Automated External Defibrillators Research Articles

Impact of the number of citizens officially certified for government-organized civilian cardiopulmonary resuscitation courses on the prognosis for patients with out-of-hospital cardiac arrest in Japan

Abstract Background To improve the prognosis of patients with out-of-hospital cardiac arrest (OHCA), the rate of high-quality cardiopulmonary resuscitation (CPR) and immediate use of automated external defibrillators (AEDs) by citizens must be further increased. Japanese government launched certified CPR courses for citizens throughout Japan in 1994 and the number of citizens certified on the course is increasing. However, the impact of the number of citizens officially certified for the courses on the rate of CPR implementation by citizens and the outcomes in patients with OHCA is unclear. Methods From a prospective, nationwide, population-based registry of patients with OHCA in Japan, we identified 350,444 patients from 2005 through 2020 with bystander-witnessed OHCA with 72,069 ventricular-fibrillation (VF) and the other non-VF cardiac arrests. The association between the number of citizens certified for the CPR courses and the rate of CPR implementation by citizens throughout Japan was analyzed by Poisson distribution and Cochran–Armitage test for trend. The primary outcome was survival at 1 month. The secondary outcomes were favorable neurologic outcome at 1 month. The associations between the CPR attempted by citizens [categorized into three (chest-compression-only CPR, chest compression with rescue breathing, and use of AEDs with chest compression and rescue breathing)] and outcomes were determined by multivariable mixed logistic regression analyses. Results Cumulative number of citizens certified for the CPR courses increased from 717,808 in 2005 to 34,938,322 in 2020, which reached to 27.8% of total Japanese population. Annual course receivers were also linearly increased during the period (Incidence Rate Ratios 1.03, p<0.001). Similarly, the rate of patients receiving CPR by citizens increased linearly from 40.6% in 2005 to 56.8% in 2020 (P for trend<0.001). In the multivariable mixed logistic regression analyses, higher CPR activity by citizens were significantly associated with better 1-year survival in both VF and non-VF patients even after adjusted for covariates [VF = chest compression: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.98–1.39; P =0.078; chest compression with rescue breathing: OR 1.22; 95% CI 1.02–1.49; P =0.030; use of AEDs with chest compression and rescue breathing: OR 1.54; 95% CI 1.54–1.92; P <0.001 vs no CPR, non-VF= chest compression: OR 1.19; 95% CI 0.76–1.87; P =0.45; chest compression with rescue breathing: OR 2.26; 95% CI 1.34–3.82; P =0.020 vs non-CPR]. Similar results were also found in neurological outcomes in 1 month. Conclusions The rate of CPR implementation by citizens throughout Japan has continuously and linearly increased in these 15 years in proportion to the increase in the number of citizens certified for the government-organized CPR courses. Higher CPR activity by citizens were significantly associated with better 1-year survival and favorable functional status in both VF and non-VF patients.

Release velocity improvement with a new metronome-guided chest compression protocol: preliminary results of the RITMICO study

Abstract Introduction Annually, emergency medical services treat over 350’000 out-of-hospital cardiac arrests in the U.S. and over 25’000 in Europe. Outcomes vary widely, according also to the quality of the CardioPulmonary Resuscitation (CPR) provided. Recently, it was demonstrated how, on top of the compression phase, chest release phase is also important to obtain an adequate heart and brain perfusion. However, no studies describe how to ameliorate this parameter during resuscitation. Purpose We investigated if a modified metronome-guided procedure might improve chest compression release velocity during CPR simulation on standard manikin, compared to the standard procedure. Methods We developed a double-click metronome for CPR: the first click corresponds to chest compression and the second to the end of chest release. Volunteers with different levels of expertise in CPR and with a valid BLS-D certification have been included in the study. Each subject performed two CPR manikin simulations following a 4-min protocol with the standard and the modified metronome (Figure 1), in a random order. An Automated External Defibrillator (AED) equipped with pads allowed continuous measurement of CPR quality during simulations. Three CPR parameters have been measured: compression depth, rate and release velocity. CPR simulation was guided only by the external metronome, all audio prompts from the AED were silenced. The two procedures have been compared, in terms of CPR quality, using Wilcoxon signed-ranks test. Impact of subject-specific factors on the difference in CPR quality has been evaluated using stepwise regression. Results 151 volunteers were included in the study, 23 of them have been excluded due to incomplete data recording. Comparison between the two procedures (Figure 2) showed a significant increase of median chest compression depth (p<<0.001) and release velocity (p<0.05) with the modified metronome. Percentage of compressions within the optimal range was significantly higher for compression depth (p<0.05) and significantly lower for compression rate (p<0.01) with the modified metronome. Chest compression release velocity difference was not statistically significant (p=0.20). No significant impact of sex, age and level of expertise was observed. Conclusions The double-click metronome significantly increased CPR quality in terms of both compression depth and release velocity. The decrease of compressions within the optimal rate range in the modified procedure could be due to lack of familiarity with the new rhythm and needs further evaluation. Our study represents the first trial trying to improve chest compression release velocity. Demonstrating the efficacy of this procedure could pave the way to clinical trials in real resuscitations to confirm the potential impact on the outcome of out-of-hospital cardiac arrest.Study protocolComparison between the two procedures

Abstract 340: Automated External Defibrillator Utilization After Out-of-Hospital Cardiac Arrest at Recreational Facilities in the United States

Background: Given the importance of public access defibrillation, some U.S. states have passed laws requiring an automatic external defibrillator (AED) to be available on-site at athletic facilities. However, rates of bystander AED application during out-of-hospital cardiac arrest (OHCA) in states with and without such laws remain unknown. Research Question: What are the rates of bystander AED application during OHCA at recreational facilities in U.S. states that mandate AEDs availability at such locations? Aim: To examine the rates of bystander AED application for OHCA at recreational facilities in states with and without laws mandating the presence of AEDs at athletic facilities. Methods: We included adults (≥18 years) in the Cardiac Arrest Registry to Enhance Survival (CARES) registry with a non-traumatic OHCA during 2013-2021 at a recreational facility in the U.S. The primary outcome was bystander AED application during OHCA. Secondary outcomes included survival to hospital admission and survival to hospital discharge. We examined the rates of bystander AED application and survival outcomes in states with laws that mandate AEDs at athletic facilities and in states without such laws. Results: Overall, there were 4,145 OHCAs cases at recreational facilities in 13 states that mandated AEDs at athletic facilities and 5,145 cases in 27 states that did not. In states with laws, the median rate of bystander AED application was 19.0%, with large between-state variation (IQR: 15.1%-22.0%). The median rate of survival to hospital admission was 44.5% (IQR 39.4%-56.9%) and survival to hospital discharge was 31.0% (IQR 25.2%-32.8%). In non-law states, the median rate of bystander AED application was 18.2% (IQR: 13.9%-25.0%). The median rate of survival to hospital admission was 45.0% (IQR 38.4%-52.1%) and survival to hospital discharge was 28.4% (IQR 25.9%-37.5%). Conclusions: Despite state laws that mandate on-site availability of an AED, rates of bystander AED application for OHCA at recreational facilities in such states remain low, with notable state-level variability. Our findings highlight that improving bystander AED application during OHCA will need to go beyond making AEDs available on-site.

Abstract 421: Automated External Defibrillator Implementation Gaps in Three Non-Urban U.S. Communities

Introduction: Automated external defibrillators (AEDs) represent a crucial component of bystander response to out-of-hospital cardiac arrest (OHCA), yet epidemiologic evidence suggests that AEDs are deployed by laypersons in less than 5% of OHCA events in the US. The reasons for low utilization remain poorly characterized, especially in rural/suburban environments. We hypothesized that in these non-urban environments, layperson AED use is mostly in commercial or public locations despite most arrests occuring in private residences. Methods: We conducted an analysis of EMS-treated atraumatic OHCA events from 3 non-urban US regions (Cumberland County, PA; Jackson, TN; Forsyth County, GA), abstracted from EMS patient care reports. Data included Utstein reporting elements, arrest location type, and response intervals as calculated by dispatch and EMS arrival times. We excluded events in skilled nursing facilities and prisons. CPR and AED delivery by laypersons was measured. Results: Between 12/8/17-12/31/21, we identified 1542 adult OHCA patients with median age 66.5 y (IQR 22.5), 37% female, 18% had initial shockable rhythms, and 75% occurred in private residences. Return of spontaneous circulation was obtained in 19% of cases. Bystander CPR was performed in 23% and AEDs were deployed by laypersons in 3%. Laypersons applied AEDs in 12% of OHCA in commercial locations, 6% of OHCA in public, and 3% of OHCA in private residences. EMS response times were 4% less than 4 min, 48% 4-9 min, and 48% >9 min; prevalence of AED use was indistinguishable between time intervals of EMS response. 16% OHCA victims still had initial shockable rhythms even among the >9 min EMS response cases; of these, 1% received AED use from laypersons. Conclusion: In three non-urban US regions, most arrests occurred in private residences while AED use was much more likely in public or commercial locales, suggesting an important gap in AED deployment. Even in cases with prolonged response times, many patients had shockable rhythms, suggesting an important opportunity for earlier AED deployment. Future work will test whether placement of AEDs in residential areas using trained volunteer responders in these same communities will improve OHCA response and survival outcomes.

Abstract 18326: The Association of s Shockable Rhythm and Automated External Defibrillator Use With Outcomes in Infants With Out of Hospital Cardiac Arrest: A Study From the Cardiac Arrest Registry to Enhance Survival

Introduction: Defibrillation with an automated external defibrillator (AED) is critical in the chain of survival following a cardiac arrest caused by pulseless ventricular tachycardia and ventricular fibrillation. However, in 2022 the International Liaison Committee on Resuscitation could not make a recommendation for or against the use of AEDs in infants. Hypothesis: We aimed to describe the association of a shockable rhythm with outcomes in infants with out of hospital cardiac arrest (OHCA) and test the hypothesis that a shockable rhythm and AED use with defibrillation would be associated with improved neurologically favorable survival at hospital discharge by analyzing data from a large cardiac arrest registry in the United States Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age < 1 year of age and non-traumatic OHCA from January 1, 2013 through December 31, 2021. The primary outcome was neurologically favorable survival defined as a Cerebral Performance Category Scale of 1 or 2. Results: A total of 10,108 infants with OHCA were evaluated of which 308 (3%) had a shockable rhythm and 9,800 (97%) had a non-shockable rhythm. Compared to infants with non-shockable rhythms infants with shockable rhythms were more likely to be white (37.7% white, 25.6% black, 7.5% Hispanic), have a witnessed arrest (44.5% vs. 16%), a non-home/public arrest (16.9% vs. 6.7%), and bystander AED application with defibrillation (19.4% vs. 0.18%) (p<0.05 for all). Neurologically favorable survival (19.2% shockable vs. 4.2% non-shockable was higher in arrests with a shockable rhythm compared to non-shockable arrests, p<0.001). AEDs were applied by bystanders in 1479 (14.5%) arrests and were associated with neurologically favorable survival (11% AED with defibrillation vs. 3.5% AED without defibrillation, p=0.002) Conclusions: Although infants infrequently had an OHCA with a shockable rhythm survival outcomes were superior in arrests with a shockable rhythm and in arrests where there was bystander AED use with defibrillation. These results emphasize the importance of AED use in infants with shockable rhythms following an OHCA.

Abstract 236: Agency Factors Associated With First Response Systems That Improve Out-of-Hospital Cardiac Arrest Outcomes

Background: Data are conflicting regarding the association between first responder (FR) cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) with improved outcomes after out-of-hospital cardiac arrest (OHCA). Additionally, little is known about why this association varies between EMS agencies, with FR interventions being associated with better survival for only some agencies. Hypothesis: Agency characteristic differ between agencies that do a do not successfully implement FR CPR/AED for OHCA. Methods: We studied the 2016-2021 national cardiac arrest registry to enhance survival (CARES) database. We defined the exposures as FR CPR and FR AED. The outcome was survival with favorable neurologic status. We used logistic regression models to evaluate the association between FR CPR/AED and OHCA outcome for each individual agency. Based on each agency’s association between FR AED/CPR and outcomes, we stratified agencies into positive association (95% confidence interval falling entirely above 1) and no association (95% confidence below or including 1). Agencies with poor model fit were excluded. We then compared characteristics between strata. Results: For the association between FR CPR and outcomes, 21 agencies caring for 42,856 patients had a positive association; 371 agencies caring for 449,824 OHCAs had no association. For FR AED, 47 agencies caring for 103,120 OHCAs had a positive association;262 agencies caring for 327,761 OHCAs had no association. For FR CPR and compared to the no association strata, agencies with a positive association had more annual OHCAs (+300), a lower rate of FR CPR (-11.3%), and a lower rate of FR AED (-10.8%). For FR AED and compared to the no association strata, agencies with a positive association FR AED and outcomes had more OHCAs per year (+150.5), a lower rate of FR CPR (-6.8%), a lower rate of FR AED (-13.3%), lower response times (-0.6 minutes), and more OHCAs from high-income neighborhoods (+3.7%). Conclusion: More agencies had a positive association between FR AED and survival with favorable neurologic outcome than between FR CPR and survival with favorable neurologic outcome. Agencies with better outcomes from FR interventions treated more OHCAs and had lower rates of FR intervention.

Abstract 311: Accuracy of Automated External Defibrillator Pad Placement During Out-of-Hospital Cardiac Arrest Resuscitation Simulations

Introduction: Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. Aim: We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR). Methods: We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LR and FR. LR received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer’s recommendations and distance to anatomical landmarks (mid, nipple, and naval lines). Incorrect AP placement was defined as more than 6 cm medial or 10 cm inferior. Incorrect LP placement was defined as more than 6 cm superior, 9 cm inferior, or 10 cm medial. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (< 1 year) with AED application for FR using Chi-square tests. Results: LR correctly placed the AP in 30/38 (79%) and the LP 30/38 (79%) simulations. Application did not differ significantly based on previous CPR training (AP p= .187, LP p=.578). The most common incorrect placement was too low for both AP (5/8, 63%) and LP (4/8, 50%). FRs applied the AP correctly in 31/36 (86%) and the LP in 22/36 (61%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP p=.29, LP p=.563). The most common incorrect placement was too low for both AP (5/5, 100%) and LP (12/14, 86%). Conclusion: Both LRs and FRs may not apply AEDs per manufacturer’s recommendations. Further research is needed to improve instructions and follow-up training to ensure appropriate placement of AEDs, and to understand how improper AED placement impacts the accuracy of rhythm analysis and defibrillation success.

Abstract 337: Bystander Defibrillation in High Risk Neighborhoods

Background: Whether public health efforts successfully prioritize bystander automated external defibrillator (AED) application in areas with highest of hospital cardiac arrest (OHCA) burden is unknown. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we identified all adult, public OHCAs linked to a census tract between 2013- 2021. We ranked all census tracts by annual public OHCA volume to ascertain relative burden, then assessed the association of census tract OHCA burden and bystander AED application rate (application prior to emergency personnel arrival), using a hierarchical modified poisson regression model, to account for clustering within tracts, and arrest characteristics. Results: Among 25,787 tracts with 90,898 public OHCAs, the mean (SD) age was 57.1 (16.0) years, with 70,900 (78.0%) male and 45,388 (49.9%) White victims. Overall, bystander AED application rates were low (10.9%). There was a modest association between neighborhood OHCA burden and bystander AED application rates (ρ=0.243). After adjustment, neighborhoods with the highest OHCA burden (>2/ year) had a higher relative risk of bystander AED application than those with lowest burden (<1/ every other year) (RR 2.07; 95% CI 1.95, 2.20, p<.0001). However, this was due to a small proportion of high performing communities, as 700/1145 (61.1%) of highest OHCA burden communities had a bystander AED application rate less than the overall mean, 10.9%. Conclusion: High OHCA burdened areas have increased odds of bystander AED application, however this is driven by a few high performing neighborhoods. Targeted, context informed strategies are necessary to improve application rates and survival for the majority of high-risk neighborhoods.

Abstract 267: Neighborhood Socioeconomic Status Influences Rates of Pre-EMS Cardiac Arrest Resuscitation

Introduction: Out-of-hospital cardiac arrest is a leading cause of both morbidity and mortality in the United States and globally. After cardiac arrest onset, emergency medical services (EMS) might not arrive before irreversible injury takes place. Thus, pre-EMS resuscitation - including CPR and automated external defibrillator (AED) use - is associated with improvements in outcomes. We sought to determine if rates of pre-EMS CPR and pre-EMS AED use vary across neighborhood socioeconomic status using a database of EMS activations throughout the United States. Methods: The National Emergency Medical Services Information System (NEMSIS) is a large and nationally-representative database of EMS activations populated from more than ten-thousand EMS agencies throughout the US. We examined cardiac arrests in adult patients (18+ years of age) between January 2017 and December 2019 where EMS providers documented the ZIP code of the arrest, whether CPR prior to EMS arrival was provided, and whether an AED was applied prior to EMS arrival. The ZIP code of the arrest was used to group arrests based on socioeconomic status data from the US Census Bureau. Rates of pre-EMS CPR and pre-EMS AED use were then compared, and ZIP codes with under 5% of residents below the poverty line served as benchmarks. Results: 366,280 cardiac arrests met inclusion criteria. Both Pre-EMS CPR and pre-EMS AED use were highest in ZIP Codes where less than 5% of the population is below the poverty line (p< .00001). Furthermore, a consistent decrease in rates of pre-EMS interventions was seen as the percent of individuals below the poverty line increased (Figure 1). Conclusion: We found a strong relationship between neighborhood socioeconomic status and pre-EMS cardiac arrest interventions. One explanation may be access to CPR training. Further studies should continue to interrogate cardiac arrest disparities that have already been reported and seek to identify new unreported disparities as well.

Abstract 231: Assessing the Effectiveness of Food Delivery Service Integration for Automated External Defibrillator Delivery in Out-of-Hospital Cardiac Arrest Response Through Computer Simulation

Background: The number of food delivery (FD) motorcycle riders in Taipei has rapidly increased. These riders often wait near popular restaurants during rush hours and could potentially act as first responders to retrieve automated external defibrillators (AED) for out-of-hospital cardiac arrests (OHCA). Objectives: This study aimed to assess the feasibility of integrating FD riders into the emergency medical service (EMS) system as OHCA responders. Methods: We enrolled OHCAs from the Taipei registry between 2017 and 2019. Using the Uber Eats website, a prominent FD service platform, we obtained data on FD hotspots to establish a reference point. Assumptions were made in our simulation to develop an integrated system where FD riders could participate in a crowdsourcing program. In the simulation, FD riders were assigned to respond to an OHCA within a 2-km distance by retrieving an AED or directly responding to the OHCA if bystander CPR was unavailable. We tested response rates from 10 to 100% and compared simulated AED arrival time with documented EMS response time in the registry. Results: During the study periods, 8,952 of 11,660 OHCA cases were accessible by FD riders. There were 418 restaurants clustered around 24 hotspots, and 2,050 AEDs were found within range of these restaurants (Image1). For FD-accessible OHCA cases, with simulating response rates ranging from 10 to 100%, the AED arrival time was reduced by 2.99 to 3.67 minutes. The effect was more pronounced during peak hour (Image 2). Conclusion: The results indicate that incorporating FD riders as OHCA responders into the EMS system is practical and beneficial in reducing the defibrillation waiting time for OHCA patients.

Abstract 221: Heart Rhythm Analysis During Chest Compressions in Case of Out-of-Hospital Cardiac Arrest: Are Confirmation Analysis a Safety Issue?

Purpose: During out-of-hospital cardiac arrest (OHCA), automated external defibrillators (AEDs) can analyze the patient's cardiac rhythm using a Shock Advisory System (SAS) that runs during chest compressions (CC). We aimed to evaluate the safety of a SAS that enables analysis during CC, referred to as Analyze Whilst Compressing (AWC). AWC classifies the cardiac rhythm as shockable (Sh) or non-shockable (NSh) in the presence of CC. If shockable, the rescuer backs off while the AED confirms the rhythm in the absence of CC with a confirmation analysis (CoA). We aimed to verify the safety of AWC when patients present NSh rhythm during CC. Method: In this retrospective study, we utilized data from the Paris Fire Brigade collected between 01/01/2021 and 31/01/2022. The inclusion criteria were adult OHCA patients with initial Ventricular Fibrillation analyzed by the AWC algorithm. We analyzed patients' safety by assessing false positive cases in the presence of chest compressions: ill-advised CoA compared to appropriate CoA within the first 10 minutes of intervention. The main outcome was the rate of patients presenting ill-advised CoA. Results: We analyzed 285 consecutive OHCA patients, corresponding to 2011 rhythm analyses ; 205 patients had at least 1 CoA, which led to a confirmation rate of 27.7% over 557 analyses; 175 patients had at least one appropriate CoA; 76 patients (26.6%) had at least one ill-advised CoA: 48 (16.8%) had one ill-advised CoA, 19 (6.7%) had two ill-advised CoA, six patients (2.1%) had three ill-advised CoA, two patients (0.7%) had four ill-advised CoA, and one (0.35%) had six ill-advised CoA. The global amount of ill-advised CoA was 118, which leads to an ill-advised confirmation rate of 5.9%. The rhythm distribution implied with ill-advised CoA was: 72 (61%) asystole, 45 (38%) other non-shockable, one (0.85%) transition from Sh to NSh. The hands-off time that each ill-advised CoA generated was 10 [8-18] (median [IQR]) seconds. Conclusion: AWC presents comparable results to other methods of analysis during chest compressions in detecting some non-shockable rhythms as false positives. In a majority of patients, CoA was appropriate. Only one patient (0.35%) had up to six ill-advised CoA, making his impact negligible over the cohort.

Abstract 416: Conversion From Initial Non-Shockable Rhythm to Shockable Rhythm During Resuscitation With a Public Access Defibrillator Compared With Initial Shockable Rhythm; Incidence and Survival Outcomes

Incidence of initial non-shockable rhythm during cardiac arrest is increasing and is associated with poorer outcomes. The aim of this analysis was to study non-shockable to shockable rhythm conversion treated using a public access defibrillator (PAD) and to study survival rates related to initial shockable rhythm. HeartSine PAD data were collected between October 2012 to May 2023. The dataset consisted of data downloaded from PADs, and data recorded in case report forms. Initial rhythm and conversion to shockable rhythm were determined. First shock success (FSS) was defined as the termination of the shockable rhythm for at least 5 seconds. Chi-squared test was applied to determine if there was difference in outcomes between those patients with: a shockable rhythm, non-shockable rhythm that converted to shockable, and non-shockable rhythm that did not convert to a shockable rhythm. Of the 6877 cases submitted initial shockable rhythm could be determined for 6736 cases. For the 30.5% (2053/6736) of cases with an initial shockable rhythm, patient outcome was reported for 1923, and 62.9% (1209/1923) survived to hospital admission. Incidence of initial non-shockable rhythm was 69.5% (4683/6736). Change to a shockable rhythm could be determined for 4664 cases and occurred in 5.0% (233/4664). A shock was delivered in 94.8% (221/233) of these cases. FSS could be determined for 165 cases. FSS was 85.5% (141/165). Patient outcome was reported for 87.6% (204/233) where 22.5% (46/204) resulted in survival to hospital admission. For the 95% (4431/4664) of non-shockable cases that did not convert to a shockable rhythm, patient outcome was reported for 82.2% (3644/4431), where 10.8% (395/3644) of patients survived to hospital admission.Thus, conversion from non-shockable to shockable rhythm had improved survival compared to patients who did not convert. Furthermore, when initial rhythm was shockable significantly higher survival to hospital admission was recorded.

Large Language Model (LLM)-Powered Chatbots Fail to Generate Guideline-Consistent Content on Resuscitation and May Provide Potentially Harmful Advice.

Innovative large language model (LLM)-powered chatbots, which are extremely popular nowadays, represent potential sources of information on resuscitation for the general public. For instance, the chatbot-generated advice could be used for purposes of community resuscitation education or for just-in-time informational support of untrained lay rescuers in a real-life emergency. This study focused on assessing performance of two prominent LLM-based chatbots, particularly in terms of quality of the chatbot-generated advice on how to give help to a non-breathing victim. In May 2023, the new Bing (Microsoft Corporation, USA) and Bard (Google LLC, USA) chatbots were inquired (n = 20 each): "What to do if someone is not breathing?" Content of the chatbots' responses was evaluated for compliance with the 2021 Resuscitation Council United Kingdom guidelines using a pre-developed checklist. Both chatbots provided context-dependent textual responses to the query. However, coverage of the guideline-consistent instructions on help to a non-breathing victim within the responses was poor: mean percentage of the responses completely satisfying the checklist criteria was 9.5% for Bing and 11.4% for Bard (P >.05). Essential elements of the bystander action, including early start and uninterrupted performance of chest compressions with adequate depth, rate, and chest recoil, as well as request for and use of an automated external defibrillator (AED), were missing as a rule. Moreover, 55.0% of Bard's responses contained plausible sounding, but nonsensical guidance, called artificial hallucinations, that create risk for inadequate care and harm to a victim. The LLM-powered chatbots' advice on help to a non-breathing victim omits essential details of resuscitation technique and occasionally contains deceptive, potentially harmful directives. Further research and regulatory measures are required to mitigate risks related to the chatbot-generated misinformation of public on resuscitation.

TakoTsubo secondary to acute kidney disease.

We report the case of a 62-year-old man who was admitted to the Cardiac Department for TakoTsubo and ACC by torsades de point, secondary to acute kidney disease. We decide to discharge with a portable defibrillator. One month after cardiac magnetic resonance showed a complete recovery of left ventricular function.

Em Busca da Melhor Metodologia para Avaliação Cardíaca Pré-competitiva do Atleta Jovem

The aim of this text is to highlight the aspects of the study recently published in the European Heart Journal (Value of screening for the risk of sudden cardiac death in young competitive athletes) and the two comments and one editorial that followed it, which, due to their relevance and uniqueness, could drive future processes to optimise athlete screening methodologies, improving their efficiency, and reducing costs. This will require further studies with follow-up, the refinement of normality criteria and the implementation of immediate and effective resuscitation measures with automatic external defibrillation in all sports venues and gyms.

389 Use of the AEDs by lay rescuers. Analysis of 121 real cases of use of public access defibrillators (PAD)

389 Use of the AEDs by lay rescuers. Analysis of 121 real cases of use of public access defibrillators (PAD)

6 Survival After Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America - 17 years

6 Survival After Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America - 17 years

359 Optimisation of Public Access Defibrillator Deployment in England

359 Optimisation of Public Access Defibrillator Deployment in England

184 Defining the appropriate age for teaching the usage of Automatic External Defibrillators in Kids Save Lives project

184 Defining the appropriate age for teaching the usage of Automatic External Defibrillators in Kids Save Lives project

201 Defining resuscitation attempt in an era of public-access defibrillators

201 Defining resuscitation attempt in an era of public-access defibrillators