Bystander defibrillation for out-of-hospital cardiac arrest in Ireland

Aims: To describe and explore predictors of bystander defibrillation in Ireland during the period 2012 to 2020. To examine the relationship between bystander defibrillation and health system developments.

Methods: National level Out of Hospital Cardiac Arrest (OHCA) registry data were interrogated, focusing on patients who had defibrillation performed. Bystander defibrillation (as compared to EMS initiated defibrillation) was the key outcome of concern. Logistic regression models were built and refined by fitting predictors, performing stepwise variable selection and by adding pairwise interactions that improved fit.

Results: The data included 5,751 cases of OHCA where defibrillation was performed. Increasing year over time (OR 1.17, 95% CI 1.13, 1.21) was associated with increased adjusted odds of bystander defibrillation. Non-cardiac aetiology was associated with reduced adjusted odds of bystander defibrillation (OR 0.30, 95% CI 0.21, 0.42), as were increasing age in years (OR 0.99, 95% CI 0.987, 0.996) and night-time occurrence of OHCA (OR 0.67, 95% CI 0.53, 0.83). Six further variables in the final model (sex, call response interval, incident location (home or other), who witnessed collapse (bystander or not witnessed), urban or rural location, and the COVID period) were involved in significant interactions. Bystander defibrillation was in general less likely in urban settings and at home locations. Whilst women were less likely to receive bystander defibrillation overall, in witnessed OHCAs, occurring outside the home, in urban areas and outside of the COVID-19 period women were more likely, to receive bystander defibrillation.

Conclusions: Defibrillation by bystanders has increased incrementally over time in Ireland. Interventions to address sex and age-based disparities, alongside interventions to increase bystander defibrillation at night, in urban settings and at home locations are required.

Link to article below;

Bystander defibrillation for out-of-hospital cardiac arrest in Ireland – ScienceDirect

Resuscitation with an AED: putting the data to use

The increased use of the automated external defibrillator (AED) contributes to the rising survival rate after sudden cardiac arrest in the Netherlands. When used, the AED records the unconscious person’s medical data (heart rhythm and information about cardiopulmonary resuscitation), which may be important for further diagnosis and treatment. In practice, ethical and legal questions arise about what can and should be done with these ‘AED data’. In this article, the authors advocate the development of national guidelines on the handling of AED data. These guidelines should serve two purposes: (1) to safeguard that data are handled carefully in accordance with data protection principles and the rules of medical confidentiality; and (2) to ensure nationwide availability of data for care of patients who survive resuscitation, as well as for quality monitoring of this care and for related scientific research. Given the medical ethical duties of beneficence and fairness, existing (sometimes lifesaving) information about AED use ought to be made available to clinicians and researchers on a structural basis. Creating a national AED data infrastructure, however, requires overcoming practical and organisational barriers. In addition, further legal study is warranted.

Full article below;

Resuscitation with an AED: putting the data to use – PubMed (nih.gov)

Resuscitation with an AED: putting the data to use | Netherlands Heart Journal (springer.com)

 

 

Public Access Defibrillators: Urgent Need to Keep them Alive

Added to chest compressions, automated and semi-automated defibrillators are virtually the only treatment capable of reducing cardiac arrest mortality.

Over the past decades, these devices have been widely deployed for public access as well as for healthcare and emergency professionals, both medical and non-medical. However, their accessibility remains limited in daily setting. Firstly, many defibrillators are not or are insufficiently geolocated, preventing Emergency Medical Services (EMS) from guiding a first responder to the nearest device. Secondly, many defibrillators are not accessible 24/7. Lastly, in most countries, there are no robust plans for their maintenance. To ensure efficiency, both the defibrillator itself and its batteries and electrodes need regular checking. The alert rate for actual or potential malfunctions is estimated at 1 per 100 defibrillator-years. These malfunctions compromise defibrillators effectiveness. Due to the increasing number of defibrillators, preventing such malfunctions becomes a true priority.

The results of an audit conducted by a private service provider (Matecir Defibril®) prior to the maintenance of defibrillators installed in French public areas (excluding those used by rescue teams and healthcare facilities). Defibrillators were inspected at their installation sites, and non-compliance criteria were recorded: improper storage (i.e., no temperature monitoring and/or regulation system to maintain a temperature between 0 and 40 °C to preserve the device and the electrodes which are particularly sensitive to extreme temperatures), expired or non-compliant electrodes or batteries.
Out of 6,021 defibrillators inspected between 2021 and 2023, 3,558 (59%) were found to be non-compliant. The main causes of non-compliance included expired electrodes and/or batteries (N = 1,949; 32%), improper storage (N = 479; 8%), safety recalls of electrodes (N = 472; 8%), safety recalls of AEDs (N = 228; 4%), non-compliant electrodes (N = 212; 4%), and expired backup batteries (N = 218; 4%). Overall, nearly two-thirds of the inspected defibrillators did not meet expected standards. Regardless of whether they would have been effective in use, this result is alarming. Currently, many defibrillators are not maintained at all.

Significant progress has been made to increase the accessibility of early defibrillation by multiplying the number of defibrillators (in France, the number of defibrillators has more than doubled in five years), by registering them in a national database (Géo’DAE), and by using various apps guiding citizen rescuers both, to the patient in cardiac arrest and to the nearest defibrillator.

Evidently, further progress can be made by continuing the deployment of defibrillators, improving the completeness of registers, and increasing the number of citizen rescuers. However, such investment is meaningful only if 100% of defibrillators are fully operational at anytime. Many of early deployed defibrillators are aging and have never been serviced. Numerous defibrillators are installed outdoors in non-temperature-regulated boxes, making the electrodes particularly vulnerable to extreme temperatures that can permanently damage the conducting gel that coats them. The challenge of deploying defibrillators is currently on its way to being met. Now, we are facing an equally important challenge: maintaining the fleet of defibrillators in a state of readiness.

Reference below;

Public Access Defibrillators: Urgent Need to Keep them Alive – PubMed (nih.gov)

Public access defibrillators: Urgent need to keep them alive – Resuscitation (resuscitationjournal.com)

The automated external defibrillator, an underused simple life-saving device: a review of the literature. A joint document from the Italian Resuscitation Council (IRC) and Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC)

 

Abstract: The role of early defibrillation has been well established as a pivotal ring of the chain of survival since the nineties. In the following years, the scientific evidences about the beneficial role of early defibrillation have grown, and most of all, it has been demonstrated that the main determinant of survival is the time of defibrillation more than the type of rescuer. Early lay defibrillation was shown to be more effective than delayed defibrillation by healthcare providers. Moreover, because of the ease of use of automated external defibrillators (AEDs), it has been shown that also untrained lay rescuers can safely use an AED leading the guidelines to encourage early defibrillation by untrained lay bystanders. Although strong evidence has demonstrated that an increase in AED use leads to an increase in out-of-hospital cardiac arrest (OHCA) survival, the rate of defibrillation by laypeople is quite variable worldwide and very low in some realities. The review of this literature about lay defibrillation highlights that the AED is a life-saving device as simple and well tolerated as underused.

 

Full reference below;

Journal of Cardiovascular Medicine (lww.com)

The automated external defibrillator, an underused simple life-saving device: a review of the literature. A joint document from the Italian Resuscitation Council (IRC) and Associazione Italiana di Aritmologia e Cardiostimolazione (AIAC) – PubMed (nih.gov)

Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations

Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency-urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. This study aimed to analyse Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making.

Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed.

Results: The incidence in paediatric subjects was 4.5 (95% CI 3.6-5.6) per 100,000 of the population. School buildings and sports facilities had relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs were preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%).

Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools.

Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations – PubMed (nih.gov)

Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest

Background

A defibrillator should be connected to all patients receiving cardiopulmonary resuscitation (CPR) to allow early defibrillation. The defibrillator will collect signal data such as the electrocardiogram (ECG), thoracic impedance and end-tidal CO2, which allows for research on how patients demonstrate different responses to CPR. The aim of this review was to give an overview of methodological challenges and opportunities in using defibrillator data for research.

Methods

The successful collection of defibrillator files has several challenges. There is no scientific standard on how to store such data, which have resulted in several proprietary industrial solutions. The data needs to be exported to a software environment where signal filtering and classifications of ECG rhythms can be performed. This may be automated using different algorithms and artificial intelligence (AI). The patient can be classified being in ventricular fibrillation or -tachycardia, asystole, pulseless electrical activity or having obtained return of spontaneous circulation. How this dynamic response is time-dependent and related to covariates can be handled in several ways. These include Aalen’s linear model, Weibull regression and joint models.

Conclusions

The vast amount of signal data from defibrillator represents promising opportunities for the use of AI and statistical analysis to assess patient response to CPR. This may provide an epidemiologic basis to improve resuscitation guidelines and give more individualized care. We suggest that an international working party is initiated to facilitate a discussion on how open formats for defibrillator data can be accomplished, that obligates industrial partners to further develop their current technological solutions.

Full article below;

Extracting physiologic and clinical data from defibrillators for research purposes to improve treatment for patients in cardiac arrest – ScienceDirect

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

An interesting Article in the Resuscitation Journal

Abstract

Out-of-hospital cardiac arrest is a global public health issue experienced by approximately 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, behaviour change approaches, optimisation 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.

The study provides evidence- and consensus based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

Full article information below;

 

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 – PubMed (nih.gov)

Modeling optimal AED placement to improve cardiac arrest survival: The challenge is implementation – Resuscitation (resuscitationjournal.com)

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study

Abstract

Intervention by members of the public during an out of hospital cardiac arrest (OHAC) including resuscitation attempts and accessible automated external defibrillator (AED) has been shown to improve survival. This study aimed to investigate the OHCA and AED knowledge and confidence, and barriers to intervention, of the public of North East England, UK. This study used a face-to-face cross-sectional survey on a public high street in Newcastle, UK. Participants were asked unprompted to explain what they would do when faced with an OHCA collapse. Chi-Square analysis was used to test the association of the independent variables sex and first aid trained on the participants’ responses. Of the 421 participants recruited in the study, 82.9% (n = 349) reported that they would know what to do during an OHCA collapse. The most frequent OHCA action mentioned was call 999 (64.1%, n = 270/421) and 58.2% (n = 245/421) of participants reported that they would commence CPR. However, only 14.3% (n = 60/421) of participants spontaneously mentioned that they would locate an AED, while only 4.5% (n = 19/421) recounted that they would apply the AED. Just over half of participants (50.8%, n = 214/421) were first aid trained, with statistically more females (57.3%, n = 126/220) than males (43.9%, n = 87/198) being first aiders (p = 0.01 χ2 = 7.41). Most participants (80.3%, n = 338/421) knew what an AED was, and 34.7% (n = 326/421) reported that they knew how to use one, however, only 11.9% (n = 50/421) mentioned that they would actually shock a patient. Being first aid trained increased the likelihood of freely recounting actions for OHCA and AED intervention. The most common barrier to helping during an OHCA was lack of knowledge (29.9%, n = 126/421).

Although most participants reported they would know what to do during an OHCA and had knowledge of an AED, low numbers of participants spontaneously mentioned specific OHCA and AED actions.

Improving public knowledge would help improve the public’s confidence of intervening during an OHCA and may improve OHCA survival.

Full article;

 

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study – PubMed (nih.gov)

Knowledge and barriers of out of hospital cardiac arrest bystander intervention and public access automated external defibrillator use in the Northeast of England: a cross-sectional survey study | Internal and Emergency Medicine (springer.com)

Development and testing of acoustically-matched hydrogel-based electrodes for simultaneous EMG-ultrasound detection

This study explores the development and testing of a bipolar electrode for the simultaneous acquisition of ultrasound (US) images and surface electromyograms (EMGs) from the same muscle region. The developed electrode (bEMG-US) consisted of two circular sensing regions (20 mm diameter) with fixed inter-electrode distance (3.5 cm, center-to-center). Both the sensing regions and the external structure of the electrode are made of hydrogel layers separated by insulating materials. The electrical properties (i.e., impedance and noise of the electrode-skin interface) and the quality of EMGs detected with the developed electrodes during electrically elicited contractions were assessed and compared with those provided by commercially available EMG electrodes. The effect of the bEMG-US electrode on US images was evaluated by comparing images detected from the same muscle region with and without the electrode interposed between the US probe and the skin. Tests on five subjects showed that the electrode-skin impedance of bEMG-US electrodes was higher than that of conventional EMG electrodes (mean (range): 15.6 (8.5-21.1) kΩ vs. 8.2 (4.9-16.5) kΩ).

Despite higher impedance values, both electrode systems provided comparable, electrode-skin noise levels (1.4 (1.1-1.7) µV vs. 1.3 (1.0-1.5) µV) and M waves (normalized mean square error: 2.6 (0.6-6.8)%). The quality of US images detected with and without the bEMG-US electrode between the US probe and the skin was comparable, as demonstrated by the low errors in the estimation of anatomical variables in the two experimental conditions (range: (0.37-2.35) deg for pennation angle and (-0.31-0.1) cm for muscle thickness).

Results demonstrate that bEMG-US can be used to acquire concurrently EMGs and US images from the same muscle region with a negligible effect on the quality of the two detected signals, thus allowing for a simultaneous, multimodal evaluation of muscle activation.

 

Full article linked below;

Development and testing of acoustically-matched hydrogel-based electrodes for simultaneous EMG-ultrasound detection – PubMed (nih.gov)

Cardiopulmonary Resuscitation and Defibrillator Use in Sports

Abstract:

Sudden cardiac arrest (SCA) in young athletes is rare, with an estimated incidence ranging from 0.1 to 2 per 100,000 per athlete year. The creation of SCA registries can help provide accurate data regarding incidence, treatment, and outcomes and help implement primary or secondary prevention strategies that could change the course of these events. Early cardiopulmonary resuscitation (CPR) and defibrillation are the most important determinants of survival and neurological prognosis in individuals who suffer from SCA. Compared with the general population, individuals with clinically silent cardiac disease who practice regular physical exercise are at increased risk of SCA events. While the implementation of national preparticipation screening has been largely debated, with no current consensus, the number of athletes who will be diagnosed with cardiac disease and have an indication for implantable defibrillator cardioverter defibrillator (ICD) is unknown. Many victims of SCA do not have a previous cardiac diagnosis. Therefore, the appropriate use and availability of automated external defibrillators (AEDs) in public spaces is the crucial part of the integrated response to prevent these fatalities both for participating athletes and for spectators. Governments and sports institutions should invest and educate members of the public, security, and healthcare professionals in immediate initiation of CPR and early AED use. Smartphone apps could play an integral part to allow bystanders to alert the emergency services and CPR trained responders and locate and utilize the nearest AED to positively influence the outcomes by strengthening the chain of survival.

This review aimed to summarize the available evidence on sudden cardiac death prevention among young athletes and to provide some guidance on strategies that can be implemented by governments and on the novel tools that can help save these lives.

Full article below;

Cardiopulmonary Resuscitation and Defibrillator Use in Sports – PubMed (nih.gov)