External Defibrillators Research Articles

Incidence and Outcomes After Out-of-Hospital Cardiac Arrest at Train Stations in Denmark.

Following international guidelines, communities have deployed automated external defibrillators at train stations without substantive evidence. We geocoded public out-of-hospital cardiac arrests (OHCAs) (2016-2020), automated external defibrillators, and train stations. The stations were divided into the following groups according to passenger flow: 1 (0-499), 2 (500-4999), 3 (5000-9999), and 4 (>10 000) passengers per day. Risk ratios (RRs) were calculated using Poisson regression of rates, and odds ratios (ORs) were analyzed through logistic regression. OHCAs at train stations accounted for 102 (2.3%) of 4467 public OHCAs. The incidence rate (IR) and RR for OHCAs were for group 1: IR, 0.02 OHCA per station per year, RR, 1.0 (reference); group 2: IR, 0.07, RR, 4.1 (95% CI, 2.3-7.3); group 3: IR, 0.25, RR, 12.7 (95% CI, 6.2-25.9); and group 4: IR, 0.34, RR, 16.3 (95% CI, 8.6-30.9). Compared with other public OHCAs, OHCAs at train stations were just as likely to receive bystander cardiopulmonary resuscitation (OR, 1.13 [95% CI, 0.60-2.12]). However, they had higher odds of bystander defibrillation (OR, 1.66 [95% CI, 1.06-2.58]), were more likely to achieve return of spontaneous circulation (OR, 1.88 [95% CI, 1.24-2.85]), and survive 30 days (OR, 2.37 [95% CI, 1.57-3.59]). The incidence of OHCAs at train stations was associated with passenger flow, with the busiest stations having a 16-fold higher risk of OHCAs than the lowest. OHCAs at train stations had better outcomes compared with other public OHCAs.

Preparticipation Cardiovascular Screening of Athletes: Current Controversies and Challenges for the Future

Sports cardiology is an evolving field in cardiology, with several topics remaining controversial. Beyond the several well-known benefits of regular exercise practice, the occurrence of adverse clinical events during sports in apparently healthy individuals, especially sudden cardiac death, and the described long-term adverse cardiac adaptations associated to high volume of exercise, remain challenging. The early identification of athletes with increased risk is critical, but the most appropriate preparticipation screening protocols are also debatable and a more personalized evaluation, considering individual and sports-related characteristics, will potentially optimize this evaluation. As the risk of major clinical events during sports is not zero, independently of previous evaluation, ensuring the capacity for cardiopulmonary resuscitation, especially with availability of automated external defibrillators, in sports arenas, is crucial for its prevention and to improve outcomes. As in other areas of medicine, application of new digital technologies, including artificial intelligence, is promising and could improve in near future several aspects of sports cardiology. This paper aims to review the methodology of athletes’ preparticipation screening, emphasizing current controversies and future challenges, in order to improve early diagnosis of conditions associated with sudden cardiac death.

Analysis of Prehospital Characteristics Affecting Survival Rates of Patients with Out-of-Hospital Cardiac Arrest Occurring During Work

This retrospective study analyzed survival rates of out-of-hospital acute cardiac arrest occurring during gainful work from 2013 to 2022. The survival rate at the workplace was 23.6% for patients with medical causes and 5.0% for those with non-medical causes, which was higher than the overall rate. The rate of layperson cardiopulmonary resuscitation (CPR) was 35.0% for medical causes and 11.6% for non-medical causes. Notably, cases witnessed by colleagues accounted for 72.9% of the medical cases and 76.8% of the non-medical cases, and CPR was performed in 42.7% of the medical cases and 19.6% of the non-medical cases. Survival rates were higher in both cases when there was a witness and CPR was performed. However, 45% of cardiac arrests occurring during work are still not witnessed, and the CPR performance and usage rates of automated external defibrillators (AED) remain insufficient. Enhancing the training of employees in CPR and AED usage can improve the survival rate of patients with cardiac arrest.

Knowledge, Experience and Awareness of Anesthesia Technicians in Our Country About Automatic External Defibrillator (AED) Devices: Survey Study

Background/Aims: The aim of this study was to evaluate the knowledge, experience and awareness of anesthesia technicians about Automatic External Defibrillator (AED) devices. METHODS: This study is a cross-sectional-descriptive study. The population of our research consists of people who graduated as Anesthesia Technicians in Turkey. The online survey form contains a total of 28 questions, 8 of which are sociodemographic. The data was collected online between 05.01.2024-20.01.2024. The acquired analyzes were performed with IBM SPSS version 20.0 program. RESULTS: The total number of anesthesia technicians/technicians and students graduating by 2023 in Turkey is about 63763 people. With this number of graduates, a sample group of 382 people was predicted with a 95% confidence interval and a margin of error of 0.05. A total of 392 people were reached. The average age was 28±7.72 years. 71.9% of the participants were female, 64% were single, 48.2% had been working between 1-5 years. 27.8% of the participants received First Aid Training, 20.4% received AED training, 26.5% used AED, 39.3% reported that AED device should be used by anesthesia technicians, 79.8% reported that AED device should be available in the hospital. CONCLUSION: In the result of this study, it was determined that anesthesia technician(s) had limited knowledge about the AED device and its application, and those who got first aid training did not apply AEDs in training and on patients. It is also thought that it may be useful to have AED devices in hospitals. It is thought that trainings can be organized to increase the knowledge of anesthesia technicians/technicians about the AED device, and the AED device can be kept in the hospital, thus survival rates can be increased by early defibrillation of patients.

Performance of the 2020 ACC/AHA and 2023 ESC risk stratification scales for primary prevention of sudden cardiac death in a Latin American population with hypertrophic cardiomyopathy

Abstract Background Identifying patients with hypertrophic cardiomyopathy (HCM) who are at high risk of sudden cardiac death (SCD) is essential for managing this condition. The American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) guidelines help assess and stratify the risk of determining which patients would benefit from primary prevention with an implantable cardioverter-defibrillator (ICD). Objective The study aims to evaluate the performance of the 2020 AHA/ACC and 2023 ESC risk stratification scales (AHA/ACC-rss; ESC-rss) for the primary prevention of SCD in Latin-American patients diagnosed with HCM. Methods A retrospective cohort of HCM from a single-center was analyzed. The inclusion criteria were individuals aged 16 years or older, without a history of SCD, and who had not undergone any treatment such as myomectomy or septal ablation with alcohol (Figure 1). The primary outcome was the identification of SCD or an equivalent event (successful resuscitation after cardiac arrest or appropriate therapy from the ICD). Results One hundred twenty patients were included (mean age 46.2 years old) and the mean follow-up duration was 61.1 months. From the total sample, 10 patients (8.3%) experienced an equivalent SCD event; 7 patients (5.8%) were ICD-protected and 3 (2.5%) required external defibrillation. The ESC-rss showed a greater area under the ROC curve (AUC, 0.79; 95% CI 0.62-0.94 vs AUC, 0.63; 95% CI 0.49-0.78) and specificity (85%; 95% CI 63-92 vs 51%; 95% CI 37.3-64.5). Sensitivity was similar between both scales (AHA/ACC-rss: 77%; 95% CI 50-100 vs ESC-rss: 73%; 95% CI 43-100). Remarkably, 2.5% of the patients who experienced an equivalent of SCD were incorrectly identified as low-risk individuals by either the AHA/ACC-rss, ESC-rss, or both (Table 1). Conclusion The SCD risk stratification recommended by the ESC-rss demonstrated a more effective identification of Latin American patients with HCM for ICD placement because the area under the curve was more significant than those of the AHA/ACC-rss. This single-center study highlights the need for a multicenter prospective study in Latin America.

Association Between Delay to First Shock and Successful First-Shock Ventricular Fibrillation Termination in Patients With Witnessed Out-of-Hospital Cardiac Arrest.

In patients with out-of-hospital cardiac arrest who present with an initial shockable rhythm, a longer delay to the first shock decreases the probability of survival, often attributed to cerebral damage. The mechanisms of this decreased survival have not yet been elucidated. Estimating the probability of successful defibrillation and other factors in relation to the time to first shock may guide prehospital care systems to implement policies that improve patient survival by decreasing time to first shock. Patients with a witnessed out-of-hospital cardiac arrest and ventricular fibrillation (VF) as an initial rhythm were included using the prospective ARREST registry (Amsterdam Resuscitation Studies). Patient and resuscitation data, including time-synchronized automated external defibrillator and manual defibrillator data, were analyzed to determine VF termination at 5 seconds after the first shock. Delay to first shock was defined as the time from initial emergency call until the first shock by any defibrillator. Outcomes were the proportion of VF termination, return of organized rhythm, transportation with return of spontaneous circulation, and survival to discharge, all in relation to the delay to first shock. A Poisson regression model with robust standard errors was used to estimate the association between delay to first shock and outcomes. Among 3723 patients, the proportion of VF termination declined from 93% when the delay to first shock was <6 minutes to 75% when that delay was >16 minutes (Ptrend<0.001). Every additional minute in VF from emergency call was associated with 6% higher probability of failure to terminate VF (adjusted relative risk, 1.06 [95% CI, 1.04-1.07]), 4% lower probability of return of organized rhythm (adjusted relative risk, 0.96 [95% CI, 0.95-0.98]), and 6% lower probability of surviving to discharge (adjusted relative risk, 0.94 [95% CI, 0.93-0.95]). Every minute of delay to first shock was associated with a significantly lower proportion of VF termination and return of organized rhythm. This may explain the worse outcomes in patients with a long delay to defibrillation. Reducing the time interval from emergency call to first shock to ≤6 minutes could be considered a key performance indicator of the chain of survival.

CURRENT LEVEL OF KNOWLEDGE AND AWARENESS OF HEALTHCARE PERSONNEL IN BASIC AND ADVANCED LIFE SUPPORT IN ARREST CASES WITH AND WITHOUT COVID-19 INFECTION

Objective: The knowledge of healthcare professionals about life support is crucial for saving lives. It was aimed to evaluate the knowledge and awareness level of healthcare professionals about advanced life support. Materials and methods: Our study was conducted between 15.02.2021 and 15.03.2021 with healthcare personnel working in our hospital. Data were collected by the questionnaire method. The researcher prepared the survey questions according to the European Resuscitation Council COVID-19 guidelines and American Heart Association Advanced Cardiac Life Support algorithms updated in 2020. 265 healthcare personnel (physicians, physician assistants, family physicians, nurses, health officers, and anesthesia technicians) participated in the study. Demographic characteristics of the participants (gender, age, duration of service, duties, duty stations), training and practice status, and level of knowledge were evaluated. Results: 67.2% of the participants were female, and 32.8% were male. The majority of the participants were nurses working in the inpatient clinics. 49.9% had a tenure of 1-5 years. 52.0% had received advanced cardiac life support training, and 19.6% had obtained and used automatic external defibrillators. 63.8% had performed advanced cardiac life support on a patient. In our study, the general level of advanced cardiac life support knowledge of the participants was found to be low. There was no significant difference in advanced cardiac life support scores in terms of gender, age, occupation, workplace, and tenure (p=0.604; p=0.986; p=0.927; p=0.982; p=0.295, respectively). Conclusion: Providing in-service resuscitation training to healthcare workers in line with current guidelines and supporting them with practical applications can provide quality knowledge and skills and increase their awareness of their responsibilities.

Is Anyone Ready to Save a Life? An Examination of Cardiac Emergency Preparedness in Schools.

This study explored the cardiac emergency preparedness of school employees in Illinois, as well as their attitudes toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) training. One thousand two hundred seventy-six school employees completed an online survey regarding their school's cardiac emergency preparedness, as well as their access to CPR/AED training, confidence and willingness to perform CPR/AED, and attitudes toward CPR policies and mandates. In total, results from 1273 school employees were analyzed. School employees in Illinois are not prepared to respond to a cardiac emergency, but desire training, plans, and drills. Demographic analyses revealed statistically significant differences in cardiac emergency preparedness between individuals of different personal and school characteristics. School employees in Illinois are not prepared to respond to a cardiac emergency. To increase preparedness for cardiac emergencies at school, schools should implement CPR/AED training for all employees, cardiac emergency response plans, and cardiac emergency response drills. Policies should be implemented at the state and local level to support cardiac emergency preparedness in schools, including mandated CPR/AED training for all school employees, cardiac emergency response plans for every building, and required cardiac emergency response drills.

Advancements in automated external and wearable cardiac defibrillators.

Survival statistics for out-of-hospital cardiac arrests remain unsatisfactory. Prompt defibrillation of shockable rhythms, such as ventricular fibrillation and pulseless ventricular tachycardia, is crucial for improving survival. Automated external defibrillators (AEDs) and wearable cardiac defibrillators (WCDs) seek to improve the survival rates following out-of-hospital cardiac arrests. We aim to review the indications, utility, advancements, and limitations of AEDs and WCDs, as well as their role in contemporary and future clinical practice. Recent advancements in these technologies, such as smartphone applications and drone delivery of AEDs and less inappropriate shocks and decreased size of WCDs, have increased their ubiquity and efficacy. However, implementation of this technology remains limited due to lack of resources and suboptimal patient adherence. Out of hospital cardiac arrests continue to pose a significant public health challenge. Advancements in AEDs and WCDs aim to facilitate prompt defibrillation of shockable rhythms with the goal of improving survival rates. However, they remain underutilized due to limited resources and suboptimal patient adherence. As these technologies continue to evolve to become smaller, lighter and more affordable, their utilization and accessibility are expected to improve.

Installation of Public Access Defibrillators for Out-of-Hospital Cardiac Arrests: Identifying Suitable Locations by Using a Geographic Information System.

Survival following an out-of-hospital cardiac arrest depends on prompt defibrillation. Despite the efforts made to install automated external defibrillators (AEDs) in crowded areas, their usage rate remains suboptimal. This study evaluated the efficiency of installing AEDs at key landmarks in Taoyuan City to enhance accessibility and usage. This retrospective cohort study analyzed nontraumatic public out-of-hospital cardiac arrest cases in Taoyuan City from 2017 to 2021, using data from the Taoyuan Fire Department and a regional registry. AED data were collected for 1163 devices. A geographic information system mapped target locations within the city, and real-world walking routes were examined to assess coverage. The primary outcome was actual coverage and the coverage efficiency ratio, calculated as the actual coverage divided by the number of facilities at a location. The coverage efficiency ratio compared the coverage efficiency of target locations with existing public access defibrillators (PADs). Top locations for superior coverage in both downtown and outside downtown areas were bus stops and convenience stores (7-Eleven and FamilyMart), which outperformed existing PADs. Convenience stores had a higher coverage efficiency ratio than the public service sector. Bus stops showed high AED usage rates before ambulance arrival. The current PAD locations in Taoyuan City offer limited coverage, which highlights the need for strategically installed AEDs, particularly in convenience stores. Policymakers should consider using the cultural relevance and accessibility of convenience stores, particularly 7-Eleven branches, to enhance AED usage rates.

Epidemiology, Process of Care, and Associated Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in China: Results From a Prospective, Multicenter, Population-Based Registry

Objectives: To comprehensively describe the incidence, process of care, outcomes, and variation among different age groups of pediatric out-of-hospital cardiac arrest (OHCA) in China. Design: The Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) is a prospective, multicenter, population-based registry of emergency medical services (EMS)-assessed OHCA in China. Setting: A total of 25 monitoring sites of all seven geographical regions were included, covering a pediatric population (age ≤ 19) of around 22.3 million in China. Patients: Pediatric patients enrolled in BASIC-OHCA from August 2019 to December 2020 were included. Interventions: None. Measurements and Main Results: A total of 1493 pediatric patients with EMS-assessed OHCA were enrolled, and resuscitation was attempted in 651 cases (43.6%). The crude incidence of EMS-assessed and EMS-treated OHCA was 5.5 (95% CI, 5.2–5.9) and 2.4 (95% CI, 2.2–2.6) per 100,000 pediatric population. Among 651 EMS-treated OHCA cases, 434 patients (66.7%) were male, and 353 (54.2%) had nonmedical causes (trauma, asphyxia, and drowning being the most common). There were 396 patients (60.8%) who collapsed at home, and the proportion of cases that occurred in public places such as streets and schools increased with age. There were 26 patients (4.0%) who had an initial shockable rhythm. For 626 non-EMS-witnessed patients, 152 patients (24.3%) received bystander cardiopulmonary resuscitation (CPR), 68 (10.9%) received dispatcher-assisted CPR, and 3 (0.5%) had automated external defibrillator applied. The survival to discharge or 30 days was 3.5% (23/651), and the favorable neurologic prognosis was 3.1% (20/651), with no differences among age groups. Conclusions: This study provides the first national exploration of pediatric OHCA in China. The high proportion of nonmedical causes underscores the importance of preventing accidents in children. Gaps in the chain of survival and patient outcomes provide a focus for improving the treatment of pediatric OHCA in China and other developing countries.

Emergency Action Planning in United States High Schools.

Rates of emergency action plan (EAP) implementation and compliance with EAP guidelines vary in United States secondary schools. There are limited data on emergency preparedness in schools without athletic trainers (ATs). Rural and high poverty schools have poor emergency preparedness for high school athletic events due to financial barriers and lack of ATs. Cross-sectional study. Level 5. A web-based questionnaire was emailed by each State High School Athletics Association to ATs, athletic directors, and coaches of recipient schools to assess emergency preparedness. A total of 686 responses were received (response rate ~3.5%). Schools with an AT on staff were more likely to have an EAP (P < 0.01). Schools with a higher enrollment were more likely to have an EAP (P < 0.01), an AT on staff (P < 0.01), require additional training for coaches (P < 0.01), and have an automated external defibrillator (AED) onsite for all events (P < 0.01). Urban (odds ratio [OR], 3.514; 95% CI [2.242, 5.507]; P < 0.01) and suburban (OR, 4.950; 95% CI [3.287, 7.454]; P < 0.01) districts were more likely than rural districts to have an AT on staff. High poverty districts were less likely to have an AED (OR, 0.660; 95% CI [0.452, 0.964]; P = 0.03) or EAP (OR, 0.511; 95% CI [0.306, 0.853]; P < 0.01) at athletic venues. Lower enrollment, high poverty, and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty, and suburban counterparts as these schools are generally less likely to have an AT on staff, AEDs, and EAPs and less likely to provide additional training to coaches and other staff. This study assesses athletic emergency preparedness-a critical component of ensuring athlete safety and recovery after injury.

Construction and psychometric validation in Spanish schoolchildren of a knowledge questionnaire on basic life support and Automated External Defibrillator (ConocES-BLS/AED) in Spain

The 60 % of cardiac arrests happen in the out-of-hospital setting. In 2023, the International Liaison Committee on Resuscitation issued a statement entitled “Children save lives”, recommending the teaching of basic life support to children from the age of 12. However, we have not identified validated instruments that assess the level of knowledge of schoolchildren about BLS and AED. Objective: Construction and psychometric validation of a questionnaire to assess knowledge on Basic Life Support (BLS) and Automated External Defibrillator (AED) in primary to secondary school children. Method: Cross-sectional descriptive study of validation of the questionnaire consisting of several phases: construction of the questionnaire on knowledge on BLS and AED (ConocES-BLS/AED), content validation, pilot test and psychometric validation. Results: The ConocES-SVB/AED questionnaire was constructed, content validation was carried out by 14 experts, the pilot test carried out on 105 students reported good reliability (0.84), and finally with the psychometric validation a questionnaire composed of 12 items was obtained and psychometrically validated using the Item Response Theory in a final sample of 182 participants. Adequate fit values and acceptable reliability (0.65) were obtained, demonstrating its usefulness to accurately measure the level of knowledge about SVB/AED maneuvers in schoolchildren. Conclusions: The created and validated questionnaire provides educators with a fundamental resource to identify areas of lack of knowledge, improve and design effective educational interventions for schoolchildren on SVB/AED maneuvers.

Social determinants of health and their associations with outcomes in pediatric out-of-hospital cardiac arrest: A national study of the NEMSIS database

BackgroundSocial determinants of health (SDOH) impact health disparities, though little is known about the effects of SDOH on pediatric out-of-hospital cardiac arrest (POHCA). MethodsThis cross-sectional study utilized the NEMSIS Database to obtain nationwide POHCA data from 2021 to 2023. Outcomes included performance of bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) usage, and obtainment of return of spontaneous circulation (ROSC). SDOH data was obtained from the US Census Bureau and included minority race/ethnicities status, poverty levels, and educational attainment of the community where POCHAs occurred. Multivariable logistic regression and Cochran-Armitage trend tests were used to assess associations between SDOH and POHCA outcomes. ResultsQuery of the NEMSIS Database yielded 27,137 POHCAs. The odds of CPR performance and obtainment of ROSC were significantly higher (p < 0.001) in communities with lower levels of minority races/ethnicities. The odds of bystander CPR, AED usage, and obtainment of ROSC all increased significantly (p < 0.001) in the wealthiest communities compared to the poorest communities. The odds of bystander AED usage (p = 0.001) and ROSC (p = 0.003) were significantly higher in communities with the highest educational attainment. As the minority status and poverty level of the community increased and educational attainment decreased, there was a significant decreasing trend (p < 0.001) in performance of bystander CPR, AED usage, and obtainment of ROSC. ConclusionsCommunity-level SDOH, including increasing community minority status, poverty levels, and decreasing educational attainment, are associated with less bystander CPR, AED usage, and ROSC obtainment in POHCAs. Understanding SDOH offers opportunities for public health interventions addressing disparities in POHCA outcomes.

Potential Development in Knowledge, Chest Compression Skill, Automated External Defibrillator Skill and Basic Life Support for Thai Village Health Volunteer

Background and objectives: Currently, emergencies from complications, congenital disease, or physical pathology, such as out-of-hospital cardiac arrest (OHCA), are important causes of death and hospital admission, and sudden cardiac arrest occurs until the heart stops working immediately. This study aims to To examine the results of repeated measurements with Qualitative Confirmation of results, knowledge, understanding, chest compression skills, use of AEDs, and basic life support for village health volunteers (VHV). Methods: This mixed-method. Phase 1 quasi-experimental research. The sample group consisted of 30 Village Health Volunteers (VHV) selected using a simple random sampling method. The tool used in this research was the basic life support program that seduces a group process. Knowledge assessment form and basic life support skills. Data collection was performed by repeated measurement six times; Phase 2, qualitative research by discussing Basic life support program of Village Health Volunteers (VHV) that participated in the quantitative research program. After the 6th follow-up repeat measurement for one month, the sample was selected randomly from 10 participants in the program in phase 1. Quantitative data were analyzed using descriptive statistics, one-way analysis ANOVA with repeated measures, and statistical data. Qualitative data were analyzed using content analysis. Results: The findings of the quantitative study showed that Village Health Volunteer (VHV) had knowledge scores on patient assessment and environment, chest compression, use of AED, and basic life support. From each measurement, there was a better direction statistically significant at the qualitative level of 0.01. Conclusion: Basic life support program using group processes can develop potential and increase confidence in knowledge and understanding, skills in patient assessment and environment, chest compression, use of AED, and basic life support. Therefore, knowledge, understanding, and basic life support skills should be regularly and continuously reviewed to ensure resuscitation efficiency. Word count: 5,578 words, excluding references. Funding Statement: The study was supported by a grant from Non Sung Hospital, Nakhon Ratchasima Province, Thailand. Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Author Contributions: AV and PC contributed to the design and implementation of the research, JK and KV to the analysis of the results, and TB and TP to the writing of the manuscript.

Public Awareness of Automated External Defibrillator Locations

Public Awareness of Automated External Defibrillator Locations

Strengthening Community Service Collaboration Through Basic Life Support (BLS) Training

The community service project aims to enhance public knowledge and skills in providing immediate assistance during cardiac emergencies. Conducted in collaboration with the Indonesian Emergency and Disaster Nurses Association (HIPGABI) North Sumatra and the Regional Crisis Center Team North Sumatra, this program focuses on training participants in the fundamental techniques of Basic Life Support (BLS), including cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs). The training is specifically designed for the congregation of HKBP Resort Kwala Bekala Church. The involvement of HIPGABI North Sumatra and the Regional Crisis Center Team North Sumatra brings expertise and professionalism, ensuring that the training adheres to national standards and best practices in emergency response. The outcomes of this training are expected to strengthen community resilience and preparedness in dealing with health emergencies in Medan and the surrounding areas.

The association of time to key prehospital interventions recorded by EMT-worn video devices and sustained return of spontaneous circulation in out-of-hospital cardiac arrests

ABSTRACT OBJECTIVES The quality of prehospital resuscitation provided by emergency medical technicians (EMTs) is essential to ensure better outcomes following out-of-hospital cardiac arrests (OHCA). We assessed the quality of prehospital resuscitation by recording time to key prehospital interventions using EMT-worn video devices and investigated its association with outcomes of patients with OHCA. METHODS This retrospective, cross-sectional study included cases of non-traumatic OHCA in adults treated by EMS in Hsinchu City, Taiwan, during 2022 and 2023. We used data from high-resolution, chest-mounted wearable cameras to define and measure six Quality Indices (QIs) for prehospital resuscitation interventions (i.e., time spent recognizing OHCA). To evaluate the association between QI performance and sustained return of spontaneous circulation (ROSC), we used multivariable logistic regression. RESULTS Of 745 patients eligible for this study, 187 (25.1%) achieved sustained ROSC. Six core QIs were analyzed: recognition of OHCA (median time: 9.0 seconds), time from recognizing OHCA to initiating cardiopulmonary resuscitation (CPR; 9.0 seconds), automated external defibrillator setup (34.0 seconds), time from recognizing OHCA to beginning ventilation (160.0 seconds), advanced airway management (300 seconds), and deploying a mechanical CPR device (50 seconds). The performance of the six QIs were not associated with sustained ROSC (Adjusted odds ratio [95% confidence interval]: 1.00 [0.99-1.00], 0.99 [0.98-1.00], 1.00 [1.00-1.01], 1.00 [1.00-1.00], 1.00 [1.00-1.00] and 0.99 [0.99-1.00], respectively). CONCLUSIONS This study describes the rate of sustained ROSC and time to key interventions captured by EMT-worn video devices in non-traumatic OHCA patients. Although we found no direct link between QI performance and improved OHCA outcomes, this study highlights the potential of video-assisted QIs to enhance the documentation and understanding of prehospital resuscitation processes. These findings suggest that further refinement and application of these QIs could support more effective resuscitation strategies and training programs.

Potential and Challenges in Airborne Automated External Defibrillator Delivery by Drones in a Mountainous Region

Delivering an automated external defibrillator (AED) to a patient suffering from out-of-hospital cardiac arrest (OHCA) as quickly as possible is a critical task. In this field, airborne drones may help to overcome long response times, especially in mountainous regions where topography and weather pose several challenges for rescuers. Drones are considered a fast option to shorten the time to the first AED shock. This study presents insights into the safety regulations, performance, reliability and public perception of this specific drone-based application. The findings are based on field tests that focused on the operational/logistical benefits and challenges of semi-autonomous drone-based AED delivery to simulated emergency sites in mountainous terrain. The generated results underline the operational and technical feasibility of the proposed system given successful AED delivery in all simulation scenarios. Several challenges remain, such as improvements in terms of the AED pick-up, mobile phone connectivity, tracking of GPS coordinates and weather resistance of the used drone are required. Overall, the study supports paving the way for future trials and real-world implementations of drones into existing emergency response systems.

Drone-delivered automated external defibrillators for out-of-hospital cardiac arrest: A simulation-based feasibility study

Background Cardiopulmonary resuscitation (CPR) and defibrillation markedly increases survival following out-of-hospital cardiac arrest (OHCA). Members of the public can perform both before the ambulance service arrives. However, bystanders use a public-access Automated External Defibrillator (AED) in around 5% of cases. Using Unmanned Aerial Vehicles (‘drones’) to deliver AEDs may overcome many of the barriers preventing public-access AED use. The study team investigated how quickly and easily bystanders performing CPR could use drone-delivered AEDs. Methods The study team developed an AED-capable drone between May and November 2020 and conducted 18 OHCA simulations in July and September 2021. A single participant found a simulated patient inside a building and made a 999-call to a Welsh Ambulance Services NHS Trust call-handler. Once cardiac arrest was confirmed during the 999-call a nearby drone launched, reached hovering altitude and delivered the AED immediately outside the building. The participant retrieved the AED when instructed to do so, attached it to the patient and delivered a single shock. The primary outcome was hands-off CPR time. Secondary outcomes included ease of AED retrieval, by using a questionnaire adapted from the System Usability Scale and exploring participant behaviours via post-simulation interviews and reviews of audio and video recordings of the simulation. Results Hands-off CPR time was (median) 109 s (interquartile range 87–130 s). Participants spent 19 s (16–22 s) away from the patient's side when retrieving the AED. Participants found it easy to use the AED but often sought the call-handler's reassurance that it was appropriate to retrieve it. Conclusion Participants found it easy to retrieve and use an AED delivered by drone in simulated OHCAs. Hands-off CPR time was potentially clinically relevant in this lone bystander simulation, but there was only a small increase in hands-off time caused by retrieval of the drone-delivered AED.