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Resuscitation possible within six minutes everywhere in Netherlands
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.
https://nltimes.nl/2021/12/06/resuscitation-possible-within-six-minutes-everywhere-nl
Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review
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.
Calculating real-world travel routes instead of straight-line distance in the community response to out-of-hospital cardiac arrest
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592858/
A simulation study of drone delivery of Automated External Defibrillator (AED) in Out of Hospital Cardiac Arrest (OHCA) in the UK
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.
Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home
Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. In residential areas 785 AEDs were placed and 5735 volunteer responders recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. Survival from OHCAs in residences increased from 26% to 39% [adjusted relative risk (RR) 1.5 (95% CI 1.03-2.0)]. Defibrillation by first responders in residences increased from 22% to 40% (p < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (p = 0.81). Time from emergency call to defibrillation decreased from median 11.7 min to 9.3 min; mean difference -2.6 (95% CI -3.5 – -1.6). Conclusion: Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study
The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). This study performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. The study recommends the following to all the European countries and their governments:
- To issue a law that allow all citizens, including untrained ones, to use an AED in the case of a suspected OHCA and protecting them against any legal consequences.
- To make an AED map compulsory that includes all public AEDs and that is linked to the emergency medical system dispatch center.
- To implement FR systems, including both citizens trained in CPR and professional FRs (i.e., police officers, firefighters, off-duty medical personnel) possibly equipped with an AED, to increase the rate of defibrillation before the arrival of the EMS.
- To unify cardiac arrest registries among European countries to harmonize data collection and better comprehend the European strategies to implement an improved OHCA survival.
Are there disparities in the location of Automated External Defibrillators in England?
Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence. This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England.
Methods: Details of the location of AEDs registered with English Ambulance Services were obtained from individual services or internet sources. Neighbourhood characteristics of lower layer super output areas (LSOA) were obtained from the Office for National Statistics. Comparisons were made between LSOAs with and without a registered AED.
Results: AEDs were statistically more likely to be in LSOAs with a lower residential but higher workplace population density, with people predominantly from a white ethnic background and working in higher socio-economically classified occupations (p<0.05). There was a significant correlation between AED coverage and the LSOA Index of Multiple Deprivation (IMD) (r=0.79, p=0.007), with only 27.4% in the lowest IMD decile compared to about 45% in highest. AED density varied significantly across the country from 0.82/km2 in the north east to 2.97/km2 in London.
Conclusions: In England, AEDs were disproportionately placed in more affluent areas, with a lower residential population density. This contrasts with locations where OHCAs have previously occurred. Future PAD programmes should give preference to areas of higher deprivation and be tailored to the local community.
Layperson use of AEDs – what happens after shock delivery?
High-quality cardiopulmonary resuscitation (CPR) and early defibrillation with minimal peri-shock pauses are crucial for improving survival from cardiac arrest. This Dutch study describes layperson actions after shock delivery with AEDs and how voice prompts may affect post-shock pauses. We found significant differences in time to shock delivery. Overall, 15 participants (13%) removed the electrodes after shock delivery, 20 participants (17%) did not resume compressions, and major differences in post-shock pauses were observed. Importantly, our findings of removal of electrodes have not previously been reported. Removal of electrodes before starting compressions may prevent further rhythm checks and shock deliveries. As patients may require several shocks, this may decrease chance of survival. Importantly, future CPR training and public campaigns should emphasize to resume compressions and keeping electrodes attached for further rhythm check and defibrillation.
https://www.resuscitationjournal.com/article/S0300-9572(21)00439-1/fulltext
AI helps the defibrillator think
In the future, the Automatic External Defibrillator (AED) and the defibrillator will be able to do more than they do today. In time it will be possible, with the help of artificial intelligence, to say more about the condition of the resuscitated patient. Jos Thannhauser is affiliated with the Radboudumc and will received his PhD for his research on the use of AI in the AED and defibrillator. Cardiopulmonary resuscitation (CPR) involves alternating chest compressions and ventilations. Thannhauser: “During these breaths, a ‘smart’ defibrillator can calculate the ideal moment for a shock: immediately or, on the contrary, continue chest compressions for longer?” Research into the effectiveness of such an algorithm on the outcome of a resuscitation is ongoing in Italy. “My dissertation shows which requirements such an algorithm must meet so that it can actually be applied in practice. For example, the electrodes of the defibrillator must always be stuck to the patient in the same way,” explains Thannhauser. The ultimate goal is to build these algorithms into AEDs and defibrillators.
https://www.radboudumc.nl/en/news-items/2021/ai-helps-the-defibrillator-think