External Defibrillators Research Articles

Multi-phase implementation of automated external defibrillator use by nurses during in-hospital cardiac arrest and its impact on survival

ObjectiveWe sought to evaluate the impact of a medical directive allowing nurses to use defibrillators in automated external defibrillator-mode (AED) on in-hospital cardiac arrest (IHCA) outcomes. MethodsWe completed a health record review of consecutive IHCA for which resuscitation was attempted using a pragmatic multi-phase before-after cohort design. We report Utstein outcomes before (Jan.2012–Aug.2013;Control) the implementation of the AED medical directive following usual practice (Sept.2013–Aug.2016;Phase 1), and following the addition of a theory-based educational video (Sept.2016–Dec.2017;Phase 2). ResultsThere were 753 IHCA with the following characteristics (Before n = 195; Phase 1n = 372; Phase 2n = 186): mean age 66, 60.0% male, 79.3% witnessed, 29.1% noncardiac-monitored medical ward, 23.9% cardiac cause, and initial ventricular fibrillation/tachycardia (VF/VT) 27.2%. Comparing the Before, Phase 1 and 2: an AED was used 0 time (0.0%), 21 times (5.7%), 15 times (8.1%); mean times to 1st analysis were 7 min, 3 min and 1 min (p < 0.0001); mean times to 1st shock were 12 min, 10 min and 8 min (p = 0.32); return of spontaneous circulation (ROSC) was 63.6%, 59.4% and 58.1% (p = 0.77); survival was 24.6%, 21.0% and 25.8% (p = 0.37). Among IHCA in VF/VT (n = 165), time to 1st analysis and 1st shock decreased by 5 min (p = 0.01) and 6 min (p = 0.23), and ROSC and survival increased by 3.0% (p = 0.80) and 15.6% (p = 0.31). There was no survival benefit overall (1.2%; p = 0.37) or within noncardiac-monitored areas (-7.2%; p = 0.24). ConclusionsThe implementation of a medical directive allowing for AED use by nurses successfully improved key outcomes for IHCA victims, particularly following the theory-based education video and among the VF/VT group.

Cardiopulmonary Resuscitation Education in United States Schools: Shortcomings and Future Directions.

Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that is performed during a cardiac arrest. CPR consists of chest compressions, rescue breaths, and the usage of an automated external defibrillator (AED) based on availability. Performance of CPR can greatly increase the chances of survival by enabling the manual perfusion of vital organs in lieu of the heart's normal function. Despite extensive studies demonstrating the efficacy and necessity of CPR in an emergency, most of the public across the United States is ill-equipped and/or educated on how to perform it. While there may be other contributing factors, the lack of CPR education across schools in the United States almost certainly furthers the CPR illiteracy of the general population. Although states require some degree of CPR training, the level of education that students receive varies widely across communities and school districts, largely dictated by the available funding for training courses. Despite the lack of CPR education in the United States, studies conducted abroad have shown the efficacy of a CPR course in preparing students to respond in emergencies-lending hope to mending the current situation in the United States. In this article, we analyze legislation dictating CPR instruction and hypothesize ways in which states' Department of Education might be able to promote education and hands-on experience for students across all ages of schooling. Ultimately, we hope to highlight the importance and feasibility of preparing the next generation of citizens across the United States to respond when their name is called upon in an emergency.

Automatic external defibrillator: The pros and cons of using this technology for cardiac resuscitation after arrhythmias

Automatic external defibrillator: The pros and cons of using this technology for cardiac resuscitation after arrhythmias

Online platform for cardiopulmonary resuscitation and automated external defibrillator training in a rural area: a community clinical trial protocol

IntroductionSudden death resulting from cardiorespiratory arrest carries a high mortality rate and frequently occurs out of hospital. Immediate initiation of cardiopulmonary resuscitation (CPR) by witnesses, combined with automated external defibrillator...

Sudden Death In Sports: Modern Concepts.

Regular physical activity provides significant health benefits and reduces the risk of premature death from any cause, including cardiovascular diseases (CVD). However, physical activity may provoke sudden cardiac death (SCD), especially in presence of unrecognized diseases. It is essential to identify risk factors that contribute to SCD in athletes and to implement effective prevention of such episodes. For this purpose, SCD registries are being created, medical terminology is being unified, and schedules of medical examination are being developed. The best strategy to combat SCD during sport activities is a combination of primary prevention by screening examination to identify athletes with CVD at risk and a proper planning of first aid measures during sports events, including the availability of an automatic external defibrillator on site.

Early intranasal medication administration in out-of-hospital cardiac arrest: Two randomized simulation trials.

Intranasal medications have been proposed as adjuncts to out-of-hospital cardiac arrest (OHCA) care. We sought to quantify the effects of intranasal medication administration (INMA) in OHCA workflows. We conducted separate randomized OHCA simulation trials with lay rescuers (LRs) and first responders (FRs). Participants were randomized to groups performing hands-only cardiopulmonary resuscitation (CPR)/automated external defibrillator with or without INMA during the second analysis phase. Time to compression following the second shock (CPR2) was the primary outcome and compression quality (chest compression rate (CCR) and fraction (CCF)) was the secondary outcome. We fit linear regression models adjusted for CPR training in the LR group and service years in the FR group. Among LRs, INMA was associated with a significant increase in CPR2 (mean diff. 44.1s, 95% CI: 14.9, 73.3), which persisted after adjustment (p=0.005). We observed a significant decrease in CCR (INMA 95.1 compressions per min (cpm) vs control 104.2cpm, mean diff. -9.1cpm, 95% CI -16.6, -1.6) and CCF (INMA 62.4%vs control 69.8%, mean diff. -7.5%, 95% CI -12.0, -2.9). Among FRs, we found no significant CPR2 delays (mean diff. -2.1s, 95% CI -15.9, 11.7), which persisted after adjustment (p=0.704), or difference in quality (CCR INMA 115.5cpm vs control 120.8cpm, mean diff. -5.3cpm, 95% CI -12.6, 2.0; CCF INMA 79.6%vs control 81.2% mean diff. -1.6%, 95% CI -7.4, 4.3%). INMA in LR resuscitation was associated with diminished resuscitation performance. INMA by FR did not impede key times or quality.

Analysis of Out-of-Hospital First Aid for Recovery of Spontaneous Circulation after Cardiac Arrest in Korea.

The characteristics of an individual patient experiencing out-of-hospital cardiac arrest who recovered spontaneous circulation with the assistance of witnesses and paramedics were examined. The analysis of bystander cardiopulmonary resuscitation (CPR) and the professional first aid efforts of paramedics in the pre-hospital environment is pivotal to enhancing the survival rate of out-of-hospital cardiac arrest patients. The data used in this study were extracted from the Korea Centers for Disease Control and Prevention (KCDC) nationally recognized statistics, Acute Heart Failure big data survey. Out-of-hospital cardiac arrest (OHCA) customer data were collected from the Gangwon Fire Headquarters public information database as social management data. The data were analyzed using SPSS 24. The study's results emphasized the significance of offering basic CPR training to the public. This is evident from the fact that 90.5% of the first witnesses in the study performed CPR on OHCA patients, resulting in the recovery of spontaneous circulation (ROSC). The majority of patients with ROSC were male, with the highest age group being 41-50 years. Heart disease, hypertension, and diabetes were common medical conditions. The rate of witnessing cardiac arrest was high. Among the first witnesses, about 78.4% were of cardiac arrest incidents involving family members, co-workers, or acquaintances; 12.2% were on-duty medical healthcare personnel; and 9.5% were off-duty healthcare personnel. Cardiac arrest was treated in 83.8% of cases, with 90% of witnesses performing CPR. The percentage of witnesses that used an automated external defibrillator (AED) was 13.5%. In this study, the rates of ECG monitoring, CPR performance, and defibrillation performed by paramedics were high, but intravascular access and drug administration had a lower rate of performance. The time elapsed depended on the patient's physical fitness. The study found that paramedics had the highest CPC restoration rate in patients with cardiac arrest, followed by EMTs and nurses. Significant differences were observed in cerebral performance scores after care by these paramedics and nurses. To increase the performance of AEDs, more AEDs should be installed in public spaces so that the public can access them conveniently in cases of emergency. In addition, it is necessary to improve the quality of professional first aid physical activity services performed by first-class paramedics.

Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study.

Public access defibrillation (PAD) programs have been implemented globally over the past decade. Although PAD can substantially increase the survival of cardiac arrest, PAD use remains low. This study aimed to evaluate whether drawing upon the successful experiences of dispatcher-assisted cardiopulmonary resuscitation programs would increase the use of PAD in dispatcher-assisted PAD programs. This study using a before-and-after design was conducted in Taoyuan City using a local out-of-hospital cardiac arrest registry system and data of dispatcher performance derived from audio recordings. The primary outcomes were the rate of bystander PAD use, sustained return of spontaneous circulation, survival to discharge, and favorable neurological outcomes. The secondary outcomes were the performance of dispatchers in terms of PAD instruction and dispatcher-assisted cardiopulmonary resuscitation administration, the time interval indicators of dispatcher-assisted cardiopulmonary resuscitation. A total of 1159 patients were included and divided into 2 groups: the before-run-in group (502 patients) and the after-run-in group (657 patients). No significant difference was observed between the 2 groups in terms of baseline characteristics. The rate of PAD use in the after-run-in group significantly increased from 5.0% to8.7% (P=0.015). The rate of favorable neurological outcomes increased from 4.4% to 5.9%, which was not a statistically significant difference. Compared with the before-run-in group, the rate of successful automated external defibrillator acquisition was 13.5% in the after-run-in group (P<0.001). Implementing a dispatcher-assisted PAD protocol in a municipality setting significantly increased bystander PAD use without affecting dispatcher performance in out-of-hospital cardiac arrest recognition, cardiopulmonary resuscitation instruction, or dispatcher-assisted cardiopulmonary resuscitation time indicators.

Public knowledge and willingness in the use of public access defibrillation of Hubei Province in China: A cross-sectional study.

To understand the current status of public knowledge of automated external defibrillator (AED) and their willingness to use public AED in Hubei Province, along with the influencing factors. A self-designed questionnaire was used for convenience sampling of the public in Hubei Province. The questionnaire consists of three parts: basic information, AED knowledge questions, and willingness to use public AED and influencing factors. Data was collected between May 2022 and March 2023. A total of 1561 valid questionnaires were collected from 1602 distributed. In the study conducted in Hubei Province, it was found that 875 respondents (56.05%) had knowledge of automated external defibrillator, and they achieved an average score of 39.27 ± 29.17. The pass rate for the survey was 28.11%. Several factors were identified as significant influencing factors, including gender, age, education level, occupation related to medicine, residential location in the past three years, family members with cardiovascular disease, marital status, residential population density, whether there are family members over 65 years old, and participation in AED-related training (P < .05).Furthermore, 692 respondents (72.99%) expressed their willingness to cardiopulmonary resuscitation for someone experiencing cardiac arrest. On the other hand, 686 respondents (43.95%) had no knowledge of AED. Among those who were not willing to perform defibrillation, the highest percentages cited "fear of incorrect use" (129, 31.2%) and "fear of harming the patient" (121, 29.3%) as their reasons. The study also found statistically significant differences in the willingness to use public AED based on participation in training, education level, residential location, family members with cardiovascular disease, population density, and the presence of elderly family members aged 65 or over (P < .05). In conclusion, the study highlights the general lack of public knowledge regarding AED in Hubei Province. However, there is a strong willingness among respondents to provide help during cardiac arrest situations. To improve the chances of survival for cardiac arrest patients, it is crucial to strengthen public AED training programs.

Efectividad de la formación teórico-práctica en soporte vital básico a monitoras de comedores escolares desde Atención Primaria

Introduction: cardiovascular diseases constitute a public health problem worldwide and among them cardiorespiratory arrest (CPA) stands out. School canteens are spaces with potential risk of witnessing a PCR. Materials and methods: quasi-experimental analytical study of intervention. The participants received training through an interactive virtual platform and a face-to-face clinical simulation session on the Heimlich maneuver, basic cardiopulmonary resuscitation (CPR) and the use of the semiautomatic external defibrillator (SAED). A descriptive analysis of the study population and a comparative statistical analysis between the results obtained in a test before and after the virtual training were carried out. A variable was created by subtracting the score obtained before training from that obtained after it. Clinical simulation was analyzed by direct observation. Statistical significance was defined as p &lt; 0.05. Statistical analysis with SPSS version 19.0. The principles of the Declaration of Helsinki and the guidelines on good clinical practice were followed. Results: the entire sample was women with a median age of 48.50 years. The median mark of the pre-test was 6.7/10 and the post-test had a constant result of 10/10. The difference between the post-test and the pre-test had a median of 3.3 (p 0.01) and was found in the simulation that the learning was optimal. Conclusions: training in CPR is a strategy with a social impact, related to an improvement in the response to a case of CPA, reducing the morbidity and mortality that this implies.

Automated External Defibrillators Are Only Effective If Put to Use

Automated External Defibrillators Are Only Effective If Put to Use

Automated External Defibrillator Use After Out-of-Hospital Cardiac Arrest at Recreational Facilities

This cohort study examines bystander automated external defibrillator (AED) application and survival outcomes for out-of-hospital cardiac arrest at recreational facilities in US states with and without AED legislation.

Evaluation of Sudanese nurse’s competence in automated external defibrillator (AED) knowledge and performance: Aquasi-experimental hospital base study in Khartoum locality

BackgroundThe Automated External Defibrillator represents a cornerstone of life-saving interventions, essential for responding to cardiac emergencies both within hospital walls and in community settings. Nurses shoulder the responsibility of understanding the correct protocols for AED usage, as their proficiency can be pivotal in administering timely and effective interventions during instances of cardiac arrest, significantly increasing the chances of survival. PurposeThe aim of this study Assess of Sudanese nurses Competency in Automated External Defibrillator (AED) knowledge and performance: in Khartoum Sudan. MethodsA quasi-experimental study conducted in 2023 aimed to evaluate the competencies of 100 qualified nurses regarding their knowledge and performance related to Automated External Defibrillators (AEDs). Throughout the study, seminars and lectures were delivered to the nursing staff to enhance their understanding of AED usage. Nurse performance was measured by conducting an applied experiment involving a mannequin and an AED, and following the prescribed steps. Data collection was carried out using questionnaires and observation checklists, with subsequent analysis conducted using the statistical software SPSS. ResultThe study findings indicate a predominant representation of female participants, comprising 65 % of the total sample, with a significant portion falling within the 18 to 30 years age bracket. Among the participants, the majority, at 56 %, held a B.Sc. degree, followed by diplomas (25 %), master's degrees (5 %), and Ph.D. qualifications (2 %). Surprisingly, 57 % of participants had not undergone prior training in AED usage. The study's pre-test mean for knowledge stood at 16 %, increasing substantially to 84 % in the post-test phase, with a statistically significant P-value of 0.000, reflecting a marked improvement in knowledge. Similarly, the pre-test mean for performance was 19.1 %, rising to 80.1 % in the post-test phase, with a corresponding P-value of 0.000, indicating a significant enhancement in performance. These findings collectively suggest a positive shift towards improved knowledge and performance in AED usage among the participants. ConclusionStudy concludes improves nurses’ knowledge and performance in Automated External Defibrillator.

Prospective Study to Assess Knowledge about Basic Life Support in College Students and Evaluate the Effectiveness of Basic Life Support Training

Background and Aims: Out-of-hospital cardiac arrests represent critical situations wherein prompt basic life support (BLS) intervention can significantly impact survivability. This study aimed to assess the baseline knowledge of BLS among college students and evaluate the efficacy of a training intervention, gauging changes in confidence and performance scores. Methods: Following ethical approval, a pretraining BLS questionnaire was administered to participating students. Subsequently, American Heart Association-certified BLS training providers conducted hands-on training. Posttraining, participants completed confidence and their performance was evaluated by the training providers. Data analysis utilized a percentage-based methodology. Results: The findings from the questionnaire revealed that 87% of students had witnessed emergencies, with only 7.7% initiating help and 2.3% observing resuscitation efforts. Notably, a deficit in knowledge about automated external defibrillators was observed across all the participants. Approximately 49.5% expressed interest in training, while 41.7% declined periodic training. Concerningly, 53.7% cited fear of legal repercussions as a deterrent to aiding victims, and 30.09% attributed their nonintervention to a lack of BLS knowledge. Posttraining, 81.5% of students displayed average confidence, with 18.4% exhibiting poor confidence in providing roadside BLS assistance. Performance assessments revealed that 28.15% performed well, 52.90% performed at an average level, and 18.95% performed poorly during hands-on training with a mannequin. Conclusions: The study highlights a notable lack of awareness and understanding of BLS among college students, as evidenced by the pretraining questionnaire. The single training session employed in this study did not substantially enhance confidence or performance scores in providing BLS. The findings underscore the necessity for increased awareness and recurrent BLS training initiatives among the young population to bolster both confidence and practical proficiency in responding to emergency situations.

Evaluation of the willingness to perform cardiopulmonary resuscitation (CPR) with automated external defibrillator (AED) among Hong Kong Chinese using the theory of planned behaviour framework: an online cross-sectional survey

IntroductionBystander cardiopulmonary resuscitation (CPR) and defibrillation by an automated external defibrillator (AED) in out-of-hospital cardiac arrest (OHCA) events were low in Hong Kong (HK). This study evaluated the willingness and...

Enhancing global pediatric cardiac arrest outcomes through bystander cardiopulmonary resuscitation: A comprehensive systematic review

This systematic review investigates the impact of global bystander cardiopulmonary resuscitation (CPR) on outcomes in pediatric cardiac arrest cases. Through a meticulous examination of relevant worldwide studies retrieved from PubMed spanning 2018 to 2022, employing keywords such as “worldwide Bystander CPR (BCPR),” “worldwide out-of-hospital CPR,” and “pediatric CPR” with Boolean operators “OR” and “AND,” the study incorporates 10 selected articles out of the initially identified 13. Findings reveal that bystander-initiated CPR, predominantly chest-only CPR, is administered at rates ranging from 48% to 89% globally, with no significant gender-based disparity, but a lower likelihood observed among worldwide Black children. Return of spontaneous circulation (ROSC) is achieved in 20%–35% of cases and survival to hospital discharge in 5%–10% of instances. Factors associated with worldwide prehospital ROSC include epinephrine administration, bystander intervention before emergency medical services (EMS) arrival, older age, reduced time to EMS response, and worldwide automated external defibrillators. Notably, a shorter time to EMS arrival is the sole significant predictor of worldwide survival to hospital discharge. The study discerns no substantial distinction in achieving prehospital ROSC and favorable outcomes on a global scale. The conclusion underscores the varied worldwide outcomes in out-of-hospital cardiac arrest studies, attributing these variations to multifarious confounding factors. It identifies crucial predictors of prehospital ROSC and recommends targeted CPR training for underserved communities to enhance worldwide BCPR rates and ameliorate pediatric cardiac arrest outcomes.

Left-digit bias in out-hospital cardiac arrest: The JCS-ReSS study.

The left-digit bias (LDB), a numerical-related cognitive bias, not only potentially influences decision-making among the general public but also that of medical practitioners. Few studies have investigated its role in out-of-hospital cardiac arrest (OHCA). We retrospectively included all consecutive patients with OHCA witnessed by family members registered in the All-Japan Utstein Registry of the Fire and Disaster Management Agency between January 1, 2005, and December 31, 2020. Target outcomes were the percentage of bystander cardiopulmonary resuscitation (BCPR) performed by family members or paramedics and the percentage of prehospital physician-staffed advanced cardiac life support (ACLS). Using a nonparametric regression discontinuity methodology, we examined whether a significant change occurred in the percentages of BCPR and ACLS at the age thresholds of 60, 70, 80, and 90 years, which would indicate the presence of LDB. Of the 1,930,273 OHCA cases in the All-Japan Utstein Registry, 384,200 (19.9%) cases witnessed by family members were analyzed. The mean age was 75.8 years (±SD 13.7), with 38.0% (n = 146,137) female. We identified no discontinuities in the percentages of chest compressions, mouth-to-mouth ventilation, or automated external defibrillator (AED) usage by family members for the age thresholds of 60, 70, 80, and 90 years. Moreover, no discontinuities existed in the percentages of chest compressions, advanced airway management, and AED usage by paramedics or prehospital ACLS by physicians for any of the age thresholds. In conclusion, our study did not find any evidence that age-related LDB affects medical decision-making in patients with OHCA.

Characteristics and outcomes of out-of-hospital cardiac arrest in a hilly area: Utstein Registry data from the Nagasaki Medical Region, Japan.

To analyze characteristics and investigate prognostic indicators of out-of-hospital cardiac arrest (OHCA) in a hilly area in Japan. A retrospective population-based study was conducted using the Utstein Registry for 4280 OHCA patients in the Nagasaki Medical Region (NMR) registered over the 10-year period from 2011 to 2020. The main outcome measure was a favorable cerebral performance category (CPC 1-2). Sites at which OHCA occurred were classified into "sloped places (SPs)" (not easily accessible by emergency medical services [EMS] personnel due to slopes) and "accessible places (APs)" (EMS personnel could park an ambulance close to the site). The characteristics and prognosis based on CPC were compared between SPs and APs, and multivariable analysis was performed. No significant improvement in prognosis occurred in the NMR from 2011 to 2020. Prognosis in SPs was significantly worse than that in APs. However, multivariable analysis did not identify SP as a prognostic indicator. The following factors were associated with survival and CPC 1-2: age group, witness status, first documented rhythm, bystander-initiated cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use, use of mechanical CPR (m-CPR) device or esophageal obturator airway (EOA), and year. Both m-CPR and EOA use were associated with a poor prognosis. In a hilly area, OHCA patients in SPs had a worse prognosis than those in APs, but SPs was not significantly associated with prognosis by multivariable analysis. Interventions to increase bystander-initiated CPR and AED use could potentially improve outcomes of OHCA in the NMR.

Emergency Scenario-Based Training Curriculum Development: Enhancement of Caregivers for the Elderly' Emergency Assistance Competency in a Rural Thai Community.

Caregivers for the elderly are a critical component of the health care system, especially in rural communities. They play a crucial role, assisting older people in confronting emergency illnesses. The study describes the process of developing an emergency scenario-based training curriculum (ESBTC) for caregivers of the elderly, focusing on geriatric life-threatening surveillance and emergency assistance (GLTSEA) in rural communities. The descriptive qualitative research utilized for developing the ESBTC followed Karn's six steps of curriculum development: (1) needs assessment, (2) targeted needs assessment, (3) goals and objectives, (4) educational strategies, (5) implementation, and (6) evaluation and feedback. The research sample comprised community representatives engaged in providing care during emergency illnesses, emergency experts, and health care providers. A group discussion and focus group were conducted along with semi-structured interviews. The data were analyzed by content analysis following Creswell's six steps. The results revealed problems and needs related to the care and management of emergency illnesses in rural communities. Five main themes emerged, including insufficient knowledge, difficulties in communication, mindfulness and self-confidence, Unable to assess the initial symptoms, and a need for skills development. In the development step, the curriculum focused on skill development and continued follow-up to ensure necessary skills, such as providing basic life support, using automated external defibrillators, through training scenarios. In the evaluation step, the participants indicated that their emergency assistance skills had improved. The six main themes that emerged regarding the training continuity, courses, and competencies needed to support the emergency system for caregivers were benefits and value, competence enhancements, upstreaming confidence, sustainable development, challenges in curriculum development, and effective strategies. The ESBTC combines community-based and realistic scenarios, involving the participation of community stakeholders. It is crucial to gather community feedback and needs assessments to formulate potential strategies as part of the curriculum.

A Location Analysis and Modeling Approach for Optimizing Public Access to an Automated External Defibrillator Network

A Location Analysis and Modeling Approach for Optimizing Public Access to an Automated External Defibrillator Network