Semi-automatic External Defibrillators Research Articles

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 < 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.

Implementation and use of a supraglottic airway device in the management of out-of-hospital cardiac arrest by firefighter first responders – A prospective feasibility study

AimWe wanted to assess the implementation and use of a supraglottic airway (SGA) for on-call firefighter first responders in out-of-hospital cardiac arrest. MethodsWe trained 502 firefighter first responders, located at 35 fire stations in the South-East of Norway, in the use of SGA during cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest. Training consisted of 45 minutes of theoretical and practical training in small groups.Primary outcome was successful ventilation with SGA assessed by both firefighter first responders and first paramedic arriving on-scene. Secondary outcomes included time expenditure and complications related to the procedure, evaluation of the training, and descriptive characteristics of the out-of-hospital cardiac arrest cases. ResultsAn SGA was used by firefighter first responders in 23 out-of-hospital cardiac arrests, and successful ventilation was achieved in 20 (87%) cases. Air-leak was described in the three unsuccessful cases. The median procedural time was 30 seconds (IQR = 15–40), with no observed procedural complications. Firefighter first responders arrived in median time 9 minutes (IQR = 6–10 min) before the ambulance. They performed chest compressions on all patients and 6 (26%) of the patients received shock with semi-automatic external defibrillator. After training, all participants were able to successfully ventilate a manikin with the SGA. The cost of the SGA equipment for all fire stations was 3955 GBP. ConclusionImplementation of an SGA for firefighter first responders in out-of-hospital cardiac arrest management seems feasible, safe and can be introduced with limited amount of training and limited use of resources.

A comparison of biphasic manual and semi-automatic external defibrillation

Background: Biphasic manual defibrillation (MD) is advocated as the preferred strategy for paramedics ahead of semi-automatic external defibrillation (SAED) for out-of-hospital cardiac arrest (OHCA). Methods: A systematic review involved searching CINAHL, MEDLINE and Embase academic databases. Comparative studies where both strategies were tested for time to first defibrillation (TTFD) and related Utstein-based model outcomes were examined to discern which strategy was superior. Results: Two studies met the criteria. One study found that in 4552 SAED episodes of defibrillation (30.8% of the 14 776 total defibrillation episodes), a decrease of >10% in mean TTFD (P<0.001) of an intial shockable rhythm was recorded. The same study reported an overall decrease in TTFD within 2 minutes (95% CI/P<0.001), with a 68% improved odds of receiving a shock within two minutes. SAED was associated with a 26% reduction in the risk-adjusted odds of survival (95% CI/P<0.009), attributed to cardiopulmonary resuscitation (CPR) delays. The other examined 160 defibrillations in OHCA. The MD median TTFD was 7 seconds faster (95% CI/P<0.0001) and responsible for 20% more inappropriate shocks. Conclusions: Modern SAED is superior in reducing TTFD and inappropriate shocks. The modern SAED and MD strategies can be enhanced by interruption-reducing technology. New SAED algorithms can detect shockable rhythms in 3 seconds. More randomised studies need to be conducted using up-to-date devices. A multifaceted approach incorporating technological advancements, ongoing research and training is necessary to ensure that the most effective defibrillation strategy is employed.

Methods of Signal Analysis for Automatic Diagnosis of Shockable Cardiac Arrhythmias: A Review

Ventricular fibrillation is considered the most common cause of sudden cardiac arrest. The fibrillation, and ventricular tachycardia often preceding it, are cardiac rhythms that may respond to emergency electroshock therapy and return to normal sinus rhythm when diagnosed early after cardiac arrest with the restoration of adequate cardiac pumping function. However, manually checking ECG signals on the existence of a pattern of such arrhythmias is a risky and time-consuming task in stressful situations and practically impossible in the absence of a qualified medical specialist. Therefore, systems of the computer classification of arrhythmias with the function of making a decision on the necessity of electric cardioversion with the parameters of a high-voltage pulse calculated adaptively for each patient are widely used for the automatic diagnosis of such conditions. This paper discusses methods of analyzing the electrocardiographic signal taken from the electrodes of an external automatic or semi-automatic defibrillator in order to make a decision on the necessity for defibrillation, which are applicable in the embedded software of automatic and semiautomatic external defibrillators. The paper includes an overview of applicable filtering techniques as well as subsequent algorithms for extracting, classifying and compressing features for the ECG signal.

Basic life support training for the adult lay population. A systematic review

Cardiopulmonary resuscitation (CPR) training is an influential method for improving the perception of resuscitation maneuvers, user willingness to carry it out, and also coordination of the people performing it. The main objective of the present systematic review is to evaluate the effects of basic CPR training program and Semi-Automatic External Defibrillation (AED) use on acquiring and retaining practical skills of lay adults. The included researches involved adult participants of 18 years old and over without previous CPR official training. In addition, the studies containing any training program, without a specified training method of CPR and AED use, were considered. A qualitative analysis was conducted to determine the most efficient B-CPR and AED use training program for lay adults regarding to acquisition and retention of practical skills. All randomized experimental trials followed a sequence of assigning participants to different categories. This corresponds to distinct interventions which in turn involved various CPR and AED training types or different durations of training between the groups. Overall, a specific training methodology has not been identified for approaching a clear demonstration with more effective and low-cost results. However, it seems that a training program based on simplified and short-term CPR combined with instructor-student feedback, videos, feedback devices, and simulations could cause reduction of the barriers for the lay population to help the OHCA patients and perform CPR.

Initial capnography values and resuscitation outcomes of patients assisted by basic life support units in first instance; descriptive prospective study

Introduction: Understanding the key factors which affect out hospital cardiac arrest (OHCA) outcomes is essential in order to promote patient treatment. The main objective of this research was to describe the correlations between the capnographic values obtained during the first minute of monitoring on cardiopulmonary resuscitation, assisted by basic life-support units, with the results as return of spontaneous circulation (ROSC) and alive hospital admission. The secondary objectives were to describe the sociodemographic characteristics of the patients assisted, and to analyze any correlations between receiving basic life-support units and/or defibrillation prior to the arrival of basic life-support units, and the results of the cardiopulmonary resuscitation maneuvers. Methods: A prospective, descriptive, observational study of adult non-traumatic out hospital cardiac arrest patients was conducted. The patients were initially assisted by basic life-support units on the island of Mallorca, with one minute of initial capnography monitoring. Results: From July 2018 to March 2020, fifty-nine patients meeting the inclusion criteria were assisted, 76% were men and their mean age was 64.45 (±15.07) years old. The number of emergency lifesaving technicians who participated in the study was 58, they had a mean work experience of 14.05 (±6.7) years. Thirty-seven (63.7%) patients underwent basic life-support by bystanders and in 91.5% of cases the semi-automatic external defibrillator was used. Capnometry values during the first minute were obtained in 34 (58.6%) patients, their mean values were 22 (±19.07) mmHg, 35.5% of patients had values <10 mmHg. In 25.4% of the patients, spontaneous circulation returned during cardiopulmonary resuscitation, and 18.6% were admitted to hospital alive. Conclusion: No correlations were found between initial capnography values scoring above or below 10 mmHg and survival, however, basic life-support maneuvers, and defibrillation by bystanders and first responders, did correlate with survival rates. The average patient assisted in out of hospital cardiac arrest by the basic life-support units sampled was an adult male aged over 65 years.

Epidemiology of Cardiac Events During Prehospital Care in Mountain Rescues Conducted in Aragón

Cardiac events are one of the leading causes of death in the Spanish population. Given the increase in the nontraumatic medical conditions found in mountain rescues, the objective of this study was to report on the heart conditions of patients rescued in the mountains of Aragón in the Spanish Pyrenees. We conducted a retrospective observational study based on data collected from patients' medical histories for rescues undertaken in from 2010 to 2016 (at altitudes between 500 m [1640 ft] and 3404 m [11,168 ft]). Of the 2079 individuals rescued from 2010 to 2016, 34 (2%) were diagnosed with heart conditions, accounting for 21% of all nontraumatic medical conditions. The data showed a statistically significant increase in the age of the rescued patients with heart conditions (55±15 y) and those with acute coronary syndrome/sudden death (60±8 y). Eighty-five percent of the rescued patients with heart conditions were men, 62% were rescued above 2000 m (6500 ft), 42% had acute coronary syndrome (of whom 56% had inferior infarction), and 35% died suddenly. Aragón mountain rescues show an increase in patient age in recent years. The most common medical case among rescued individuals with heart conditions was a hiker over the age of 50 y with cardiovascular risk factors, inferior infarction, and occurrence at an altitude above 2000 m. Based on our observations, appropriate training should be undertaken, especially by older hikers, who may also benefit from cardiac screening, and rescue vehicles/personnel and mountain huts should be equipped with semiautomatic external defibrillators.

Incidents occurring while using semi-automatic external defibrillators during an out-of-hospital cardiac arrest: An observational study

Incidents occurring while using semi-automatic external defibrillators during an out-of-hospital cardiac arrest: An observational study

Cost-effectiveness Study of the Introduction of a Semi-automatic External Defibrillation Program in Galicia (Spain)

Cost-effectiveness Study of the Introduction of a Semi-automatic External Defibrillation Program in Galicia (Spain)

Introduction of a semi-automatic external defibrillation program in galicia: A cost-effectiveness study

Purpose of the study: 63,000 myocardial infarctions occur annually in Spain, a third of them die before reaching the hospital. The semi-automatic external defibrillator (AED) device may sort this problem out if it is applied shortly after the collapse. Once the assistance results are analyzed, this study is intended to evaluate the cost-effectiveness relationship of the AED program, which has been carried out by the emergency service of Galicia (ES-061).

DESFIBRILADORES EXTERNOS SEMIAUTOMÁTICOS (DESA). EL PROFESIONAL DE ENFERMERÍA COMO INSTRUCTOR DE PERSONAL NO SANITARIO

The main cause of cardiac arrest in adults in out-of-hospital setting is Ventricular Fibrillation (VF). This chaotic heart rhythm represents 75-80 % of sudden cardiac deaths. The possibility of survival decreases by 10 % each minute of delay, therefore emergency action must take place almost immediately in this situation. An early defibrillation could save the life of a person with a VF, above all in the case of being witnessed. One of the most important goals in the Cardiopulmonary Resuscitation (CPR) is incorporating defibrillation into the Basic Life Support. Semiautomatic External Defibrillators (AED) are designed to be used by people without medical backgrounds. Decree 220/2007 of November 2 of the Council of the Government of Valencia regulates the use of AED by non medical personnel. Its objective is the regulation of the use of AED by non health care personnel within the region of Valencia. Nursing professionals must take part of the training team of the use of AED by non health care personnel.

Improving Survival After In-Hospital Cardiac Arrest: The Australian Experience

Survival rates after in-hospital cardiac arrest have not improved markedly despite improvements in technology and resuscitation training. To investigate clinical variables that influence return of spontaneous circulation and survival to discharge after in-hospital cardiac arrest. An Utstein-style resuscitation template was implemented in a 750-bed hospital. Data on 158 events were collected from January 2004 through November 2004. Significant variables were analyzed by using a multiple logistic regression model. Of the 158 events, 128 were confirmed cardiac arrests. Return of spontaneous circulation occurred in 69 cases (54%), and the patient survived to discharge in 41 (32%). An initial shockable rhythm was present in 42 cases (33%), with a return of spontaneous circulation in 32 (76%) and survival to discharge in 24 (57%). An initial nonshockable rhythm was present in the remaining 86 cases (67%), with a return of spontaneous circulation in 37 (43%) and survival to discharge in 17 (20%). Witnessed or monitored arrests (P=.006), time to arrival of the cardiac arrest team (P=.002), afternoon shift (P=.02), and initial shockable rhythm (P=.005) were independently associated with return of spontaneous circulation. Location of patient in a critical care area (P=.002), initial shockable rhythm (P<.001), and length of resuscitation (P=.02) were independently associated with survival to hospital discharge. The high rate of survival to discharge after cardiac arrest is attributed to extensive education and the incorporation of semiautomatic external defibrillators into basic life support management.

Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model

Rhythm analysis with current semi-automatic external defibrillators (AEDs) requires mandatory interruptions of chest compressions that may compromise the outcome after cardiopulmonary resuscitation (CPR). We hypothesised that interruptions would be shorter when the defibrillator was operated in manual mode by trained and certified ambulance personnel. Sixteen pairs of ambulance personnel operated the defibrillator (Lifepak((R))12) in both semi-automatic (AED) and manual (MED) mode in a randomised, cross-over manikin CPR study, following the ERC 2000 Guidelines. Median time from last chest compression to shock delivery (with interquartile range) was 17s (13, 18) versus 11s (6, 15) (mean difference (95% CI) 6s (2, 10), p=0.004). Similarly, median time from shock delivery to resumed chest compressions was 25s (22, 26) versus 8s (7, 12) (median difference 13s, p=0.001) in the AED and MED groups, respectively. While sensitivity for identifying ventricular fibrillation (VF) in both modes and specificity in the AED mode were 100%, specificity was 89% in manual mode. Thus, some unwarranted shocks resulting in hands-off time (time without chest compressions) were given in manual mode. However, mean hands-off-ratio (time without chest compressions divided by total resuscitation time) was still lower, 0.2s (0.1, 0.3) versus 0.3s (0.28, 0.32) in manual mode, mean difference 0.10s (0.05, 0.15), p=0.001. Paramedics performed CPR with less hands-off time before and after shocks on a manikin with manual compared to semi-automatic defibrillation following the 2000 Guidelines. However, 12% of the shocks given manually were inappropriate.

Cardiac arrest: Can the in-hospital chain of survival be improved?

Summary Survival from cardiac arrest decreases between 7 and 10% each minute defibrillation is delayed. Within the pre-hospital care environment, public access defibrillation programs and first-responders utilise semi-automatic external defibrillators to effectively increase survival following cardiac arrest from approximately 10% to approximately 60%. However, survival from an in-hospital cardiac arrest remains at approximately 10% despite the introduction of medical emergency teams. This discussion paper examines various methods to increase the in-hospital survival rate following a cardiac arrest, such as the implementation of first-responder semi-automatic external defibrillator programs and increasing education standards in basic and advanced cardiac life support.

Exploring the Volunteer First Aider's Experience Post-Resuscitation

Objectives This study aims to identify themes associated with St John volunteer first aiders’ post-resuscitation experience following an out-of-hospital sudden cardiac arrest, and to make suggestions for future practice in education and research. Methods This study was exploratory and descriptive in design, utilising a single focus group as a means of data collection. All five participants from a single resuscitation event participated in the focus group. The focus group was electronically recorded and transcribed verbatim. The results were then thematically analysed. Finding The focus group participants described four themes associated with successful resuscitation of a casualty following sudden cardiac arrest. These themes were: postresuscitation casualty management; interactions with health care professionals; critical incident stress management and learning about the casualty's outcome. Discussion Education of first aid service providers should include post-resuscitation casualty management, this could be achieved by including the chain of survival in its entirety rather than the DRABCD (danger, response, airway, breathing, circulation and defibrillation) resuscitation action plan only. Similarly, ambulance paramedics require an understanding of semi-automatic external defibrillators as used by first aid service providers. In particular, the limitations of semi-automatic external defibrillators should be included in education programs for ambulance paramedics and emergency department staff. Finally, first aid service providers should implement formal mechanisms to provide feedback to participants regarding casualty outcomes following a critical event.

Two Years of Experience in an Early Defibrillation Project

Early defibrillation projects have shown their efficacy increasing survival in cases of sudden death. In Fano in 2002 we established “Un Cuore che Rinasce – Città di Fano” (UCR) an early defibrillation project based on first-responder volunteers using semiautomatic external defibrillator (AED). 14 mobile positions were located in police, city police, carabinieri, Italian Red Cross volunteers' vehicles. 5 AED were placed in bathing establishments during summer and schools during winter 310 lay volunteers were trained in AED use. Territorial network of AED is activated by local Emergency Medical System (EMS). During the first 24 months AED was applied in 31 cases. The first cardiac rhythm analysis shows: 9 asystoles, 7 pulsless electrical activity (PEA), 11 ventricular fibrillation, 1 ventricular tachycardia, 3 others. 12 “shockable” rhythms were treated with AED. 6 successfully. 6 unsuccessfully. 6 patients were resuscitated using AED, 5 of them were admitted in hospital, 1 died in the ambulance. Of the 5 patients admitted: 3 were discharged from the hospital, 1 of them with severe neurological damage; 2 patients died in hospital.

A study comparing the usability of fully automatic versus semi-automatic defibrillation by untrained nursing students

Current international guidelines prefer the use of semi-automatic external defibrillators (SAEDs) over fully automatic external defibrillators (FAEDs). However, there is a lack of evidence supporting this recommendation. We conducted a study of usability with nursing students comparing the FAED version against the SAED version of the Lifepak CR Plus AED (Medtronic, Redmond, USA). We hypothesized that FAED use would limit the number of operator-device interactions, thereby increasing compliance by the rescuer, safety and speed. Sixty-two untrained first year nursing students were randomized to use the FAED or the SAED in a simulated cardiac arrest scenario. During analysis and delivery of three shocks, the AED guided the user with six voice prompts per shock (18 voice prompts per student). Their performance with regard to efficacy and safety was assessed using video recording. All rescuers except for two were able to attach electrodes and deliver a series of three shocks. During rhythm analysis by the device, FAED users made 30/372 (8%) errors against 62/360 (17%) errors for SAED users (P < 0.001). During shock delivery, FAED users made 0/186 errors against 12/180 (7%) for SAED users (P < 0.001). FAED use eliminated long time intervals between the first to the third shock (range 47-49s for FAED versus 41-90s for SAED). Despite a lack of BLS skills and AED training, the majority of students demonstrated safe and effective use of the AED. The use of the FAED version of the CR Plus resulted in increased compliance with the protocol and reduced variability in time to deliver three shocks. Further research is needed to confirm these findings in other groups of first responders.

CPR courses and semi-automatic defibrillators — life saving in cardiac arrest?

The aim was to assess the knowledge of life-supporting first-aid in both cardiac arrest survivors and relatives, and their willingness to have a semi-automatic external defibrillator in their homes and use it in an emergency. Cardiac arrest survivors, their families, friends, neighbours and co-workers were interviewed by medical students using prepared questionnaires. Their knowledge and self-assessment of life-supporting first-aid, their willingness to have a semi-automatic defibrillator in their homes and their willingness to use it in an emergency before and after a course in cardiopulmonary resuscitation (CPR) with a semi-automatic external defibrillator was evaluated. Courses were taught by medical students who had received special training in basic and advanced life support. Both patients and relatives, after a course of 2-3 h, were no longer afraid of making mistakes by providing life-supporting first-aid. The automated external defibrillator (AED) was generally accepted and considered easy to handle. We consider equipping high-risk patients and their families with AEDs as a viable method of increasing their survival in case of a recurring cardiac arrest. This, of course, should be corroborated by further studies.

Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation.

Early defibrillation is the most important intervention affecting survival from sudden cardiac arrest (SCA). To improve public access to early defibrillation, we established Piacenza Progetto Vita (PPV), the first system of out-of-hospital early defibrillation by first-responder volunteers. The system serves a population of 173 114 residents in the Piacenza region of Italy. Equipment for the system comprises 39 semiautomatic external biphasic defibrillators (AEDs): 12 placed in high-risk locations, 12 in lay-staffed ambulances, and 15 in police cars; 1285 lay volunteers trained in use of the AED, without traditional education in cardiac pulmonary resuscitation, responded to all cases of suspected SCA, in coordination with the Emergency Medical System (EMS). During the first 22 months, 354 SCA occurred (72+/-12 years, 73% witnessed). The PPV volunteers treated 143 SCA cases (40.4%), with an EMS call-to-arrival time of 4.8+/-1.2 minutes (versus 6.2+/-2.3 minutes for EMS, P=0.05). Overall survival rate to hospital discharge was tripled from 3.3% (7 of 211) for EMS intervention to 10.5% (15 of 143) for PPV intervention (P=0.006). The survival rate for witnessed SCA was tripled by PPV: 15.5% versus 4.3% in the EMS-treated group (P=0.002). A "shockable" rhythm was present in 23.8% (34 of 143) of the PPV patients versus 15.6% (33 of 211) of the EMS patients (P=0.055). The survival rate from shockable dysrhythmias was higher for PPV versus EMS: 44.1% (15 of 34) versus 21.2% (7 of 33), P=0.046. The neurologically intact survival rate was higher in PPV-treated versus EMS-treated patients: 8.4% (12 of 143) versus 2.4% (5 of 211), P=0.009. Broad dissemination of AEDs for use by nonmedical volunteers enabled early defibrillation and tripled the survival rate for out-of-hospital SCA.

PATIENT-DEPENDENT CURRENT DOSING FOR SEMI-AUTOMATIC EXTERNAL DEFIBRILLATORS (AED)

The improvements in semiconductors and modern circuitry allow new waveforms to be created for treating life-threatening heart fibrillation. A comparison of common waveforms shows that there is no definite optimal waveform. Especially in the case of early defibrillation by novices, the question of dosage should be re-discussed. While a physician may be able to dose the intensity of the therapeutic electric shock, one can't expect that from someone having no medical training. Common AEDs have predefined energy levels, that are delivered to a patient regardless of the patient's size and weight, etc. Current-based defibrillation provides a therapy matched to patient parameters, keeping the myocard stress as low as possible so that the heart has better chances of resuming a normal rhythm.