Category: News

Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac events. We asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons’ CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.

https://pubmed.ncbi.nlm.nih.gov/35790356/

To increase the functionality of AED, strict and reasonable guidelines may be helpful. The article outlines the guidelines for managing registered AED in South Korea.

In South Korea, a law regulating AED was established in 2007, which stipulates AED installation in specific places which provides guidelines for public access defibrillation placement and management since 2010. According to the guidelines, installation and usage of AED should be reported to a public health centre by the chief manager of each installed AED.  The government provides budgetary support for the installation and management of AEDs by covering the costs for the replacement of pads and batteries. Such a guideline with national policy support including funding could contribute to the spread of AED usage and increase the survival rate of patients with out-of-hospital cardiac arrest.

https://www.resuscitationjournal.com/article/S0300-9572(22)00591-3/fulltext

This study aimed to assess the trend of the maintenance status and usability of public automated external defibrillators (AEDs). Public AEDs installed in Seoul from 2013 to 2017 were included. An inspector checked the maintenance status and usability of the AEDs annually using a checklist.

During the study period, 23,619 AEDs were inspected. Access to the AEDs was improved, including the absence of obstacles near the AEDs (from 90.2% in 2013 to 99.1% in 2017, p < 0.0001) and increased AED signs (from 34.3% in 2013 to 91.3% in 2017, p < 0.0001). The rate of AEDs in normal operation (from 94.0% in 2013 to 97.6% in 2017, p < 0.0001), good battery status (from 95.6% in 2013 to 96.8% in 2017, p = 0.0016), and electrode availability increased (from 97.1% in 2013 to 99.0% in 2017, p < 0.0001); the rate of electrode validity decreased (from 90.0% in 2013 to 87.2% in 2017, p < 0.0001).

The overall rate of the non-ready-to-use AEDs and AEDs with less than 24-h usability accounted for 15.4% and 44.1% of the total number of AEDs, respectively. Although most AEDs had a relatively good maintenance status, a significant proportion of public AEDs were not available for 24-h use.

Invalid electrodes and less than 24-h accessibility were the main reasons that limited the 24-h usability of public AEDs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9232625/

Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention.

The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity.

Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.

https://pubmed.ncbi.nlm.nih.gov/35718646/

Illinois health clubs could be liable if staff does not use an automated external defibrillator (AED) when needed, according to a May 19 ruling by the Illinois Supreme Court.

The case before the court was Dawkins v. Fitness International, LLC, 2022 IL 127561. The plaintiff alleges that a woman who had a heart attack in  November 2012 at an LA Fitness in Oswego, Illinois, was left brain dead when an AED was not used on her. The plaintiff alleged that not using the AED on the woman was “wilful and wanton misconduct” by LA Fitness.

The court held 6-0 in favour of the plaintiff ruling that LA Fitness must face claims because two state laws, The Physical Fitness Facility Medical Emergency Preparedness Act and the Automated External Defibrillator Act, require gyms to not only have AEDs on hand and staff trained to use them, but to also use them when necessary.

https://www.clubindustry.com/industry-news/illinois-health-clubs-could-be-liable-if-aed-not-used

Introduction: Early defibrillation within minutes increases survival after in-hospital cardiac arrest (IHCA). However, early defibrillation is often not achieved even though automated external defibrillators (AEDs) are available. We aimed to investigate how AEDs were used and the barriers and facilitators for successful use.

Methods: We conducted unannounced, full-scale in-situ simulations of IHCAs in hospital wards with an AED. A debriefing followed the simulations. The simulations and debriefings were video recorded, and the debriefings were transcribed for subsequent qualitative analysis about the AED use.

Results: We conducted 36 unannounced in-situ simulations, and an AED was used in 98% of simulations. It was decided to collect an AED after a median of 62 (31; 123) seconds, the AED arrived after 99 (82; 146) seconds, were attached after 188 (150; 260) seconds, and the first shock were delivered after 221 (181; 301) seconds from time of cardiac arrest diagnosis. We identified three main domains related to barriers and facilitators of AED use: teamwork, knowledge, and transfer. Frequent reasons for successful use of an AED were recent resuscitation course, previous experience, and leadership. Reasons for unsuccessful use were doubt about responsibility, lack of knowledge, and lack of contextualized training.

Conclusion: During unannounced simulated IHCAs, time to defibrillation was often > 3 minutes. Most of the delay occurred after the AED was collected. Non-technical skills and contextualized training were among the main perceived barriers to AED usage. Facilitators for successful use included recent training, previous experience, and successful leadership.

https://pubmed.ncbi.nlm.nih.gov/35677834/

A recent summary of evidence concluded that AEDs are connected in 5–32% of drowning cases before the arrival of the Emergency Medical Services (EMS) and that a shockable rhythm is observed in 2–14. The use of AEDs on board of lifeboats has been proven feasible.

https://www.resuscitationjournal.com/article/S0300-9572(22)00161-7/fulltext

We 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 we inspected all registered and available AEDs on the island of Bornholm in Denmark. We collected information on battery status (determined by AED self-test) and electrode status, as well as AED availability. We identified all historical OHCAs registered with the Danish Cardiac Arrest Registry on Bornholm during 2016-2019 and calculated the proportion of OHCAs covered by an AED (regardless of functionality status) within ≤100, ≤750, and ≤1800 meters and the proportion of OHCAs covered by non-functioning AEDs.

Results: Of 211 registered AEDs, 181 (81.9%) were publicly accessible and functional. The remaining 40 (18.1%) were not functional, primarily due to expired electrodes (42.5%, n=17), obstacles to AED retrieval (20.0%, n=8) or failed self-tests (17.5%, n=7). Of 197 historical OHCAs, non-functional AEDs resulted in an OHCA coverage loss of 5.6%, 4.1% and 1.0 % for ≤100 m, ≤750 m and ≤1800 m, respectively.

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.

https://pubmed.ncbi.nlm.nih.gov/35618078/

This case report describes a patient in Sweden who had an out-of-hospital cardiac arrest and received defibrillation with an automated external defibrillator delivered by a drone (shown in a video). https://nej.md/3sDQhni

https://twitter.com/NEJM/status/1528726229557211136

This German based study aims to perform a systematic scoping review on experimental studies examining the human drone interaction in deliveries of defibrillators.

Methods: Two databases (MEDLINE and CINAHL) and references of identified publications were searched without narrowing the year of publication or language. Studies that investigated the human drone interaction or medical delivery with drones in an experimental manner were included (research articles). All studies that only simulated the delivery process were excluded. Results: The search revealed 83 publications with four studies being included. Three categories of human drone interaction were identified: landing, handover, and communications. Regarding landing and handover, the most important issue was the direct physical contact with the drone while regarding communications users need clearer instructions about drone´s direction, sound and look like.

Discussion: The identified studies used technology-driven approaches by investigating human drone interaction in already existing technologies. Users must become integral part of the whole development process of medical drone services to reduce concerns, and to improve security, usability and usefulness of the system. Human drone interaction should be developed according to the identified categories of human drone interaction by using demand- and technology-driven approaches

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9049298/