Underutilisation of public access defibrillation is related to retrieval distance and time dependent availability

Defibrillator

Public access defibrillation doubles the chances of neurologically intact survival following out-of-hospital cardiac arrest (OHCA). Although there are increasing numbers of automated external defibrillators (AEDs) available in the community, it is said they are used infrequently, despite often being available. This study aimed to match OHCAs with known AED locations to understand AED availability, the effects of reduced AED availability at night and the operational radius at which they can be effectively retrieved.

Results determined that existing AEDs are in fact being underused, with 36.4% of out of hospital cardiac arrests occurring withing 500m of an AED. Although more AEDs will improve availability, greater use can be made of existing AEDs, particularly by ensuring they are all available on a 24/7 basis.

Read full study below;

Underutilisation of public access defibrillation is related to retrieval distance and time-dependent availability | Heart (bmj.com)

Source – Underutilisation of public access defibrillation is related to retrieval distance and time-dependent availability – PubMed (nih.gov)

Evolution of the ECG Machine

Evolution of the ECG Machine

 

 

An electrocardiogram or “ECG machine” is a device that helps physicians understand and interpret the electrical signals that are produced by the heart as it contracts. By doing so, they can diagnose potential heart issues.

 

Over the past few decades, there have been great advances in the field of medicine. One such area is cardiac care, where modern technologies have led to a better understanding and treatment of heart conditions. When it comes to heart health, the evolution of ECG machines has played a critical role for both doctors and patients alike.

 

The below article explores the ECG machine, its evolution, and what impact it had on cardiac care.

 

“ECG machines are now a staple in every hospital and medical clinic and is one of the most common tests requested by cardiologists for their patients.

 

1887-1930: The Early Days of ECGs 

 

The first ECGs were rudimentary at best, but they laid the groundwork for the more advanced machines we have today. It was not until 1903 that Willem Einthoven, a Dutch physiologist invented the string galvanometer, which improved the accuracy of ECGs by measuring small electrical currents. This innovation earned Einthoven the Nobel Prize in Physiology or Medicine in 1924.

By the 1930’s, ECGs were being used routinely in hospitals to diagnose heart conditions like arrhythmias and myocardial infarctions (heart attacks). However, these early machines were large and bulky, making them difficult to transport from one location to another. Additionally, they required trained technicians to operate them, which limited their use outside of hospitals.

 

1930’s-1960’s: The Advent of Portable ECGs 

 

In 1939, engineer Norman Jolliffe unveiled the first portable ECG machine, which weighed just 35 pounds (16 kg). This machine allowed doctors to more easily transport ECGs from one location to another and even administer them outside traditional hospital settings.

Other advances during this time included the development of self-adhesive electrodes and disposable paper ones, which made recording an ECG quicker and easier than ever before. By the 1960’s, beat-to-beat reporting became possible thanks to new technological advances, furthering the use of ECGs in identifying heart conditions. To make ECG machines more accessible and affordable, several modifications were made over the years. One of the most important modifications was the development of solid-state electronics in the 1950’s.

This replaced the need for string galvanometers with much smaller transistors—which made ECG machines smaller, lighter, and less expensive. The 1950’s saw the development of portable ECGs which allowed patients to be mobile while still monitoring their heart activity. In 1957, John Winters started marketing his own design of an ambulatory ECG called the “Dynamo Cardio scope.”

This machine increased the mobility of patients as well as allowed longer periods of monitoring. However, these ambulatory ECGs were large, bulky, and not very user-friendly, which made them impractical for widespread use. In 1975 World Heal Corporation released their own version called the “Mini Mitter” or “Holter Monitor,” which was much smaller and lighter weight. The Holter monitor became the industry standard for ambulatory ECGs and is still used today in many hospitals around the world.

 

1970’s-Present: Modern Developments in ECG Technology

 

The 1970’s saw several important developments in ECG technology, including the introduction of digital readouts and computerized analysis. These advances made it possible for non-specialists to operate ECG machines and led to increased accuracy in diagnosis.

ECG machines continued to evolve throughout the second half of the 20th century. In recent years, digital technology has been used to create compact, handheld devices that can be easily transported from one location to another. Some modern ECG machines can be wirelessly connected to smartphones and other devices so that patients can receive real-time monitoring. Eventually, technology continued to miniaturize further until we arrived at wearable devices such as smartwatches that are now capable of performing Single Lead ECG.

Some of the latest innovations in ECG technology include ultra-portable ECG devices that measure the equivalent of a 12 Lead ECG, without leads, just by touch with the help of artificial intelligence (AI)-based software that can automatically interpret ECGs with high accuracy.

The evolution of ECG machines has played a crucial role in diagnostic medicine by allowing doctors to better understand and interpret the electrical signals produced by heart contraction. ECG machines have come a long way since they were first invented over 100 years ago. They are now smaller, more portable, and easier to use than ever before. This continuous evolution has made them an invaluable tool for diagnosing cardiac conditions. It is evident that there will be more advancement coming our way. As technology becomes more sophisticated, who knows what else the next 100 years hold!”

 

The Evolution Of ECG Machines – BW Healthcare (businessworld.in)

Public Access Defibrillation Programs: Improving Outcomes Worldwide using Five Steps

Out of hospital cardiac arrest (OHCA) is one of the most frequent causes of death and leading cause of healthcare expenditures. This has led to significant research to study ways to reduce morbidity and mortality secondary to OHCA. The American Heart Association developed a campaign to improve awareness and outcomes of patients suffering an OHCA.

There were five areas they were looking to improve on what is referred as the chain of survival when it comes to OHCA’s.

  1. Immediate recognition of cardiac arrest and activation of the emergency response system
  2.  Early cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions
  3. Rapid defibrillation
  4. Effective advanced life support
  5. Integrated post‐cardiac arrest care

 

In this study, they analysed the survival after ventricular fibrillation cardiac arrest in the Sao Paulo Metropolitan Subway System following the implementation of a targeted PAD (public access defibrillator) program. The program placed automated external defibrillators in railway stations and provided Heartsaver First Aid cardiopulmonary resuscitation (CPR) automated external defibrillator training and refresher courses for security officers. The Sao Paulo railway system carries approximately 4.5 million people which provided an optimum place to begin the roll out of the PAD program. The systems‐dedicated security officers and cameras allow for rapid recognition, CPR, and defibrillation.

 

 

Results showed that their data combined with prior studies which targeted PAD programs can be successful throughout the world. Increased advocacy is needed to establish more targeted PAD programs worldwide, along with programs to improve all parts of the chain of survival, in particular, public awareness of cardiac arrest and the need for rapid CPR administration.

 

Read full article in link below;

 

Public Access Defibrillation Programs: Improving Outcomes Worldwide – PMC (nih.gov)

Getting R-AEDI to save lives in Singapore

Early cardiopulmonary resuscitation (CPR) and defibrillation prior to the arrival of emergency medical services can improve survival from out-of-hospital cardiac arrest (OHCA) with good neurological outcome. However, the rate of local bystander CPR is only 24.3% and bystander defibrillation 2.1%.

In 2015, the R-AEDI (Registry for AED Integration) initiative was started to improve OHCA survival rates. R-AEDI alerts volunteers to nearby OHCA cases via the myResponder mobile application. In 2015-2017, 7,682 AEDs were mapped and made accessible via this app. Comprehensive site inspections also resulted in fewer non-functional AEDs, as AED owners were educated on the importance of the maintenance of pads and batteries. The AED heat map allows us to identify areas that are lacking in or require improved public access AED coverage.

The online AED registry found in the myResponder app is useful to locate AEDs rapidly during OHCAs. More community education would improve the rate of bystander defibrillation.

Getting R-AEDI to save lives in Singapore – PMC (nih.gov)

 

 

Facility-Level Factors and Racial Disparities in Cardiopulmonary Resuscitation within US Dialysis Clinics

  • Clinics caring for Black versus White cardiac arrest patients have significant differences in quality, resources, and patient case mix.
  • Accounting for differences in clinic characteristics between Black versus White cardiac arrest patients did not reduce race disparities in cardiopulmonary resuscitation.
  • Relative to younger patients, older Black patients were less likely to receive cardiopulmonary resuscitation (including AED use) in dialysis clinics compared with older White patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9255868/

The Impact of Medical Students Teaching Basic Life Support to Laypersons

Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac eventsWe asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons’ CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.

https://pubmed.ncbi.nlm.nih.gov/35790356/

Importance of proper management of automated external defibrillators

Defibrillator

To increase the functionality of AED, strict and reasonable guidelines may be helpful. The article outlines the guidelines for managing registered AED in South Korea.

In South Korea, a law regulating AED was established in 2007, which stipulates AED installation in specific places which provides guidelines for public access defibrillation placement and management since 2010. According to the guidelines, installation and usage of AED should be reported to a public health centre by the chief manager of each installed AED.  The government provides budgetary support for the installation and management of AEDs by covering the costs for the replacement of pads and batteries. Such a guideline with national policy support including funding could contribute to the spread of AED usage and increase the survival rate of patients with out-of-hospital cardiac arrest.

https://www.resuscitationjournal.com/article/S0300-9572(22)00591-3/fulltext

Sudden death in young athletes: Is it preventable?

Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention.

The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity.

Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.

https://pubmed.ncbi.nlm.nih.gov/35718646/

US State Illinois liable if health clubs do not use AEDs when needed

Illinois health clubs could be liable if staff does not use an automated external defibrillator (AED) when needed, according to a May 19 ruling by the Illinois Supreme Court.

The case before the court was Dawkins v. Fitness International, LLC, 2022 IL 127561. The plaintiff alleges that a woman who had a heart attack in  November 2012 at an LA Fitness in Oswego, Illinois, was left brain dead when an AED was not used on her. The plaintiff alleged that not using the AED on the woman was “wilful and wanton misconduct” by LA Fitness.

The court held 6-0 in favour of the plaintiff ruling that LA Fitness must face claims because two state laws, The Physical Fitness Facility Medical Emergency Preparedness Act and the Automated External Defibrillator Act, require gyms to not only have AEDs on hand and staff trained to use them, but to also use them when necessary.

https://www.clubindustry.com/industry-news/illinois-health-clubs-could-be-liable-if-aed-not-used