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Background: Automated external defibrillators (AEDs) from community first responder systems (CFR-system) are important to achieve early defibrillation in out-of-hospital cardiac arrest (OHCA). It is unclear how far community first responders (CFR) can travel to fetch and connect an AED to achieve this goal. This study aims to evaluate the relation of the distance between OHCA and the dispatched CFR-system AED and speed of AED-connection.

Methods: Within the Dutch prospective ARREST registry, OHCA patients from 2016 to 2021 with a connected CFR AED were identified. The location of each connected AED was retrieved. Straight-line distances between patient and AED-location were calculated using Google Maps. Time intervals between emergency-call and AED-connection were compared according to straight-line distances and degree of urbanization.

Results: Out of 3231 OHCAs with the CFR-system activated, 2037 (63%) patients had an AED connected before emergency medical services arrival, of which 426 by a CFR. Exact AED-locations were known in 387 OHCA (study population). Overall, the AEDs connected by a CFR where located within 949 m straight-line distance of the OHCA. AEDs connected within 6, 8, or 10 min of the emergency-call, were located within 506 m, 796 m and 838 m straight-line distance, respectively. In 44% of these cases, the CFR connected an AED to which he/she was not referred to, but taken from another address, which significantly impacted the maximal distance covered: 773 m for CFR-system referred AEDs versus 1126 m for not CFR-system referred (p = 0.001).

Conclusion: To facilitate early AED-connection (≤6 min), any address should have a CFR-system AED located within approx. 500 m.

Full article;

Distance between OHCA and AED location within a community first responder system to achieve early AED connection – PubMed

Creating a sustainable community cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) program that reaches underserved communities poses a challenge for the emergency medical services (EMS) community. Attendance, funding, and resources have all been linked to struggles surrounding community CPR/AED programs. Through our experience in conducting CPR/AED trainings in underserved regions of eastern North Carolina, we propose a method of effectively utilizing existing organizations and institutions of learning to expand and maintain a sustainable community CPR/AED program. Furthermore, we demonstrate 10 cornerstones in developing relationships within the community to increase attendance and participation in diverse communities.

Objective: Time is critical with any out of hospital cardiac arrest (OHCA). The possibility of brain cell death increases, and the likelihood of a “good” outcome decreases with time. The most prominent impairments involve memory and attentional difficulties. Limited research and few cases have shown positive cognitive results following an OHCA to the extent that this case study depicts.

Method: The current case study presents a right-handed male in his late 40s, with master’s and law degrees, and a high-level functioning in the workplace who experienced an OHCA. He was treated for his OHCA and subsequently underwent neuropsychological testing less than 2 months following his hospital discharge.

Results: Expected results suggest impairments in key cognitive areas; however, a neuropsychological exam less than 2-months post-incident, testing pre-morbid IQ, overall cognitive ability, processing speed, attention, executive functioning, language, visuospatial abilities, and memory; each showing normal or better results. Additionally, self and collateral report questionnaires examining cognitive and emotional functioning reported no difficulties and no major changes since his cardiac arrest.

Conclusions: We speculate that this patient’s exceptional outcome might be due to his cognitive reserve, and the immediateness of his intervention (5-10 min of CPR and return-of-spontaneous-circulation from an AED shock) and use of a saline cooling procedure upon arrival to the hospital. Overall, we highlight a patient with a remarkable cognitive outcome, utilizing data from neuropsychological testing within 2-months post-incident, and propose protective factors in neuropsychological functioning following an OHCA.

Background: Defibrillation in the critical first minutes of out-of-hospital cardiac arrest (OHCA) can significantly improve survival. However, timely access to automated external defibrillators (AEDs) remains a barrier.

Objectives: The authors estimated the impact of a statewide program for drone-delivered AEDs in North Carolina integrated into emergency medical service and first responder (FR) response for OHCA.

Methods: Using Cardiac Arrest Registry to Enhance Survival registry data, we included 28,292 OHCA patients ≥18 years of age between 1 January 2013 and 31 December 2019 in 48 North Carolina counties. We estimated the improvement in response times (time from 9-1-1 call to AED arrival) achieved by 2 sequential interventions: 1) AEDs for all FRs; and 2) optimized placement of drones to maximize 5-minute AED arrival within each county. Interventions were evaluated with logistic regression models to estimate changes in initial shockable rhythm and survival.

Results: Historical county-level median response times were 8.0 minutes (IQR: 7.0-9.0 minutes) with 16.5% of OHCAs having AED arrival times of <5 minutes (IQR: 11.2%-24.3%). Providing all FRs with AEDs improved median response to 7.0 minutes (IQR: 6.2-7.8 minutes) and increased OHCAs with <5-minute AED arrival to 22.3% (IQR: 16.4%-30.9%). Further incorporating optimized drone networks (326 drones across all 48 counties) improved median response to 4.8 minutes (IQR: 4.3-5.2 minutes) and OHCAs with <5-minute AED arrival to 56.3% (IQR: 46.9%-64.2%). Survival rates were estimated to increase by 34% for witnessed OHCAs with estimated drone arrival <5 minutes and ahead of FR and emergency medical service.

Conclusions: Deployment of AEDs by FRs and optimized drone delivery can improve AED arrival times which may lead to improved clinical outcomes. Implementation studies are needed.

Introduction: This study is a retrospective review of patients who sustained out-of-hospital cardiac arrest due to ventricular fibrillation. The data were analyzed to decipher predictors of good outcomes as the overall survival rate in the county is significantly higher than the national average.

Methods: The inclusion criteria for the study comprised all patients over the age of 18 for whom a call was made for unresponsiveness. Data for this project included all cardiac arrests due to ventricular fibrillation in the calendar year 2022. Results: A total of 80 patients sustained cardiac arrest due to ventricular fibrillation. The age range was 27-80 years old. The study has 71% White, 19% African American, 8.7% Hispanic, and 1% other populations. Ninety-five percent received epinephrine, 89% utilized an advanced airway, 60% underwent hypothermia protocol, 24% utilized an AED device, and 14% used a mechanical CPR device. Seventy-six percent were pronounced dead in the ER or the hospital, and 19% survived to discharge. In the survivor population, CPR was initiated in 13 minutes or less and defibrillation occurred in 23 minutes or less. While none of the variables achieved statistical significance, epinephrine use showed a trend toward statistical significance for the outcome of sustained return of spontaneous circulation (ROSC) with a p-value of 0.05346.

Conclusion: Nineteen percent of patients survived out-of-hospital cardiac arrests in the Polk County hospital system. This is significantly higher than the national average. This likely reflects the emphasis on high-quality CPR and active on-scene management, as no individual variable was statistically significant.

Full article;

Out-of-Hospital Cardiac Arrest Outcomes After Ventricular Fibrillation – PubMed

 

Aim: This study aimed to investigate trends over time in pre-hospital factors for pediatric out-of-hospital cardiac arrest (pOHCA) and long-term neurological and neuropsychological outcomes. These have not been described before in large populations.

Methods: Non-traumatic arrest patients, 1 day-17 years old, presented to the Sophia Children’s Hospital from January 2002 to December 2020, were eligible for inclusion. Favorable neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1-2 or no difference with pre-arrest baseline. The trend over time was tested with multivariable logistic and linear regression models with year of event as independent variable.

Findings: Over a nineteen-year study period, the annual rate of long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, increased significantly (OR 1.10, 95%-CI 1.03-1.19), adjusted for confounders. Concurrently, annual automated external defibrillator (AED) use and, among adolescents, initial shockable rhythm increased significantly (OR 1.21, 95% CI 1.10-1.33 and OR 1.15, 95% CI 1.02-1.29, respectively), adjusted for confounders. For generalizability purposes, only the total intelligence quotient (IQ) was considered for trend analysis of all tested domains. Total IQ scores and bystander basic life support (BLS) rate did not change significantly over time.

Interpretation: Long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, improved significantly over the study period. Total IQ scores did not significantly change over time. Furthermore, AED use (OR 1.21, 95%CI 1.10-1.33) and shockable rhythms among adolescents (OR1.15, 95%CI 1.02-1.29) increased over time.

Full article;

Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational study – PubMed

Background: Out-of-hospital cardiac arrest (OHCA) primarily affects older adults. Individuals in nursing homes are often elderly with significant comorbidities. Nursing homes are staffed by healthcare workers, able to respond immediately to cardiac arrest, including provision of bystander cardiopulmonary resuscitation (CPR). We aimed to describe the characteristics, treatments and outcome of individuals sustaining an OHCA in nursing and care home settings in England.

Methods: Patients ≥18 years between 2015 and 2021 with a recorded location of either a nursing or care home from the ‘Out-of-hospital Cardiac Arrest Outcomes’ registry for England were included. We present descriptive statistics and compare groups, where appropriate, using a χ² test.

Results: We included 4779 patients, of which 2474 (52.5%) were female and 3910 (81.8%) were aged ≥70. Cardiac arrest was witnessed by a bystander in 51.1% (n=2390) of cases. Overall, 80.2% (n=3698) of patients received bystander CPR and where an automated external defibrillator (AED) was available, 77.7% (n=331) were treated with an AED. Return of spontaneous circulation (ROSC) at any time was reported in 1614 (36.7%) and ROSC sustained to hospital handover in 1061 (22.3%) patients. Survival to hospital discharge or 30 days was observed in 97 (2.1%) patients. As age increased, there was a decrease in survival and ROSC sustained to hospital handover.

Conclusion: Survival after OHCA in a nursing home setting was low, despite high rates of key interventions, such as bystander CPR. There may be an opportunity to optimize the availability of AEDs within nursing homes.

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 to our 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.

Background: Out-of-hospital cardiac arrest (OHCA) is a serious threat to human life and health, characterized by high morbidity and mortality. However, given the limitations of the current emergency medical system (EMS), it is difficult to immediately treat patients who experience OHCA. It is well known that rapid defibrillation after cardiac arrest is essential for improving the survival rate of OHCA, yet automated external defibrillators (AED) are difficult to obtain in a timely manner.

Objective: This review illustrates the feasibility and advantages of AED delivery by drones by surveying current studies on drones, explains that drones are a new strategy in OHCA, and finally proposes novel strategies to address existing problems with drone systems.

Results: The continuous development of drone technology has been beneficial for patients who experience OHCA, as drones have demonstrated powerful capabilities to provide rapid delivery of AED. Drones have great advantages over traditional EMS, and the delivery of AED by drones for patients with OHCA is a new strategy. However, the application of this new strategy in real life still has many challenges.

Conclusion: Drones are promising and innovative tools. Many studies have demonstrated that AED delivery by drones is feasible and cost-effective; however, as a new strategy to improve the survival rate of OHCA patients, there remain problems to be solved. In the future, more in-depth investigations need to be conducted.

Aims: To investigate the association between the arrival of smartphone-activated volunteer responders before the Emergency Medical Services (EMS) and bystander defibrillation in out-of-hospital cardiac arrest (OHCA) at home and public locations.

Methods and results: This is a retrospective study (1 September 2017-14 May 2019) from the Stockholm Region of Sweden and the Capital Region of Denmark. We included 1271 OHCAs, of which 1029 (81.0%) occurred in private homes and 242 (19.0%) in public locations. The main outcome was bystander defibrillation. At least one volunteer responder arrived before EMS in 381 (37.0%) of OHCAs at home and 84 (34.7%) in public. More patients received bystander defibrillation when a volunteer responder arrived before EMS at home (15.5 vs. 2.2%, P < 0.001) and in public locations (32.1 vs. 19.6%, P = 0.030). Similar results were found among the 361 patients with an initial shockable heart rhythm (52.7 vs. 11.5%, P < 0.001 at home and 60.0 vs. 37.8%, P = 0.025 in public). The standardized probability of receiving bystander defibrillation increased with longer EMS response times in private homes. The 30-day survival was not significantly higher when volunteer responders arrived before EMS (9.2 vs. 7.7% in private homes, P = 0.41; and 40.5 vs. 35.4% in public locations, P = 0.44).

Conclusion: Bystander defibrillation was significantly more common in private homes and public locations when a volunteer responder arrived before the EMS. The standardized probability of bystander defibrillation increased with longer EMS response times in private homes. Our findings support the activation of volunteer responders and suggest that volunteer responders could increase bystander defibrillation, particularly in private homes.