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Background: The use of public-access automated external defibrillators (AEDs) has become common in Japan. To provide a strategy for appropriate public-access AED deployment, we assessed public-access defibrillation (PAD) by laypersons and the outcomes following out-of-hospital cardiac arrest (OHCA) among adult patients by location of arrest.

Methods: From a nationwide, prospective, population-based registry of patients after OHCA in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin in public locations between 2013 and 2015. The primary outcome measure was one-month favorable neurological outcome defined by cerebral performance category 1 or 2. Factors associated with favorable neurological outcome after ventricular fibrillation (VF) were assessed by multivariable logistic regression analysis.

Results: A total of 20,970 adult bystander-witnessed OHCAs of medical origin occurred in public locations. Of those, the proportions of PAD by location were: 13.1% (757/5761) in public areas, 15.9% (333/2089) at workplaces, 26.0% (544/2095) in recreation/sports areas, 36.1% (112/310) in educational institutions, and 5.8% (241/4151) on streets/highways. In a multivariable analysis of VF arrests, both bystander cardiopulmonary resuscitation [adjusted odds ratio (AOR), 1.78; 95% confidence interval (CI), 1.54-2.07] and PAD (AOR, 2.33; 95% CI, 2.05-2.66), and emergency medical service (EMS) response time (AOR, 0.89; 95% CI, 0.87-0.90) were associated with improved outcomes. Earlier PAD initiated by bystanders before EMS arrival was also associated with better outcomes after OHCA.

Conclusions: In Japan, where public-access AEDs are well-disseminated, the PAD program worked effectively for adult OHCA of medical origin occurring in public locations. Notably, the proportions of PAD differed substantially according to specific public locations.

Background: Although one-half of all public out-of-hospital cardiac arrests (OHCAs) occur outside private homes in residential neighborhoods, their characteristics and outcomes remain unexplored.

Objectives: The authors assessed interventions before ambulance arrival and survival for public OHCA patients in residential neighborhoods.

Methods: Public OHCAs from Vienna (2018-2021) and Copenhagen (2016-2020) were designated residential neighborhoods or nonresidential areas. Interventions (cardiopulmonary resuscitation [CPR], automated external defibrillator [AED] attached, and defibrillation) and 30-day survival were compared using a generalized estimation equation model adjusted for age and time of day and presented as ORs.

Results: We included 1,052 and 654 public OHCAs from Vienna and Copenhagen, respectively, and 68% and 55% occurred in residential neighborhoods, respectively. The likelihood of CPR, defibrillation, and survival in residential neighborhoods vs nonresidential areas (reference) were as follows: CPR Vienna, 73% vs 78%, OR: 0.78 (95% CI: 0.57-1.06), CPR Copenhagen, 83% vs 90%, OR: 0.54 (95% CI: 0.34-0.88), and CPR combined, 76% vs 84%, OR: 0.70 (95% CI: 0.53-0.90); AED attached Vienna, 36% vs 44%, OR: 0.69 (95% CI: 0.53-0.90), AED attached Copenhagen, 21% vs 43%, OR: 0.33 (95% CI: 0.24-0.48), and AED attached combined, 31% vs 44%, OR: 0.53 (95% CI: 0.42-0.65); defibrillation Vienna, 14% vs 20%, OR: 0.61 (95% CI: 0.43-0.87), defibrillation Copenhagen, 16% vs 36%, OR: 0.35 (95% CI: 0.24-0.51), and defibrillation combined, 15% vs 27%, OR: 0.46 (95% CI: 0.36-0.61); and 30-day survival rate Vienna, 21% vs 26%, OR: 0.84 (95% CI: 0.58-1.20), 30-day survival rate Copenhagen, 33% vs 44%, OR: 0.65 (95% CI: 0.47-0.90), and 30-day survival rate combined, 25% vs 36%, OR: 0.73 (95% CI: 0.58-0.93).

Conclusions: Two-thirds of public OHCAs occurred in residential neighborhoods with fewer resuscitative efforts before ambulance arrival and lower survival than in nonresidential areas. Targeted efforts to improve early CPR and defibrillation for public OHCA patients in residential neighborhoods are needed.

There are 350,000 out-of-hospital cardiac arrest (OHCA) cases annually in the United States of America. Using automated external defibrillators (AEDs) has increased survival in cardiac arrests (CA) with an initial shockable rhythm. Thus, guidelines recommend complete geographical coverage with AEDs. To fill in the gaps in Minnesota, the Center for Resuscitation Medicine at the University of Minnesota raised an $18.8 million grant from the Helmsley Charitable Trust to supply law enforcement first responders with AEDs and, thus, increase survival rates after OHCA by reducing the time to first shock. This report elaborates on the decision-making, fundraising, and logistic strategy required to reach statewide AED coverage.

Methods: The baseline need for AEDs was analyzed using a questionnaire sent out to state law enforcement agencies, state patrols, city and county agencies, and tribal agencies in 2021. Furthermore, OHCA cases of 2021 were reviewed. The combination of this information led to an action plan to equip and train all agencies throughout the state’s eight regions with AEDs.

Results: The electronic survey was initially sent out to 358 agencies. The initial response rate was 77% (n = 276). This resulted in a total need of 8300 AEDs to be deployed over three years (2022-2025). As of 2023, over 4769 AEDs have been distributed, covering 237 sites.

Conclusion: By equipping first responders with AED systems, the Center for Resuscitation Medicine aims to shorten the gap in statewide AED coverage, thus increasing the chances of survival after OHCA.

Background: Volunteer responder (VR) programs for activation of laypersons in out-of-hospital cardiac arrest (OHCA) have been deployed worldwide, but the optimal number of VRs to dispatch is unknown.

Objectives: The purpose of this study was to investigate the association between the number of VRs arriving before Emergency Medical Services (EMS) and the proportion of bystander cardiopulmonary resuscitation (CPR) and defibrillation.

Methods: We included OHCAs not witnessed by EMS with VR activation from the Capital Region (September 2, 2017, to May 14, 2019) and the Central Region of Denmark (November 5, 2018, to December 31, 2019). We created 4 groups according to the number of VRs arriving before EMS: 0, 1, 2, and 3 or more. Using a logistic regression model adjusted for EMS response time, we examined associations between the number of VRs arriving before EMS and bystander CPR and defibrillation.

Results: We included 906 OHCAs. The adjusted ORs for bystander CPR were 2.40 (95% CI: 1.42-4.05), 3.18 (95% CI: 1.39-7.26), and 2.70 (95% CI: 1.32-5.52) when 1, 2, or 3 or more VRs arrived before EMS (reference), respectively. The adjusted OR for bystander defibrillation increased when 1 (1.97 [95% CI: 1.12-3.52]), 2 (2.88 [95% CI: 1.48-5.58]), or 3 or more (3.85 [95% CI: 2.11-7.01]) VRs arrived before EMS (reference). The adjusted OR of bystander defibrillation increased to 1.95 (95% CI: 1.18-3.22) when ≥3 VRs arrived first compared with 1 VR arriving first (reference).

Conclusions: We found an association of increased bystander CPR and defibrillation when 1 or more VRs arrived before the EMS with a trend toward increased bystander defibrillation with increasing number of VRs arriving first.

Out-of-hospital sudden cardiac arrest (OHCA) is a major public health issue, with a survival rate at hospital discharge that remains below 10% in most cities, despite huge investments in this domain. Early basic life support (BLS) and early defibrillation using automated external defibrillators (AEDs) stand as key elements for improving OHCA survival rate. Nevertheless, the use of AEDs in OHCA remains low, for a variety of reasons, including the number, accessibility and ease of locating AEDs, as well as bystanders’ awareness of BLS maneuvers and of the need to use AEDs. Several measures have been proposed to improve the rate of AED use, including optimization of AED deployment strategies as well as the use of drones to bring the AEDs to the OHCA scene and of mobile applications to locate the nearest AED. If they are to be effective, these measures should be combined with large communication campaigns on OHCA, and wide-scale education of the public in BLS and AEDs, to reduce the burden of OHCA.

Full article;

Automated external defibrillator use in out-of-hospital cardiac arrest: Current limitations and solutions – PubMed

Maternal health includes health during pregnancy and childbirth. Each stage during pregnancy should be a positive experience, ensuring that women and their babies reach their full potential in health and well-being. However, this cannot always be achieved. According to UNFPA (United Nations Population Fund), approximately 800 women die every day from avoidable causes related to pregnancy and childbirth, so it is important to monitor mother and fetal health throughout the pregnancy. Many wearable sensors and devices have been developed to monitor both fetal and the mother’s health and physical activities and reduce risk during pregnancy. Some wearables monitor fetal ECG or heart rate and movement, while others focus on the mother’s health and physical activities. This study presents a systematic review of these analyses. Twelve scientific articles were reviewed to address three research questions oriented to (1) sensors and method of data acquisition; (2) processing methods of the acquired data; and (3) detection of the activities or movements of the fetus or the mother. Based on these findings, we discuss how sensors can help effectively monitor maternal and fetal health during pregnancy. We have observed that most of the wearable sensors were used in a controlled environment. These sensors need more testing in free-living conditions and to be employed for continuous monitoring before being recommended for mass implementation.

«Analysis of survival at cardiac arrest in events occurred in work environments in the territory served by an operations center of the 118 of Tuscany».

Background:: The global incidence of cardiac arrest is nearly one person in 1,000 per year, a rate which also applies to Italy; a great deal of these events is likely to strike people outside their homes. Objectives: To analyze a cohort of cardiac arrest events occurred in various public spaces and workplaces across an area under the responsibility of an Emergency Unit related to the national emergency number (118) and to assess the efficacy of first-aid intervention and the usage of a defibrillator while handling an acute cardiac event.

Methods:: We analyzed data of 32 sanitary interventions on cardiac arrest events occurred from January 2015 to June 2018 across USL Toscana Centro – Pistoia and Empoli’s jurisdiction. The survival rate to hospital admission has been analysed according to the following parameters: the availability of an AED at the place, the CPR maneuvers performed or not by personnel present at the site and the time of intervention of the sanitary rescuers.

Results:: Twenty-eight point two % of acute cardiac event occurred in a workplace setting, 18.7% during work activity. An AED was present for immediate cardiac arrest treatment in 15.6% of cases with a survival rate of 100% (n=5/5) (p=0.04); in 84.4% of cases the AED was available only after the arrival of national emergency rescuers and the survival rate was 40.74% (n=11/27). The survival rate appears to be higher (55.5% Vs 42.8%) when cardiopulmonary resuscitation was started by witnesses at the event.

Conclusions:: The results of this study suggest that early defibrillation provided by work-related First Aid Emergency Procedure may be a primary aid and a desirable standard to improve both workers’ and private citizens’ survival rate after cardiac arrest.

Cardiovascular diseases and cardiac arrest (CA) are the main causes of death worldwide. This review aims to identify publications on the learning outcomes for the use of an automated external defibrillator (AED) and/or cardiopulmonary resuscitation (CPR) to train laypeople (LP), the method of training used, the year of publication and their recommendations. We employed Miller’s assessment pyramid to describe learning outcomes as knowledge, skills, and confidence. The methods of training are face-to-face, online, and mixed. The evidence found in this study will be used to support the development and validation of a simulation-based training program to teach LP to operate AEDs delivered by drones in rural and remote (R&R) locations. This article is an integrative literature review with a quantitative and qualitative research design and is composed of seven steps: research question, inclusion and exclusion criteria, search and selection of studies, the role of a second reviewer of the findings, data analysis, interpretation and discussion of the results, and finally knowledge synthesis. The results of this review demonstrate that there are no significant differences in the learning outcomes of the different training methods. Since these findings suggest good results in all methods, the development of a training program based on face-to-face, online, and mixed, especially for places with few resources such as R&R places, indicates all methods can be used as good practices to develop training programs.

Sudden cardiac arrest (SCA) is the leading cause of exercise-related fatalities in athletes. A comprehensive emergency action plan (EAP) is critical to facilitate a rapid and effective response to a cardiac emergency. SCA should be suspected in any athlete that collapses suddenly and is unresponsive. All potential responders to a collapsed athlete should be trained in the recognition of SCA, cardiopulmonary resuscitation, and use of an automated external defibrillator (AED). AEDs should be accessible on-site at sporting venues with a target collapse to first shock interval of less than 3 min. Every school, club, and sporting organization that sponsors athletic activities should have a written EAP for SCA. An EAP coordinator should be designated to foster compliance with training, practice, and rehearsal of the EAP at least once annually. Some sports require special considerations for equipment removal or access to emergency services in geographically broad or water-based venues.