Category: News

Early defibrillation is a major determinant of survival in out-of-hospital cardiac arrest (OHCA). Shockable rhythms account for 18.7% of treated OHCA patients in emergency medical services (EMS), thanks to automated external defibrillators (AED). Shockable rhythms are strongly associated with improved survival rates compared to non-shockable rhythms in OHCA.

 

Defibrillation within 3–5 min of collapse can lead to survival rates as high as 50–70%.

 

Thus, reduced time between call to the emergency call centre (ECC) and AED using is a major issue.

 

Early recognition of OHCA and resuscitation performance with early defibrillation is the best way to increase survival chances. However, professional EMS arrive on site in about ten minutes in France.

 

The two steps to improve survival are one, to have volunteer rescuers on site quickly and two, to have them perform early defibrillation by an AED.

For the first step, notifying citizens as first responders to an OHCA event through a smartphone application with a mobile positioning system or a text message alert system increases early defibrillation and thereby improves survival.

 

The smartphone application SAUVLife© (Paris, France) currently used in France allows the ECC to solicit trained and registered lay rescuers. If you are connected and present in a one-kilometre perimeter around the victim, the application will alert and guide you to start CPR. It also warns another available lay-rescuer to a referenced AED and guides him to the victim.

 

In May 2022, a partnership between the EMS of the Angers University Hospital, the city of Angers, France and the SAUVLife© application was allowed to equip volunteer citizen rescuers with their own portable AED. These “super lay-rescuers” can be municipal staff, medical students or volunteers who agreed to always keep the defibrillator with them, day, and night. The geographical distribution of the portable AED in the 6 geographical districts of Angers resulted in homogeneous coverage of the city and rapid action regardless of the location of the OHCA.

 

With this innovative method, which is a first in France, aiming to increase AED usage before arrival of professional rescuers and to improve OHCA survival. This experiment should also allow to recruit more standard lay-rescuers and if successful, be extended to other areas.

 

References;

Deployment of “super lay-rescuers” equipped with AED to improve OHCA survival: An innovative partnership between emergency medical service, city hall and a mobile application in France – Resuscitation (resuscitationjournal.com)

Deployment of “super lay-rescuers” equipped with AED to improve OHCA survival: An innovative partnership between emergency medical service, city hall and a mobile application in France – PubMed (nih.gov)

Aims: Little is known about automated external defibrillator (AED) functionality in real-life settings. This study aimed to assess the functionality of all registered AEDs in a geographically selected area and calculate the proportion of historical out-of-hospital cardiac arrests (OHCAs) covered by non-functioning AEDs.

Methods: In this cross-sectional study they inspected all registered and available AEDs on the island of Bornholm in Denmark. There was information collected on battery status (determined by AED self-test) and electrode status, as well as AED availability. All historical OHCAs registered with the Danish Cardiac Arrest Registry on Bornholm during 2016-2019 were identified and then the proportion of OHCAs covered by an AED was calculated (regardless of functionality status) within ≤100, ≤750, and ≤1800 meters and the proportion of OHCAs covered by non-functioning AEDs.

Conclusion: Almost one-fifth of all registered and publicly available AEDs were not functional, primarily due to expired electrodes, failed self-tests or obstacles to retrieving AEDs. One in twenty historical OHCA was covered by a non-functional AED. Although general AED functionality was high, this finding underlines the importance of regular AED maintenance.

Link to full study;

Functionality of registered automated external defibrillators – Resuscitation (resuscitationjournal.com)

 

Functionality of registered automated external defibrillators – PubMed (nih.gov)

Out-of-hospital cardiac arrest is a global public health issue experienced by approximately 3.8 million people annually. Only 8% to 12% of these people survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival but ensuring timely access to defibrillators has been a significant challenge.

To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives:

(1) identify known barriers to public-access defibrillator use and early defibrillation,

(2) discuss established and novel strategies to address those barriers, and

(3) identify high-priority knowledge gaps for future research to address.

The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behaviour change approaches, optimisation of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors.

This study provides evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

References;

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation | Circulation (ahajournals.org)

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation – PubMed (nih.gov)

 

Aim: This study aimed to understand current community PAD placement strategies and identify factors which influence PAD placement decision-making in the United Kingdom (UK).

Methods: Individuals, groups and organisations involved in PAD placement in the UK were invited to participate in an online survey collecting demographic information, facilitators and barriers to community PAD placement and information used to decide where a PAD is installed in their experiences. Survey responses were analysed through descriptive statistical analysis and thematic analysis.

Results: There were 106 included responses. Distance from another PAD (66%) and availability of a power source (63%) were most frequently used when respondents are deciding where best to install a PAD and historical occurrence of cardiac arrest (29%) was used the least. Three main themes were identified influencing PAD placement: (i) the relationship between the community and PADs emphasising community engagement to create buy-in; (ii) practical barriers and facilitators to PAD placement including securing consent, powering the cabinet, accessibility, security, funding, and guardianship; and (iii) ‘risk assessment’ methods to estimate the need for PADs including areas of high footfall, population density and type, areas experiencing health inequalities, areas with delayed ambulance response and current PAD provision.

Conclusion: Decision-makers want to install PADs in locations that maximise impact and benefit to the community, but this can be constrained by numerous social and infrastructural factors. The best location to install a PAD depends on local context; work is required to determine how to overcome barriers to optimal community PAD placement.

 

For full article see link below;

Factors affecting public access defibrillator placement decisions in the United Kingdom: A survey study – PMC (nih.gov)

March is AED Maintenance Month!

Maintaining your defibrillator is as important as having one

With the survival rate of sudden cardiac arrest being below 10%, the emphasis to have Automatic External Defibrillators (AEDs) in all places where we live, work, and play is becoming increasingly important. It is equally important to remember that having a maintenance plan in place will ensure all AEDs are ready to help save a life when and if needed. When a defibrillator is deployed during an emergency, it is crucial the AED is ready to be used. The outcome for the patient could be even more devastating if the AED was available but not functioning properly.

 

Proper maintenance of the AED is essential to ensure that it works correctly when needed. Here are some tips on how to maintain an AED:

 

Read the user manual: To maintain properly functioning AED, read the manual thoroughly. This will help you understand the device’s functions and how to use it correctly. It will also get you familiar with the manufacturer name when needing to reorder the disposables such as batteries & pads.

 

Regularly check the battery and electrode pads: Check the AEDs battery and electrode pads regularly. Replace them immediately if they are expired, damaged, or low on charge.

 

Perform self-tests: AEDs have a self-test feature that checks the device’s internal components and battery charge. Follow the manufacturer’s instructions for performing regular self-tests.

 

Keep the AED clean: Wipe the AED with a clean, dry cloth to remove dirt, dust, or debris. Avoid using harsh chemicals or solvents that can damage the device.

 

Store the AED correctly: Store the AED in a dry, cool place. Avoid exposing the device to extreme temperatures or moisture as may inhibit the AED’s performance.

 

Keep the AED accessible: Place the AED in an easily accessible location that is visible and known to everyone. Ensure that it is not ever blocked by any obstructions, so it is clearly available when an emergency arises.

 

Train your staff: Ensure that your staff is trained in AED use and maintenance. Regular training can help them respond quickly and confidently in an emergency. Ensure it is part of the onboarding process when a new team member comes on board. You should also appoint someone to carry out monthly checks and have these checks logged.

 

Below is a checklist when doing an AED Maintenance check:

• Is the Active Status Indicator light on your AED flashing green?
• Are the AED pads plugged in and ready for use?
• Does the AED appear to be undamaged and ready for use?
• Is the AED free of chirping and warning notifications?
• Are the AED pads within their usable date?
• Is the AED battery within its usable date?

If the answer to any of these questions is no, call Customer Service/AED manufacturer to determine what the issue might be with the AED.

 

By following these tips, you can maintain your AED in good condition and ensure that it is always ready to use when needed.

 

References;

Maintaining your defib is as Important as having one – Eiremed.ie

Guide to Defibrillator Maintenance and upkeep | St John Ambulance (sja.org.uk)

How To Maintain Your AED | AED Defibrillator Maintenance (defibtech.com)

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA

It has been hypothesised that the minority student-athletes have a lower survival rate from sudden cardiac arrest (SCA) than non-minority student-athletes. The below study examined the relationship between high school indicators of socioeconomic status (SES) and survival in student-athletes with exercise-related Sudden Cardiac Arrest.

 

Methods

High school student-athletes in the USA with exercise-related SCA on school campuses were prospectively identified from 1 July 2014 to 30 June 2018 by the National Center for Catastrophic Sports Injury Research. High school indicators of SES included the following: median household and family income, proportion of students on free/reduced lunch and percent minority students. Resuscitation details included witnessed arrest, presence of an athletic trainer, bystander cardiopulmonary resuscitation and use of an on-site automated external defibrillator (AED). The primary outcome was survival to hospital discharge. Differences in survival were analysed using risk ratios (RR) and univariate general log-binomial regression models.

Conclusion

The study concluded that minority student-athletes with exercise-related SCA on high school campuses have lower survival rates than white non-Hispanic athletes, but this difference is not fully explained by SES markers of the school.

 

See link to full study below;

 

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA – PMC (nih.gov)