research: information legal systems “Consultant” (http://www.consultant.ru) and “Garant” (https://internet.garant.ru); the official Internet portal of legal information (http://pravo.gov.ru); the official website of the Ministry of Health of Russia (https://minzdrav.gov.ru) and a number of other open sources of information. Results of the study and their analysis. The systematized improved and newly developed norms of first aid in basic and expanded volumes are presented, taking into account their application in different conditions and situations as the basis of the unified basic Procedure of first aid. The definition of the concept of “special conditions of first aid provision” is given. The proposal to divide the first aid into two main types — “basic first aid” and “extended first aid” (in special conditions and situations) is made. Problematic and debatable issues of the scope of first aid measures are considered: the use of medicines, ensuring the patency of airways, the use of automatic external defibrillator when performing cardiopulmonary resuscitation, medical evacuation of victims, etc.

Characteristics and Treatment Outcomes of Out-of-Hospital Cardiac Arrests Occurring in Public Places: A National Population-Based Observational Study.

Sudden cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is a global public health concern. However, limited research exists on the epidemiology of OHCAs occurring in public places, trends and impact of bystander intervention, and influence of extraordinary circumstances. This study investigated the epidemiological factors, bystander characteristics, and outcomes of OHCAs that occurred in public places in South Korea from 2016 to 2021 and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic. A retrospective analysis was conducted using an Out-of-Hospital Cardiac Arrest Surveillance database, including 33,206 cases of OHCA that occurred in public places. Cases with do-not-resuscitate orders or insufficient data were excluded. A steady increase in bystander-performed cardiopulmonary resuscitation over the years and a constant decrease in bystander automated external defibrillator (AED) use were observed. Survival-to-discharge rates for OHCAs remained relatively steady until a marginal decrease was observed during the pandemic (pandemic, 13.1%; pre-pandemic, 14.4%). Factors affecting survival included the presence of a shockable rhythm, witnessed arrest, cardiac arrest due to disease, use of bystander AED, and period relative to the COVID-19 pandemic. These findings emphasize the critical role of bystanders in outcomes of OHCAs and inform public health strategies on better management of OHCAs in public places.

Documented Use of Emergency Medical Dispatch Protocols is Associated with Improved Survival in Out of Hospital Cardiac Arrest

Objective There are over 300,000 out-of-hospital cardiac arrests (OHCA) annually in the United States (US) and despite many scientific advances in the field, the survival rate remains low. We seek to determine if return of spontaneous circulation (ROSC) is higher when use of emergency medical dispatch (EMD) protocols is documented for OHCA calls compared to when no EMD protocol use is documented. We also seek identify care-related processes that differ in calls that use EMD protocols. Methods This is a retrospective cohort study of U.S. adults with OHCA prior to emergency medical services (EMS) arrival using 2019 National EMS Information System data. The primary exposure was EMD usage during EMS call. The primary outcome was prehospital ROSC, and secondary outcomes included automated external defibrillator (AED) use before EMS arrival, bystander CPR, and end-of-event EMS survival (survival to the end of the EMS care at transport destination). Multivariable logistic regression adjusted for age, sex, race/ethnicity, primary insurance, rurality, initial rhythm, arrest etiology, and witnessed arrest. Results Of the 96,269 OHCA cases included, EMD use was documented in 73%. Overall, 26% of subjects achieved ROSC in EMS care. EMD subjects were more likely to achieve ROSC (27.2% vs. 23.5%, uOR 1.22, 95%CI 1.18 − 1.26) even after adjusting for subject and arrest characteristics (aOR 1.13, 95%CI 1.08 − 1.17). EMD subjects also had higher end-of-event survival (19.1% vs. 16.4%, aOR 1.20, 95%CI 1.15 − 1.25). AED use before EMS arrival was more common in the EMD group (28.3% vs. 26.3% %diff 2.0, 95%CI 1.4 to 2.6), as was CPR before EMS arrival (63.8% vs. 55.1%, difference 8.6%, 95%CI 7.9 to 9.3%). Conclusions In this retrospective analysis, the rate of ROSC was higher in adult OHCA patients when EMD protocol use was reported compared to when it was not reported. The group with documented EMD use also experienced higher rates of bystander AED use, bystander CPR, and end-of-event survival.

Using the Evidence-Development-Validation-Consensus (EDVC) Approach to Develop and Validate maxSIMdrone: A Training Program for Healthcare Professionals to Provide Cardiac Arrest Care Using Drones.

Introduction The challenges of delivering cardiac arrest (CA) courses in rural and remote (R&R) locations worldwide have been further exacerbated by the COVID-19 pandemic. However, it is important to note that this problem has always existed. The implementation of social distancing measures to combat the pandemic has had a significant impact on healthcare and medical education, particularly in relation to the training of students, laypeople (LP), and healthcare professionals (HCPs) in CA care. The combination of pandemic restrictions and pre-existing difficulties faced in R&R locations and large cities has disrupted the provision of comprehensive medical education. The suspension of basic lifesupport and defibrillation(BLSD) courses during the pandemic may have negatively affected pre-hospital care for CA. However, it is essential to acknowledge that challenges in delivering these courses in R&R areas predate the pandemic. Materials and methods A 2021 epidemiological study in the Brazilian Amazon identified CA as the primary cause of death, followed by COVID-19. This highlights the importance of providing BLSD courses and training to emergency medical service (EMS) personnel in R&R locations. Even during a pandemic. Researchers from Ontario Tech Universityand Memorial UniversitySchool of Medicinedeveloped a drone with a simulation scenario to train HCPsin automated external defibrillators (AED) operation and guide LPin safe use through BLSD protocols. A literature review showed that different training methods yielded similar outcomes. Based on these findings, the evidence-development-validation-consensus (EDVC) hybrid approach was used to develop and validate an online training program using a learning management system (LMS) as a model. Results Teaching HCPs and LP in R&R locations, such as northern Canada and the Brazilian Amazon, presents challenges due to limited resources and internet access. One potential solution lies in the utilization of remote online LMS that facilitate the administration, documentation, tracking, reporting, automation, and delivery of educational courses and training programs. The literature review indicated that mixed training approaches, including face-to-face, online, and hybrid formats, produced similar outcomes in learning assessment, self-confidence, performance, skills, and knowledge acquisition. These findings support the viability of using LMS as a model to develop and validate a course where drones deliver AEDs and provide training to HCPs and LP in R&R locations. A comprehensive training program should encompass cognitive, affective, and psychomotor learning domains, addressing various skills and knowledge aspects. Conclusion This research study develops and validates LMS teaching methods to support a training program for HCPs and LP in using AEDs delivered by drones. The program combines design-based research and consensus development methods, such as design thinking and think-aloud observations. Drones are used to provide AEDs and develop simulation scenarios for training in R&R locations. The hybrid approach ensures a valid and evidence-based training program. The study presents the EDVC approach used to enhance the maxSIMdrone training program, enabling effective out-of-hospital CA care. The program incorporates participant feedback and improves knowledge and techniques in AED use. It has the potential to improve patient outcomes in resource-limited R&R locations.

Sudden Cardiac Arrests in the Polish Tatra Mountains: A Retrospective Study.

Achieving the optimal survival rate for sudden cardiac arrest in mountains is challenging. The odds of surviving are influenced mainly by distance, response time, and organization of the emergency medical system. The aim of this study was to analyze the epidemiology and outcomes of patients with out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation was performed in the Polish Tatra Mountains. This was a retrospective analysis of data on sudden cardiac arrest collected from the database of the Tatra Mountain Rescue Service and local emergency medical system from 2001 to 2021. A total of 74 cases of sudden cardiac arrest were recorded. The mortality rate was 88% (65/74). Return of spontaneous circulation was achieved in 22 (30%) patients. A group of survivors was characterized by more frequent use of an automated external defibrillator (AED) (56% vs 14%, P=0.011), a shorter interval between cardiac arrest and emergency team arrival (12 vs 20 min, P=0.005), and a shorter time to initiation of advanced life support (ALS) (12 vs 22 min, P=0.004). All survivors had a shockable initial rhythm. The majority of survivors (8/9, 89%) had a good or moderate neurological outcome. This study confirms poor survival rate after sudden cardiac arrest in the mountain area. The use of AED, shockable initial rhythm, and shorter time interval to emergency team arrival and ALS initiation are associated with better outcomes.

Cardiac Resuscitation Procedures in US Nursing Facilities: Time to Reevaluate the Standard of Care?

Although the use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrest (OHCA) response has become the standard of care in many community settings over the past 20+ years, the adoption of AEDs in US nursing facilities is variable and the current number of facilities with AEDs is unknown. Recent research into the use of AEDs as part of cardiopulmonary resuscitation (CPR) procedures for nursing facility residents with sudden cardiac arrest demonstrates improved outcomes in the limited cohort with witnessed arrests, early bystander CPR, and an initial amenable rhythm, shocked with an AED before the arrival of Emergency Medical Services (EMS) personnel. This article reviews data about outcomes of CPR in older adults and nursing facility settings and proposes that standard procedures for CPR attempts in US nursing facilities should be reevaluated and continue to evolve, commensurate with the evidence and community standards.

The First Responder Shock Trial (FIRST): Can We Improve Cardiac Arrest Survival by Providing Community Responders With Ultraportable Automated External Defibrillators?

Out-of-hospital cardiac arrest (OHCA) is the ultimate prehospital emergency. Early CPR and defibrillation are key to survival. During an emergency call, algorithms are applied to detect OHCA to dispatch emergency medical services (EMS). Simultaneously, nearby community responders who are confident in cardiopulmonary resuscitation and using an automated external defibrillator (AED) are alerted via the GoodSAM app. GoodSAM responders are provided with the patient location and the nearest AED (if available). Despite this, AED use before EMS arrival is 5%. The FIRST trial examines whether equipping community responders with an ultraportable defibrillator (CellAED) can increase survival to 30 days in OHCA. FIRST is a multicentre trial co-led by St John NZ and Ambulance Victoria. High-frequency GoodSAM responders (≥0.5 accepted alerts/year) were invited to participate. Participants were cluster randomised to the control or the CellAED intervention arm, stratified by region. Participants are instructed to carry the device as much as practical. Inclusion criteria are all OHCA patients assessed by EMS and activation of an eligible GoodSAM responder where the responder accepts the alert and arrives on scene before EMS. The primary outcome is survival at 30 days. The trial aims to detect a 7% improvement in the proportion of 30-day survivors (16% vs 9%). The FIRST trial has recruited 1,805 participants, with 903 community responders allocated a CellAED. Participants have been successfully trained in CellAED use online. To date, 1,788 alerts have been sent to CellAED participants, with 104 responders arriving before EMS. The world-first FIRST trial aims to improve prehospital defibrillation and patient survival in OHCA.

Incidence, characteristics and outcomes of out-of-hospital cardiac arrest due to ventricular fibrillation in the general population: data from a single-center long-term registry

Abstract Funding Acknowledgements: Type of funding sources: None. Out-of-hospital cardiac arrest (OHCA) is a major public health problem and ventricular fibrillation (VF) is the most common initial rhythm when cardiac disease is the cause of arrest. It can be favorably treated with defibrillation but rapidly tends to deteriorate to non-shockable rhythms over time, so that reported survival rates vary from 3% to 10%. Early defibrillation strategy has led to a considerable survival improvement; however, automated external defibrillators are still used in <3% of episodes of OHCA. Here, we analyze data from a single-center emergency-medical-service (EMS) registry, involving all consecutive OHCA occurring from January 2013 to June 2022 in whom resuscitation or defibrillation has been attempted. The "Progetto Vita" initiative has been developed in our province since 1999 with the aim of improving deployment of automated external defibrillators into the public space so that the first line involved in the chain of survival (laic bystander or policemen/health care staff) and the use of automatic external defibrillators (AED) by policemen/citizens before the arrival of the EMS personnel are crucial indicators involved in the registry. Patients presenting with OHCA due to VF were considered eligible for this analysis. During the 10-year period of examination, 3,124 patients received medical care for OHCA; 323 of them presented VF and were considered for subsequent analysis. VF occurred prevalently at home (73%), in men (75%); mean age was 70. Bystander or laic citizen CPR was performed in 35 cases (11%) with a survival rate of 63%. AED used by either laic bystander or police was used in 30 cases (9%) with a success rate of 77%. Cardiac comorbidities were noted in 67 patients (21%), predominantly males, and CAD was the most common disease. Main historical, clinical, ECG, instrumental features and therapeutic management and differences in sex groups are listed in Table 1. As expected, incidence increased with age; male predominance was observed in all age subgroups although we observed a different distribution between sexes in age subgroups (Table 1). There were 237 deaths (mortality rate 73%), 41 (17%) of them occurring after arrival at Emergency Service.Among successfully admitted patients, VF was mostly related to coronary artery disease (70%) and STEMI was the most frequent manifestation of acute ischemic heart disease, both in males and females. Overall, 87 (27%) patients survived and were successfully admitted to intensive care unit (57%) or coronary care unit (43%). Multivariate logistic regression analysis showed that laic-performed CPR (OR 2.52, 95% CI 1.04, 6.1, p=0.04) and use of AED (OR 7.15; 95% CI 2.66, 19.19, p<0.001) were both independent predictors of survival. VF in the general population is still poorly predictable and mortality remains high: implementation of community involvement in early-defibrillation through publicly available AEDs appears effective in improving survival. Study population Population characteristics

AP-452680-2 GEOSPATIAL ANALYSIS OF BYSTANDER-INITIATED AUTOMATED EXTERNAL DEFIBRILLATOR UTILIZATION IN A LARGE US COMMUNITY

Bystander use of automated external defibrillators (AED) can improve survival from out-of-hospital sudden cardiac arrest (SCA), but utilization can be variable. We hypothesized that AED distribution and utilization is determined by race/ethnicity and socioeconomic status of neighborhoods. To evaluate the distribution and utilization of bystander-initiated AED use for SCA events in a single large US community. All consecutive SCA cases with resuscitation attempted by emergency medical services (EMS) in Ventura County, CA (pop. 848,112, 43% Hispanic) were prospectively identified during 2015-2022. AED locations were obtained from the Ventura County Healthcare Agency Registry. Census tracts in the county (US Census 2018 estimates), were dichotomized as above or below the median census tract household income categorized as SES1 (income <median income) and SES2 (income >median income). AED and SCA event locations were geocoded and merged with the 2018 census tract geospatial map. The Euclidean distance (meters) between these two locations was calculated. AEDs were considered in viable proximity if located within 300 meters of the SCA event. Differences were analyzed using univariate statistical methods. Among 2515 cases (70.5±16.33 y, 65% male) of whom 684 (27%) were Hispanic, 782 (31%) were in viable proximity of an AED (Figure). There were no ethnicity-based differences in viable AED proximity (Hispanic n= 225(33%), non-Hispanic n=557 (30%), p=0.23). A total of 1442 (57%) cases (70±16.17 y, 65% male) were categorized as SES1 and 1070 (43%) cases (71±16.52 y, 65% male) as SES2. No significant differences in viable AED proximity were identified between SES1 (n= 434, 30%), and SES2 (n=348(33%); p=0.19). A total of 1361(54%) received bystander CPR, but bystander-initiated AED use was observed in 75 (3%). AED use was observed in 75/782 (9%) SCA cases in viable proximity to an AED of whom 3.1% were Hispanic and 12.2% non-Hispanic (p <0.001). SES2 cases had higher AED utilization than SES1 cases (12.4% vs. 7.8%, p = 0.02). In this western US community, AEDs in viable proximity to SCA events were distributed equitably, and not affected by neighborhood SES or ethnicity. However, bystander-initiated use for AEDs in close proximity was under 10%, indicating significant missed opportunities. These findings highlight the critical need to enhance community-wide education in bystander-initiated CPR and AED use for further improvement in SCA survival outcomes.

Training in Basic Life Support and Bystander-Performed Cardiopulmonary Resuscitation and Survival in Out-of-Hospital Cardiac Arrests in Denmark, 2005 to 2019

Strategies to improve survival from out-of-hospital cardiac arrest (OHCA) include mass education of laypersons with no official duty to respond to OHCA. In Denmark, basic life support (BLS) course attendance has been mandated by law in October 2006 for obtaining a driver's license for all vehicles and in vocational education programs. To examine the association between yearly BLS course participation rate and bystander cardiopulmonary resuscitation (CPR) and 30-day survival from OHCA and to examine if bystander CPR rate acted as a mediator on the association between mass education of laypersons in BLS and survival from OHCA. This cohort study included outcomes for all OHCA incidents from the Danish Cardiac Arrest Register between 2005 and 2019. Data concerning BLS course participation were supplied by the major Danish BLS course providers. The main outcome was 30-day survival of patients who experienced OHCA. Logistic regression analysis was used to examine the association between BLS training rate, bystander CPR rate, and survival, and a bayesian mediation analysis was conducted to examine mediation. A total of 51 057 OHCA incidents and 2 717 933 course certificates were included. The study showed that the annual 30-day survival from OHCA increased by 14% (odds ratio [OR], 1.14; 95% CI, 1.10-1.18; P < .001) when BLS course participation rate increased by 5% in analysis adjusted for initial rhythm, automatic external defibrillator use, and mean age. An average mediated proportion of 0.39 (95% QBCI, 0.049-0.818; P = .01). In other words, the last result indicated that 39% of the association between mass educating laypersons in BLS and survival was mediated through an increased bystander CPR rate. In this cohort study of Danish BLS course participation and survival, a positive association was found between annual rate of mass education in BLS and 30-day survival from OHCA. The association of BLS course participation rate on 30-day survival was mediated by the bystander CPR rate; approximately 60% of the association of BLS course participation rate on 30-day survival was based on factors other than increased CPR rates.

Evaluation of automated external defibrillator designed for people in dogs.

To determine if human automated external defibrillators (AEDs) could successfully record cardiac electrical activity in dogs, make appropriate recommendations regarding shock delivery, and characterize skin preparation required for a readable ECG based on dog haircoat characteristics. Prospective study of AED use in dogs conducted between January and March 2021. University teaching hospital. Three groups of client-owned dogs were evaluated. Group 1 consisted of 23 healthy dogs with sinus rhythms, group 2 consisted of 9 dogs with documented cardiac arrhythmias, and group 3 consisted of 9 dogs receiving CPR following naturally occurring cardiopulmonary arrest. Haircoat characteristics and clipping or ECG paste required to obtain a readable ECG were recorded. The time interval from a readable ECG by the investigator until AED shock advisement was measured. Correctness of shock advice was recorded. Analyses were performed using commercial statistical software. P-values <0.05 were considered significant. The attending veterinarian judged the ECG on the AED to be readable in all dogs. Time to shock advisement in all dogs was median 18 (range: 7-180) seconds. Dogs with heavy, long, or double haircoats required clipping in 24 of 27 (89%) cases to obtain a readable ECG. ECG paste on the AED pad was required in 36 of 40 dogs (90%) in order to obtain a readable ECG. The AED advice for delivery of shock was appropriate in 51 of 52 (98%) queries of the machine across all groups. Human AEDs can successfully record cardiac electrical activity in dogs. AEDs appropriately recommend delivery of a shock most times, contingent on skin preparation. Dogs with double, long, or heavy haircoats should be clipped prior to pad application. ECG paste will aid AED reading in all haircoat types. Further investigation is warranted into AED use in dogs, particularly in general practices.

Sudden Cardiac Arrest in Basketball and Soccer Stadiums, the Role of Automated External Defibrillators: A Review. For the BELTRAN Study (BaskEtbaLl and soccer sTadiums: Registry on Automatic exterNal defibrillators).

Sudden cardiac arrest (SCA) during sports events has a dramatic impact on stadium-goers and the public and is often associated with poor outcomes unless treated with an automated external defibrillator (AED). Despite this, stadiums vary in AED use. This review aims to identify the risks and incidences of SCA, and the use of AEDs in soccer and basketball stadiums. A narrative review of all relevant papers was conducted. Athletes across all sports face an SCA risk of 1:50,000 athlete-years, with the greatest risk of SCA in young male athletes (1:35,000 person-years) and black male athletes (1:18,000 person-years). Africa and South America have the poorest soccer SCA outcomes at 3% and 4% survival. AED use on-site improves survival greater than defibrillation by emergency services. Many stadiums do not have AEDs implemented into medical plans and the AEDs are often unrecognisable or are obstructed. Therefore, AEDs should be used on-site, use clear signalling, have certified trained personnel, and be incorporated into stadiums' medical plans.

Bystander cardiopulmonary resuscitation, automated external defibrillator use, and survival after out-of-hospital cardiac arrest

IntroductionWe aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) with and without automated external defibrillator (AED) use and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in Korea. MethodsThis cross-sectional study used a nationwide Korean OHCA registry between 2015 and 2019. Patients were categorised into no bystander CPR and bystander CPR with and without AED use groups. The primary outcome was good neurological recovery at discharge. We also analysed the interaction effects of place of arrest, response time, and whether the OHCA was witnessed. ResultsIn total, 93,623 patients were included. Among them, 35,486 (37.9%) were in the no bystander CPR group, 56,187 (60.0%) were in the bystander CPR without AED use group, and 1950 (2.1%) were in the bystander CPR with AED use group. Good neurological recovery was demonstrated in 1286 (3.6%), 3877 (6.9%), and 208 (10.7%) patients in the no CPR, bystander CPR without AED use, and bystander CPR with AED use groups, respectively. Compared to the no bystander CPR group, the adjusted odds ratio (95% confidence intervals) for good neurological recovery was 1.54 (1.45–1.65) and 1.37 (1.15–1.63) in the bystander CPR without and with AED use groups, respectively. The effect of bystander CPR with AED use was more apparent in OHCAs with witnessed arrest and prolonged response time (≥8 min). ConclusionBystander CPR was associated with better neurological recovery compared to no bystander CPR; however, the benefits of AED use were not significant. Efforts to disseminate bystander AED availability and ensure proper utilisation are warranted.

Cardiopulmonary Resuscitation and Automated External Defibrillator Awareness, Practice and Attitude Among Athletes in the Eastern Province

Background: The prevalence of sudden cardiac arrest (SCA) among athletes has increased recently. The American Heart Association (AHA) emphasizes early cardiopulmonary resuscitation (CPR) using an automated external defibrillator (AED). The study aimed to assess the current knowledge, skills, and attitude toward CPR and the use of AED among athletes in the Eastern Region of Saudi Arabia. Methods: This cross-sectional online survey study was conducted between May and September 2021 in the Eastern Province. The questionnaire was developed following the AHA (2020) guidelines and the Arabic and English version were validated. The study recruited Sports facilities staff and adults who regularly practiced sports as competitive or non-competitive athletes. Results: The study recruited 421 participants. The majority were males (75%) and Saudis (97%), living in the Qatif region and practicing the sport for over 20 years. The Heartsaver trained group constituted 181 (43%). The majority of the trained group (92%) knew the Red Crescent emergency call number compared to 75% of the nontrained participants (P &lt; 0.001). Only 30% of the trained group claimed they were competent in performing all skills and using the AED, but unable to operate it in actual events. The majority of the sample does not know if the AED is available in their sports facilities (70%), while 27% of the participants confirmed that the AED is unavailable. Conclusion: The study found limited knowledge and skill about the AED's use among athletes. Sports centres are inadequately equipped with AEDs, which is a potential concern. There is a great need to enhance the training quality with follow-up sessions to ensure the effective utilization of these skills in community settings.

Knowledge about first aid among physical education professionals outside school settings

Approaches of Physical Education professionals, which work in non-school settings, include the development of simple physical activities for health maintenance and quality of life improvement, physical training prescriptions for high performance purposes and orientation of therapeutic protocols. However, the interventions may lead to accidents of all types to the practitioners and, therefore, it obliges the professionals to act as a primary rescuer in situations of urgency and emergency. This research aimed to investigate the knowledge level in first aid of Physical Education professionals who work in non-school settings. Three hundred eighteen Physical Education professionals, who work non-school settings, were submitted to questionnaires with multiple choices, and essay questions about First Aid. The participants, on a larger scale, had access to First Aid contents during the academic education period, either at college or through external courses (92.8%). However, the course completion, at a specific time in the undergraduate process, has not been sufficient to prepare them for urgency and/or emergency situations. In addition, they presented little ability with basic concepts and behaviors, especially regarding cardiopulmonary resuscitation and the use of automatic external defibrillator. Additionally, 72% of professionals answered they do not have self-confidence to provide first aid in any situation. In conclusion, Physical Education professionals present insufficient theoretical knowledge in first aid, being necessary some better training in this area, both in the theoretical and practical aspects.

Community Cardiac Arrest as a Challenge for Emergency Medical Services in Poland

The problem of cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is the subject of continuous research. The aim of this study was to analyze the use of an automated external defibrillator (AED) during the resuscitation of an adult in public places in Poland between 2015 and 2020. A retrospective analysis of the selected documentation obtained from AED distributors, the medical records obtained from the emergency call center, and the emergency medical teams was conducted. During the analysis period, there were 100 cases of recorded and documented use of AEDs in OHCAs in public places. In 70% of the cases, defibrillation was performed with an AED. This result could be higher, but the study's methodology and limited access to data only allowed for this result. In Poland, there are no legal acts on the registration of automatic external defibrillators and their implementation. Appropriate registries should be introduced nationwide as soon as possible. Due to the inadequacy of the medical records of the emergency medical teams to record the use of automated external defibrillators by a bystander to an incident, changes to these documents should be pursued. Based on such a small cohort, it is not possible to conclude that the return of spontaneous blood circulation is correlated with the use of AEDs and public access to defibrillation PADs.

Effect of Smartphone Dispatch of Volunteer Responders on Automated External Defibrillators and Out-of-Hospital Cardiac Arrests

Smartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs). To evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR). This randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services. Volunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR. Overall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application. Volunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, -0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR. In this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant. ClinicalTrials.gov Identifier: NCT02992873.

Sports-related sudden cardiac arrest in young adults.

Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18-35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85-6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48-43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.

179 Association Between Bystander Cardiopulmonary Resuscitation With and Without Public Access Defibrillator Use and Neurologic Outcomes After Out-of-Hospital Cardiac Arrest

The aim of this study was to investigate the association between bystander cardiopulmonary resuscitation with and without AED (automated external defibrillator) use and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in Korea.

Sudden cardiac death related to physical exercise in the young: a nationwide cohort study of Australia.

Sudden cardiac death (SCD) during physical exercise is devastating. To evaluate causes and circumstances of exercise-related SCD in the young in Australia. We reviewed the National Coronial Information System database for deaths in Australia relating to cardiovascular disease in cases aged 10-35 years between 2000 and 2016. Cases who had undertaken physical exercise at the time of the event were included. We collected demographics, circumstances of death, type of physical exercise, bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use prior to ambulance arrival. Over a 17-year period, 1925 SCD cases were identified, of which 110 (6%) cases (median age 27 years (interquartile range 21-32 years); 92% male) were related to sports/physical exercise. Thirteen (12%) cases occurred in active athletes. Most common causes were coronary artery disease (CAD; 37%) and sudden arrhythmic death syndrome (SADS; 20%). Among Aboriginal and Torres Strait Islanders (n = 10), all deaths were related to CAD. Australian Rules Football (24%), running/jogging (14%) and soccer (14%) were the most frequent physical exercise activities. Prior symptoms were present in 39% (chest pain 37%, pre-syncope/syncope 26%). Most (87%) were witnessed, with bystander CPR in 70%. AED use prior to ambulance arrival was 8%. The present study demonstrates the high occurrence of CAD and SADS in SCD in the young related to physical exercise. Aboriginal and Torres Strait Islanders were disproportionately affected by CAD. Although events were commonly witnessed, AED was seldom used prior to ambulance arrival and highlights an important opportunity to improve outcomes in the post-arrest chain of survival.