Public Access Defibrillator Use Research Articles

Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023.

The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19-confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and χ2 were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1% cases) occurred at home. A witness was present in 45.9% (n=10,723) of the cases, and bystander CPR was initiated in 44.6% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health.

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.

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.

Sex- and Age-Based Disparities in Public Access Defibrillation, Bystander Cardiopulmonary Resuscitation, and Neurological Outcome in Cardiac Arrest

ImportanceYounger females with out-of-hospital cardiac arrest (OHCA) in public locations have less likelihood to receive public access defibrillation and bystander cardiopulmonary resuscitation (CPR). However, the association between age- and sex-based disparities and neurological outcomes remains underexamined.ObjectiveTo investigate the association between sex and age and the rate of receiving bystander CPR, automated external defibrillator defibrillation, and neurological outcomes in patients with OHCA.Design, Setting, and ParticipantsThis cohort study used the All-Japan Utstein Registry, a prospective, population-based, nationwide database in Japan containing data on 1 930 273 patients with OHCA between January 1, 2005, and December 31, 2020. The cohort comprised patients with OHCA of cardiac origin that was witnessed by citizens and treated by emergency medical service personnel. The data were analyzed from September 3, 2022, to May 5, 2023.ExposureSex and age.Main Outcomes and MeasuresThe primary outcome was favorable neurological outcome at 30 days after an OHCA. Favorable neurological outcome was defined as a Cerebral Performance Category score of 1 (indicating good cerebral performance) or 2 (indicating moderate cerebral disability). The secondary outcomes were the rates of receiving public access defibrillation and bystander CPR.ResultsThe 354 409 included patients who experienced bystander-witnessed OHCA of cardiac origin had a median (IQR) age of 78 (67-86) years and 136 520 were females (38.5%). The rate of receiving public access defibrillation was higher in males than females (3.2% vs 1.5%; P &amp;amp;lt; .001). Stratified by age, age- and sex-based disparities in prehospital lifesaving interventions by bystanders and in neurological outcomes were observed. Although younger females had a lower rate of receiving public access defibrillation and bystander CPR than males, younger females had a higher favorable neurological outcome compared with males of the same age (odds ratio [OR], 1.19; 95% CI, 1.08-1.31). In younger females with OHCA that was witnessed by nonfamily bystanders, receiving public access defibrillation (OR, 3.51; 95% CI, 2.34-5.27) or bystander CPR (OR, 1.62; 95% CI, 1.20-2.22) was associated with a favorable neurological outcome.Conclusions and RelevanceResults of this study suggest a pattern of significant sex- and age-based differences in bystander CPR, public access defibrillation, and neurological outcomes in Japan. Improvement in neurological outcomes in patients with OHCA, especially younger females, was associated with increased use of public access defibrillation and bystander CPR.

I don’t want to put myself in harm’s way trying to help somebody: Public knowledge and attitudes towards bystander CPR in North East England – findings from a qualitative interview study

BackgroundBystander cardiopulmonary resuscitation (BCPR), and public access defibrillator (PAD) use are essential links in the ‘Chain of Survival’ for out of hospital cardiac arrest (OHCA). In England, BCPR is delivered in only 40% of cases and population-level studies suggest this may be because of lower socio-economic status (SES). There is little qualitative evidence exploring BCPR and SES in Northern England. The aim of this study was to explore the perceptions and willingness of members of the public to deliver BCPR and use a PAD in communities of varying SES across Northern England. MethodsIn-depth interviews between September 2021–January 2022 with 20 participants. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. FindingsPerceptions and attitudes towards BCPR were underpinned by multiple, intersecting factors, contextualised by the individual’s unique societal position. A poor understanding of BCPR and very limited knowledge of PAD use was identified, precipitated by language and education marginalisation. Willingness and confidence to attempt BCPR was driven by a sense of social cohesion. Barriers to delivering BCPR initiatives centred upon difficulties with engagement in all communities, particularly closed communities and those not in employment. ConclusionsWillingness and ability to deliver BCPR lie beyond SES alone. Future initiatives to improve rates of BCPR should take an intersectional, place-based approach, and be co-developed in conjunction with local communities and delivered in a format that people find convenient. Further research is required to understand how targeted initiatives should be delivered and how these result in improved outcomes from OHCA.

Public access defibrillation: challenges and new solutions.

The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest. Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.

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

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

Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation.

Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Real-world insight into public access defibrillator use over five years.

BackgroundPublic access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period.MethodsData were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack.ResultsData were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events.ConclusionThis is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.

Comparing public access defibrillator use in the home and public locations. Identifying a need for home-based AED solutions

Comparing public access defibrillator use in the home and public locations. Identifying a need for home-based AED solutions

P1746The prognosis of out-of-cardiac arrest patients with refractory shockable rhythm who could not obtain return of spontaneous resuscitation by citizen use of public-access defibrillation

P1746The prognosis of out-of-cardiac arrest patients with refractory shockable rhythm who could not obtain return of spontaneous resuscitation by citizen use of public-access defibrillation

Saving lives with public access defibrillation: A deadly game of hide and seek

BackgroundEarly defibrillation is a critical link in the chain of survival. Public access defibrillation (PAD) programmes utilising automated external defibrillators (AEDs) aim to decrease the time-to-first-shock, and improve survival from out-of-hospital cardiac arrest. Effective use of PADs requires rapid location of the device, facilitated by adequate signage. We aimed to therefore assess the quality of signage for PADs in the community. MethodFrom April 2017 to January 2018 we surveyed community PADs available for public use on the ‘Save a Life’ AED locator mobile application in and around Southampton, UK. Location and signage characteristics were collected, and the distance from the furthest sign to the AED was measured. ResultsResearchers evaluated 201 separate PADs. All devices visited were included in the final analysis. No signage at all was present for 135 (67.2%) devices. Only 15/201 (7.5%) AEDs had signage at a distance from AED itself. In only 5 of these cases (2.5%) was signage mounted more than 5.0 m from the AED. When signage was present, 46 used 2008 ILCOR signage and 15 used 2006 Resuscitation Council (UK) signage. Signage visibility was partially or severely obstructed at 27/66 (40.9%) sites. None of the 45 GP surgeries surveyed used exterior signage or an exterior 24/7 access box. ConclusionsCurrent signage of PADs is poor and limits the device effectiveness by impeding public awareness and location of AEDs. Recommendations should promote visible signage within the operational radius of each AED.

Attitudes to CPR and public access defibrillation: A survey of the UK public

Purpose of the study: To determine the proportion of UK adults who have witnessed an out-of-hospital-cardiac-arrest (OHCA), been trained in cardiopulmonary resuscitation (CPR), compression only CPR (COCPR) or Public Access Defibrillator (PAD) use. To investigate the influence of training and demographic characteristics on likelihood of acting in the event of witnessing an OHCA. Materials and methods: Literature and collaborators’ expertise informed question development for an online omnibus survey, run by a market research and data company (YouGov). In April 2017, a representative sample of 2084 UK adults responded to the survey. Results: 19% reported witnessing one or more OHCAs; 58% reported having ever received CPR training and 22% defibrillator training, reducing to 37% and 15% respectively within the last 5 years. Of those ever trained, 53% reported receiving training at work and 15% whilst a pupil at school. If witnessing an OHCA, most people (93%) were likely to phone Emergency Medical Services (EMS); 58% to perform CPR, 56% to perform COCPR, 42% to retrieve a PAD and 35% to use a PAD. 43% knew where to find the nearest PAD to their home. If trained in PADuse, 74% said they would retrieve one compared to 33% of those untrained and 74% of those trained compared to 24% not trained would likely use one. For those trained in CPR, 76% were likely to perform CPR compared to 28% who were untrained. Conclusions: In England in 2014, PAD use in public places for non-EMS witnessed OHCAs was only 4.1% [1]. With only 42% of the UK population likely to retrieve a defibrillator, 15% trained in defibrillator use and 37% in CPR within the last 5 years, the potential to increase survival rates through continuing attempts to improve public awareness and resuscitation skills remains high, especially as almost 1 in 5 people have witnessed an OHCA.

A shocking picture: Automated external defibrillators are poorly signposted in the community

Background: Early defibrillation as part of basic life support is a critical link in the chain of survival. Public access defibrillation (PAD) programmes utilising automated external defibrillators (AEDs) decrease the time to first shock, with demonstrable mortality benefits for out-of-hospital cardiac arrest (OHCA). Effective use of PADs requires rapid location of the device, facilitated by adequate signage. We aimed to assess the proportion of registered PADs with external signage visible within a 300 m radius (considered by the Resuscitation Council (UK) as the useable range).

A profile of out-of-hospital cardiac arrests in Northern Emirates, United Arab Emirates

Objectives:To report the characteristics of out-of-hospital cardiac arrest patients and their outcomes in the emirates of Sharjah, Ras-al-Khaimah, Umm Al-Quwain, Fujairah, and Ajman in the United Arab Emirates (collectively known as the Northern Emirates).Methods:This is a prospective descriptive cohort study of out-of-hospital cardiac arrest incidents transported by the national ambulance crews between February 2014 and March 2015 in the Northern Emirates.Results:A total of 384 patients were enrolled in this study. Male victims of out-of-hospital cardiac arrest represented 76% of the participants. The mean age of the study population was 50.9 years. An over-all prehospital return of spontaneous circulation rate of 3.1% was documented, as well as a 30% rate of bystander cardiopulmonary resuscitation being performed. Public access defibrillators were applied in 0.5% of cases. Data is presented according to Utstein reporting criteria.Conclusion:Baseline data for out-of-hospital cardiac arrest was established for the first time in the Northern Emirates of the United Arab Emirates. A low survival rate for out-of-hospital cardiac arrest, low rates of bystander cardiopulmonary resuscitation, and low public access defibrillator use were discovered. Although low by comparison to established western systems results are similar to other systems in the region. Determining the baseline data presented in this study is essential in recommending and implementing strategies to reduce mortality from out-of-hospital cardiac arrest.

Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan

BackgroundEarly defibrillation plays a key role in improving survival in patients with out-of-hospital cardiac arrests due to ventricular fibrillation (ventricular-fibrillation cardiac arrests), and the use of publicly accessible automated external defibrillators (AEDs) can help to reduce the time to defibrillation for such patients. However, the effect of dissemination of public-access AEDs for ventricular-fibrillation cardiac arrest at the population level has not been extensively investigated.MethodsFrom a nationwide, prospective, population-based registry of patients with out-of-hospital cardiac arrest in Japan, we identified patients from 2005 through 2013 with bystander-witnessed ventricular-fibrillation arrests of presumed cardiac origin in whom resuscitation was attempted. The primary outcome measure was survival at 1 month with a favorable neurologic outcome (Cerebral Performance Category of 1 or 2, on a scale from 1 [good cerebral performance] to 5 [death or brain death]). The number of patients in whom survival with a favorable neurologic outcome was attributable to public-access defibrillation was estimated.ResultsOf 43,762 patients with bystander-witnessed ventricular-fibrillation arrests of cardiac origin, 4499 (10.3%) received public-access defibrillation. The percentage of patients receiving public-access defibrillation increased from 1.1% in 2005 to 16.5% in 2013 (P<0.001 for trend). The percentage of patients who were alive at 1 month with a favorable neurologic outcome was significantly higher with public-access defibrillation than without public-access defibrillation (38.5% vs. 18.2%; adjusted odds ratio after propensity-score matching, 1.99; 95% confidence interval, 1.80 to 2.19). The estimated number of survivors in whom survival with a favorable neurologic outcome was attributed to public-access defibrillation increased from 6 in 2005 to 201 in 2013 (P<0.001 for trend).ConclusionsIn Japan, increased use of public-access defibrillation by bystanders was associated with an increase in the number of survivors with a favorable neurologic outcome after out-of-hospital ventricular-fibrillation cardiac arrest.

Infrequent use of Public Access Defibrillation in spite of great benefit

Infrequent use of Public Access Defibrillation in spite of great benefit

Infrequent use of Public Access Defibrillation in spite of great benefit

Background Despite wide dissemination of Public Access Defibrillation (PAD) and attempts to raise public awareness, use of Out of Hospital Cardiac Arrest (OHCA) is still limited. We aimed to study the use of PAD in Copenhagen. We primarily sought to determine the proportion of OHCA victims with an Automated External Defibrillator (AED) deployed before arrival of the Emergency Medical Services (EMS). In addition, we compared characteristics of OHCA victims according to use of AED.

Public knowledge and confidence in the use of public access defibrillation

IntroductionGrowing numbers of public access defibrillators aim to improve the effectiveness of bystander cardiopulmonary resuscitation prior to ambulance arrival. In the UK, however, public access defibrillators are only deployed successfully...