Category: News

 

Recent advancements in wearable electrochemical biosensors have opened new avenues for on-body and continuous detection of biomarkers, enabling personalized, real-time, and preventive healthcare. While glucose monitoring has set a precedent for wearable biosensors, the field is rapidly expanding to include a wider range of analytes crucial for disease diagnosis, treatment, and management. In this review, recent key innovations are examined in the design and manufacturing underpinning these biosensing platforms including biorecognition elements, signal transduction methods, electrode and substrate materials, and fabrication techniques. The applications of these biosensors are then highlighted in detecting a variety of biochemical markers, such as small molecules, hormones, drugs, and macromolecules, in biofluids including interstitial fluid, sweat, wound exudate, saliva, and tears. Additionally, the review also covers recent advances in wearable electrochemical biosensing platforms, such as multi-sensory integration, closed-loop control, and power supply. Furthermore, the challenges associated with critical issues are discussed, such as biocompatibility, biofouling, and sensor degradation, and the opportunities in materials science, nanotechnology, and artificial intelligence to overcome these limitations.

 

Wearable devices are being developed faster and applied more widely. Wearables have been used to monitor movement-related physiological indices, including heartbeat, movement, and other exercise metrics, for health purposes. People are also paying more attention to mental health issues, such as stress management. Wearable devices can be used to monitor emotional status and provide preliminary diagnoses and guided training functions. The nervous system responds to stress, which directly affects eye movements and sweat secretion. Therefore, the changes in brain potential, eye potential, and cortisol content in sweat could be used to interpret emotional changes, fatigue levels, and physiological and psychological stress. To better assess users, stress-sensing devices can be integrated with applications to improve cognitive function, attention, sports performance, learning ability, and stress release. These application-related wearables can be used in medical diagnosis and treatment, such as for attention-deficit hyperactivity disorder (ADHD), traumatic stress syndrome, and insomnia, thus facilitating precision medicine. However, many factors contribute to data errors and incorrect assessments, including the various wearable devices, sensor types, data reception methods, data processing accuracy and algorithms, application reliability and validity, and actual user actions. Therefore, in the future, medical platforms for wearable devices and applications should be developed, and product implementations should be evaluated clinically to confirm product accuracy and perform reliable research.

Objectives: To examine the incidence and survival rates of sudden cardiac arrest that were documented during school organized sports in Japan.

Design: Retrospective cohort study.

Methods: Insurance claim data of cardiac events (sudden cardiac death and sudden cardiac arrest with resultant disabilities) that occurred during Japanese high school organized sports between 2009 and 2018 were retrieved. Participation data from All Japan High School Athletic Federation and Japan High School Baseball Federation were used for incidence rate calculations. Incidence rate ratios with 95 % confidence interval were calculated to compare the risk by sports and sex. The survival rate was calculated with the proportion of resuscitated cases to total number of cardiac events in this dataset.

Results: A total of 55 cardiac events (25 survivors and 30 deceased) were identified in the dataset. The majority affected male student-athletes (92.7 %). The frequency and incidence rate of cardiac events were highest in male baseball (n = 16 [29.1 %], incidence rate: 0.91 per 100,000 athlete-years). Incidence rate ratio revealed that male basketball (2.19, 95 % confidence interval: 1.04-4.60), male baseball (2.31, 95 % confidence interval: 1.32-4.03), and first-year male baseball (4.11, 95 % confidence interval: 2.10-8.07) had significantly higher risk of cardiac events, compared to the overall incidence rate (0.38 per 100,000 athlete-years). The survival rates were 37.5 % in the first half (2009-2013) and 56.5 % in the latter half (2014-2018) of the study period.

Conclusions: The risk of cardiac events was highest in male, baseball, first-year student-athletes. Rapid AED application by bystanders should be advocated to enhance better survival.

 

Out-of-hospital cardiac arrests (OHCAs) have high mortality rates, worsened by limited access to automated external defibrillators (AEDs). This study analyzed OHCA response times, identified areas with prolonged ambulance travel times, and proposed optimal AED locations in a medium-sized city in southern Brazil. Data from 278 non-traumatic OHCA cases (2019-2022) in patients over 18 years old, with ambulance response times under 20 min, were included. Spatial survival analysis assessed the probability of exceeding the recommended 5-min (300 s) ambulance response time. The maximal covering location problem identified 100 strategic AED sites within a 150-s reach for bystanders. AED and ambulance travel times were compared using the Wilcoxon test (p < 0.01). Defibrillation occurred in 89 cases (31.01%), and bystander CPR was performed in 149 cases (51.92%). Despite these efforts, 77% of patients died. The median ambulance response time was 11.63 min, exceeding 5 min in most cases, particularly at peak times like 11 a.m. AED placement in selected locations could cover 76% of OHCA occurrences, with a mean AED travel time of 320 s compared to 709 s for ambulances. Strategic AED placement could enhance early defibrillation and improve survival outcomes.

 

Background: Nursing home residents are typically excluded in studies of out-of-hospital cardiac arrest (OHCA). Since nursing homes have on-site healthcare staff, cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) for OHCA would ideally be 100% before arrival of 9-1-1 emergency responders. However, little is known about healthcare provider bystander response and the degree of variability in initiating CPR and AED use in nursing homes.

Methods: Within the U.S. CARES registry, we identified 71,530 adults at nursing homes who had resuscitation initiated for OHCA between 2013-2021. We assessed rates of bystander CPR and AED application by nursing home healthcare staff. Using multivariable hierarchical logistic regression, we quantified variation in healthcare provider bystander CPR and AED application rates using the median odds ratio (OR), which estimates the difference in odds that 2 similar patients with OHCA would receive healthcare provider bystander CPR or have an AED applied at two randomly selected nursing homes.

Results: Mean age was 74 ± 13 years and 53.5% were men. Overall, 58,814 (82.2%) patients received healthcare provider bystander CPR and 20,302 (28.4%) had an AED applied. Among 4014 nursing homes with ≥5 OHCAs (n = 42,399), the median OR for healthcare provider bystander CPR was 2.13 (95% CI: 2.05-2.22) and the median OR for healthcare provider bystander AED application was 4.54 (95% CI: 4.31-4.76), both suggesting several-fold variation in treatment across nursing homes.

Conclusion: In U.S. nursing homes, healthcare provider bystander CPR and AED application rates were not ideal, with large variation in both rates across sites.

During the past 20 years the survival after out-of-hospital cardiac arrest (OHCA) has almost quadrupled from 4% in 2001 to 14% in 2020. There has been a huge focus on layman education in cardiopulmonary resuscitation and use of automated external defibrillators (AED), implementation of healthcare staff at 1-1-2 dispatch centers, early recognition of OHCA, establishment of a national AED register with publicly available AEDs, and dispatch of volunteer responders in case of nearby OHCA. This review describes implemented initiatives with the purpose of improving survival from OHCA in Denmark.

 

Aims: To evaluate the association of basic life support with survival after sports-related sudden cardiac arrest (SR-SCA).

Methods and results: In this systematic review and meta-analysis, a search of several databases from each database inception to 31 July 2021 without language restrictions was conducted. Studies were considered eligible if they evaluated one of three scenarios in patients with SR-SCA: (i) bystander presence, (ii) bystander cardiopulmonary resuscitation (CPR), or (iii) bystander automated external defibrillator (AED) use and provided information on survival. Risk of bias was evaluated using Risk of Bias in Non-randomized Studies of Interventions. The primary outcome was survival at the longest follow up. The meta-analysis was conducted using the random-effects model. The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach was used to rate certainty in the evidence. In total, 28 non-randomized studies were included. The meta-analysis showed significant benefit on survival in all three groups: bystander presence [odds ratio (OR) 2.55, 95% confidence interval (CI) 1.48-4.37; I2 = 25%; 9 studies-988 patients], bystander CPR (OR 3.84, 95% CI 2.36-6.25; I2 = 54%; 23 studies-2523 patients), and bystander AED use (OR 5.25, 95% CI 3.58-7.70; I2 = 16%; 19 studies-1227 patients). The GRADE certainty of evidence was judged to be moderate.

Conclusion: In patients with SR-SCA, bystander presence, bystander CPR, and bystander AED use were significantly associated with survival. These results highlight the importance of witness intervention and encourage countries to develop their first aid training policy and AED installation in sport settings.

 

Importance: The lack of evidence-based implementation strategies is a major contributor to increasing mortality due to out-of-hospital cardiac arrest (OHCA) in developing countries with limited resources.

Objective: To evaluate whether the implementation of legislation is associated with increased bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use and improved clinical outcomes for patients experiencing OHCA and to provide policy implications for low-income and middle-income settings.

Design, setting, and participants: This observational cohort study analyzed a prospective city registry of patients with bystander-witnessed OHCA between January 1, 2010, and December 31, 2022. The Emergency Medical Aid Act was implemented in Shenzhen, China, on October 1, 2018. An interrupted time-series analysis was used to assess changes in outcomes before and after the law. Data analysis was performed from May to October 2023.

Exposure: The Emergency Medical Aid Act stipulated the use of AEDs and CPR training for the public and provided clear legal guidance for OHCA rescuing.

Main outcomes and measures: The primary outcomes were rates of bystander-initiated CPR and use of AEDs. Secondary outcomes were rates of prehospital return of spontaneous circulation (ROSC), survival to arrival at the hospital, and survival at discharge.

Results: A total of 13 751 patients with OHCA (median [IQR] age, 59 [43-76] years; 10 011 men [72.83%]) were included, with 7858 OHCAs occurring during the pre legislation period (January 1, 2010, to September 30, 2018) and 5893 OHCAs occurring during the post legislation period (October 1, 2018, to December 31, 2022). The rates of bystander-initiated CPR (320 patients [4.10%] vs 1103 patients [18.73%]) and AED use (214 patients [4.12%] vs 182 patients [5.29%]) increased significantly after legislation implementation vs rates before the legislation. Rates of prehospital ROSC (72 patients [0.92%] vs 425 patients [7.21%]), survival to arrival at the hospital (68 patients [0.87%] vs 321 patients [5.45%]), and survival at discharge (44 patients [0.56%] vs 165 patients [2.80%]) were significantly increased during the post legislation period. Interrupted time-series models demonstrated a significant slope change in the rates of all outcomes.

Conclusions and relevance: These findings suggest that implementation of the Emergency Medical Aid Act in China was associated with increased rates of CPR and public AED use and improved survival of patients with OHCA. The use of a systemwide approach to enact resuscitation initiatives and provide legal support may reduce the burden of OHCA in low-income and middle-income settings.

 

Background: Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.

Methods: Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.

Results: Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.

Conclusions: Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

 

Background: Rapid public defibrillation with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest survival. Concerns about AED theft and vandalism have led to implementing security measures, including locked cabinets. This scoping review, conducted as part of the evidence review for the International Liaison Committee on Resuscitation, explores the impact of securing AEDs in locked cabinets.

Methods: Searches of Medline, Embase, Cochrane, CINAHL (from database inception to 25/5/2024) and Google Scholar (first 200 articles). Studies of any type or design, published with an English abstract, examining the impact of locked AED cabinets were included. The included studies were grouped by outcomes, and an iterative narrative synthesis was performed.

Results: We screened 2,096 titles and found 10 relevant studies: 8 observational studies (4 published as conference abstracts) and 2 simulation studies. No study reported patient outcomes. Studies reported data on between 36 and 31,938 AEDs. Most studies reported low rates (<2%) of theft/missing/vandalism, including AEDs that were accessible 24/7. The only study comparing unlocked and locked cabinets showed minimal difference in theft and vandalism rates (0.3% vs. 0.1%). Two simulation studies showed significantly slower AED retrieval when additional security measures, included locked cabinets, were used. A survey of first responders reported half (25/50) were injured while accessing an AED that required breaking glass to access.

Conclusion: The limited literature suggests that vandalism and the loss of AEDs are rare and occur in locked and unlocked cabinets. Research on this topic is needed that focuses on real-life retrieval and patient outcomes.