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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.

https://www.sciencedirect.com/science/article/abs/pii/S0300957220305566

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.

https://pubmed.ncbi.nlm.nih.gov/34894042/

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.

https://pubmed.ncbi.nlm.nih.gov/34883217/

Wishing all our customers, suppliers, friends and family the very best for this festive season and a prosperous and healthy  2022 From all at Intelesens

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

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.

https://pubmed.ncbi.nlm.nih.gov/34853034/

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/

 

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.

https://pubmed.ncbi.nlm.nih.gov/34780477/

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.

https://pubmed.ncbi.nlm.nih.gov/34791171/

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.

https://www.mdpi.com/2077-0383/10/21/5018/htm