An autonomous drone helped save the life of a man who suffered an out-of-hospital cardiac arrest in Sweden, it emerged this week. The 71 year-old man was shovelling snow in his driveway in the Swedish city of Trollhättan on the morning of December 9, 2021 when the incident happened. The time from when the alarm was raised until the defibrillator was safely delivered at the doorstep of the incident address was just over three minutes. The drone is a partnership between the Karolinska Institutet – Sweden’s largest medical university – together with the national emergency operator SOS Alarm, Region Vastra Gotaland and Everdrone. “This is an excellent real-world example of how Everdrone’s cutting-edge drone technology, fully integrated with emergency dispatch, can minimise the time for access to life-saving AED equipment”, said Mats Sällström, CEO of Everdrone.
Sudden cardiac arrest (SCA) is a common event, affecting almost 400,000 individuals annually in North America. Initiation of cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are critical for survival, yet many bystanders are reluctant to intervene. Digital technologies, including mobile devices, social media and crowdsourcing may help play a role to improve survival from SCA. In this article we review the current digital tools and strategies available to increase rates of bystander recognition of SCA, prompt immediate activation of Emergency Medical Services (EMS), initiate high quality CPR and to locate, retrieve and operate AEDs.
Smartphones can help to both educate and connect bystanders with EMS dispatchers, through text messaging or video-calling, to encourage the initiation of CPR and retrieval of the closest AED. Wearable devices and household smartspeakers could play a future role in continuous vital signs monitoring in individuals at-risk of lethal arrhythmias and send an alert to either chosen contacts or EMS. Machine learning algorithms and mathematical modeling may aid EMS dispatchers with better recognition of SCA as well as policymakers with where to best place AEDs for optimal accessibility. There are challenges with the use of digital tech, including the need for government regulation and issues with data ownership, accessibility and interoperability.
Future research will include smart cities, e-linkages, new technologies and using social media for mass education. Together or in combination, these emerging digital technologies may represent the next leap forward in SCA survival.
With bystander AED usage being critical for prehospital cardiac arrest patient outcomes, it is important to analyze if the gender and location disparities found in bystander CPR rates also exist for bystander AED usage. Using the National Emergency Medical Services Information System (NEMSIS) database, 1,144,969 bystander AED cases were analyzed on the basis of gender and location and measured using relative risk (RR). Using female patients as a baseline, the RR for bystander AED usage for male patients was 1.34 (95% CI [1.3310, 1.3557], p < 0.001) indicating male patients are 34% more likely to receive bystander AED usage compared to female patients. Analyzing bystander AED showed a sharp decline in the chance of bystander AED usage in rural and frontier areas.
Conclusions: Female patients are less likely to receive bystander AED usage compared to male patients and improvements in rural and frontier AED availability and training are necessary to increase bystander AED usage rates in those regions.
Background: Football (soccer) is popular among those of Masters age (≥35 years). Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. Aim: The aim of this survey of Masters Age Footballers was to gain insight into cardiac risk factors, symptoms, and knowledge, attitudes and beliefs about myocardial infarction (MI), and support for prevention.
Methods: A web-based survey using REDCap was completed by 153 amateur Masters footballers from A grade competition (n=24), B or lower grade (n=95) or social games (n=34) in Sydney, Australia.
Results: Participants were aged 49.3±7.5 years and primarily male (92.2%), Caucasian (88.9%) and university educated (75.2%). Risk factors included hypercholesterolaemia (37.3%), hypertension (19.6%), smoker (7.8%), overweight (40.5%) or obese (13.1%). One fifth (21.6%) reported ≥1 potential cardiac symptom during activity in the prior year, for which one quarter (24.2%) sought medical attention. Knowledge of typical MI symptoms was high (>80%) but lower (<40%) for less typical symptoms. Half (49.6%) were unconfident to recognise MI in themselves. Half (49.0%) would remain on the field for 5-10 minutes with chest pain. Only 39.9% were aware that warning signs may precede MI by days. They overestimated survival from cardiac arrest (43%). Participants supported training in automatic external defibrillators (AED) and CPR (84%), AEDs at games (85%) and cardiac education (>70%).
Conclusions: Cardiac risk factors are common In Masters footballers, with one in five experiencing possible cardiac symptoms in the prior year. While gaps exist in knowledge and optimal responses, strong support exists for preventive measures.
Mathematical optimization of automated external defibrillator (AED) placement has demonstrated potential to improve survival of out-of-hospital cardiac arrest (OHCA). Existing models do not account for detailed impact of delayed defibrillation on survival. We aimed to predict OHCA survival based on time to defibrillation and developed an AED placement model to directly maximize the gain. The survival gain of maximum expected survival rate (MESR) was assessed through 10-fold cross-validation for placement of 20 to 1000 new AEDs in Singapore.
Results: During the study period, 15,345 OHCAs occurred. It predicted a survival of 54.9% with defibrillation within the first two minutes after collapse that was reduced by more than 60% without defibrillation within the first 4 minutes.
Conclusion: We developed a novel AED placement model based on the impact of time to defibrillation on OHCA outcomes. Mathematical optimization can improve OHCA survival.
The national network of volunteers in Netherlands who can help in the case of cardiac arrest with an Automated External Defibrillator (AED) has grown to 245,000 people with 24,000 AEDs now across the country, up from 12,000 four years ago. As a result, resuscitation can be started within six minutes throughout the Netherlands. According to the foundation, civilian emergency workers are on site 2.5 minutes faster than an ambulance. According to Hartstichting, approximately 17,000 people have a cardiac arrest outside the hospital every year.
Objective: To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA).
Study eligibility criteria: Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA.
Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
Using straight-line distance to estimate the proximity of public-access Automated External Defibrillators (AEDs) or volunteer first-responders to potential out-of-hospital cardiac arrests (OHCAs) does not reflect real-world travel distance. The difference between estimates may be an important consideration for bystanders and first-responders responding to OHCAs and may potentially impact patient outcome. Researchers mapped 4355 OHCA (01/04/2016-31/03/2017) and 2677 AEDs in London (UK), and 1263 OHCA (18/06/2017-17/06/2018) and 4704 AEDs in East Midlands (UK) using ArcGIS mapping software.
Real-world travel routes to the nearest AED were (median) 219 m longer (623 m vs 406 m) than straight-line estimates in London, and 211 m longer (568 m vs 357 m) in East Midlands. The identity of the nearest AED changed on 26% occasions in both areas when calculating real-world travel routes.
Calculating real-world travel routes increases the estimated travel distance and time for those responding to OHCAs. Calculating straight-line distance may overestimate the benefit of the community response to OHCA.
Drones are increasingly used in healthcare, and feasibility studies of deployment of Automated External Defibrillators (AED) in Out-of-hospital cardiac arrest (OHCA) have been conducted. Despite the potential contribution of drones to healthcare, regulatory barriers exist, including limits on flights beyond visual line-of-sight (BVLOS). The aim of this project was to deliver an AED BVLOS in Wales.
We completed six flights totalling 92km, 1:02.5 hours of flight time and four successful parachute payload drops. We conducted a successful end-to-end flight demonstration of an AED delivered via BVLOS by drone to a simulated OHCA and resuscitation by lay responder’s in a remote location; the final delivery of 4.5km was completed in 2:50 minutes.
We have delivered an AED by parachute, from fixed wing drone BVLOS in the UK in simulated OHCA. This project adds to the body of knowledge required for regulatory assurance on drone use BVLOS.