Category: News

Aim: To evaluate the association between bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and survival after out-of-hospital cardiac arrest (OHCA) across the urban-rural spectrum in Canada. This was a retrospective cohort study of 325,477 adult OHCAs within the Cardiac Arrest Registry to Enhance Survival from 2013-2019. Bystander interventions were categorized into no bystander intervention, bystander CPR alone, and bystander AED use (with or without CPR). The primary outcome was survival to hospital discharge with good neurological outcome.

Results: Bystander CPR alone occurred most often in rural areas (50.8%), and least often in urban areas (35.4%). Bystander AED use in public settings was similar across the urban-rural spectrum (10.5%-13.1%). Survival with good neurological outcome varied for urban (8.1%), suburban (7.7%), large rural (9.1%), small town (7.1%), and rural areas (6.1%). In comparison to no bystander intervention, the adjusted odds ratios (95% confidence intervals) for bystander AED use and survival were 2.57 (2.37-2.79) in urban areas, 2.58 (1.81-3.67) in suburban areas, 1.99 (1.44-2.76) in large rural areas, 1.90 (1.27-2.86) in small towns, and 3.05 (1.99-4.68) in rural areas. Bystander CPR alone was also associated with survival in all areas (adjusted odds ratio range: 1.29-1.45). There was no strong evidence of interaction between bystander interventions and geographical status on the primary outcome (p=0.63).

Conclusion: Bystander CPR and AED use are associated with positive clinical outcomes after OHCA in all areas along the urban-rural spectrum.

https://pubmed.ncbi.nlm.nih.gov/35469933/

The aim of our study was to determine whether businesses can be identified that rank highly for their potential to improve coverage of out-of-hospital cardiac arrests (OHCAs) by automated external defibrillators (AEDs), both in public locations and private residences. The cohort comprised 10,422 non-traumatic OHCAs from 2014 to 2020 in Perth, Western Australia. We ranked 115 business brands (across 5,006 facilities) for their potential to supplement coverage by the 3,068 registered public-access AEDs in Perth, while accounting for AED access hours.

Results: Registered public-access AEDs provided 100 m coverage of 23% of public-location arrests, and 4% of arrests in private residences. Of the 10 business brands ranked highest for increasing the coverage of public OHCAs, six brands were ranked in the top 10 for increased coverage of OHCAs in private residences. A public phone brand stood out clearly as the highest-ranked of all brands, with more than double the coverage-increase of the second-ranked brand. If all 115 business brands hosted AEDs with 24-7 access, 57% of OHCAs would remain without 100 m coverage for public arrests, and 92% without 100 m coverage for arrests in private residences.

Conclusion: Many businesses that ranked highly for increased coverage of arrests in public locations also rank well for increasing coverage of arrests in private residences. However, even if the business landscape was highly saturated with AEDs, large gaps in coverage of OHCAs would remain, highlighting the importance of considering other modes of AED delivery in metropolitan landscapes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065707/

Do you need an electrode designer, manufacturer or both – then check out our unique range of capabilities including having the longest shelf life in the industry of 5.5yrs

Access time to emergency patients is a critical factor that affects the outcomes of life-or-death situations, especially in the cases of out-of-hospital cardiac arrests (OHCA). This study focused on developing a new model of emergency medical services (EMS) using a motorcycle-based ambulance (motorlance) with an automated external defibrillator (AED). There are currently no studies regarding access time for this vehicle. This study aimed at utilization of an AED in conjunction with motorlance and comparing the response time between a traditional ambulance and a motorlance. This was a prospective study from September 2021 to January 2022. Data were recorded employing a national standard of operations record form used for Thailand EMS departments nationwide.

Results: The 891 cases were divided into two groups which were motorlance and ambulance. The activation times for motorlance and ambulance were 0.44 minutes and 1.42 minutes, respectively (p < 0.001) and the response time in the motorlance group was 7.20 minutes compared with 9.25 minutes in the ambulance group. In OHCA, the motorlance with AED arrived at patients location and assisted to continue resuscitation at the hospital 88.9% of the time.

Conclusion: AED used in conjunction with motorcycle ambulances had shorter periods of both activation time and response time compared to ambulances. The use of AEDs clearly increases the number of continuous resuscitations in out-of-hospital cardiac arrest patients.

https://pubmed.ncbi.nlm.nih.gov/35437357/

The webpage explains – What Are AEDs? A section noting what AEDs are approved in the US; Important information  for AED Manufacturers and commentary from the FDA’s on their Continued Efforts to Keep AEDs Reliable

https://www.fda.gov/medical-devices/cardiovascular-devices/automated-external-defibrillators-aeds#approved

Shock advice algorithm plays a vital role in the detection of sudden cardiac arrests on electrocardiogram signals and hence, brings about survival improvement by delivering prompt defibrillation. The last decade has witnessed a surge of research efforts in racing for efficient shock advice algorithms, in this context. On one hand, it has been reported that the classification performance of traditional threshold-based methods has not complied with the American Heart Association recommendations. On the other hand, the rise of machine learning and deep learning-based counterparts is paving the new ways for the development of intelligent shock advice algorithms.

In this paper, we firstly provide a comprehensive survey on the development of shock advice algorithms for rhythm analysis in automated external defibrillators. Shock advice algorithms are categorized into three groups based on the classification methods in which the detection performance is significantly improved by the use of machine learning and/or deep learning techniques instead of threshold-based approaches. Indeed, in threshold-based shock advice algorithms, a parameter is calculated as a threshold to distinguish shockable rhythms from non-shockable ones. In contrast, machine learning-based methods combine multiple parameters of conventional threshold-based approaches as a set of features to recognize sudden cardiac arrest.

Noticeably, those features are possibly extracted from stand-alone ECGs, alternative signals using various decomposition techniques, or fully augmented ECG segments. Moreover, these signals can be also used directly as the input channels of deep learning-based shock advice algorithm designs. Then, we propose an advanced shock advice algorithm using a support vector machine classifier and a feature set extracted from a fully augmented ECG segment with its shockable and non-shockable signals. The relatively high detection performance of the proposed shock advice algorithm implies a potential application for the automated external defibrillator in the practical clinic environment. Finally, we outline several interesting yet challenging research problems for further investigation.

https://pubmed.ncbi.nlm.nih.gov/35366906/

It is well documented that the success of resuscitation attempts and defibrillation in the patient in cardiac arrest is time-critical. Great efforts have been made globally to improve patient survival rates from out-of-hospital cardiac arrest (OHCA), but despite these efforts in many places success rates still stand in single-digit percentage figures. In Israel, thousands of automated external defibrillators (AEDs) have been placed in locations with the intention to increase availability of PADs. The defibrillator is the most vital piece of equipment in CPR, along with the performance of good quality chest compressions. In one recent project, in cooperation with the International Committee of the Red Cross (ICRC), 15 new smart stands were placed in rural towns and villages from north to south of the country, particularly as they are remote and EMS response will take some time to arrive.  

https://www.jems.com/patient-care/cardiac-resuscitation/public-access-defibrillators-improving-survival-rates-in-israel/

Not too many years ago, the chances of surviving a sudden cardiac event outside of a hospital setting were slim. Realizing the need for a life-saving treatment that could be used almost anywhere, and by almost anyone, the Royal Victoria Hospital-Belfast, under the direction of Dr. Frank Pantridge and Dr. Geddes, launched the world’s first mobile coronary care unit, which included the world’s first portable defibrillator. The research team, which formed the company, HeartSine in 1988, now owned by Stryker, continued to refine the device to make it more lightweight and portable. The Ulster University academics have since gone from a team of five employees to being acquired by one of the world’s largest medtech companies by a process of constantly refining and improving their devices.

“Much of our early work was focused on the development of suitable technology to allow this miniaturization to be realized,” Finlay explained. “These developments, including the integration and in-house research of new flat-panel displays, compact capacitors, flexible defibrillator pads, high-density batteries, and embedded software, primarily led to a device that was suitable for transportation in an ambulance to a patient suspected of having a cardiac arrest.”

This work provided the platform for which the modern wall-mounted automated external defibrillator (AED) is based on, Finlay said. HeartSine’s flagship product, the HeartSine Samaritan public access defibrillator (PAD; pictured above), has been deployed in thousands of facilities in more than 70 companies and in more than 30 languages.

The evolution of the device was based on many years of experience, explained Professor James McLaughlin, Head of School of Engineering, Ulster University. “As with all of Ulster University’s work in medical devices and related technology development, we have learned that many iterations of the technology are required to facilitate a final viable solution,” he explained.

https://www.mddionline.com/cardiovascular/lessons-evolution-automated-external-defibrillator

Introduction: Drone-delivered automated external defibrillators (AEDs) may reduce delays to defibrillation for out-of-hospital cardiac arrests (OHCAs). We sought to determine how integration of drones and selection of drone bases between emergency service stations (i.e., paramedic, fire, police) would affect 9-1-1 call-to-arrival intervals.

Methods: We identified all treated OHCAs in southern Vancouver Island, British Columbia, Canada from Jan. 2014 to Dec. 2020. We developed mathematical models to select 1-5 optimal drone base locations from each of: paramedic stations, fire stations, police stations, or an unrestricted grid-based set of points to minimize drone travel time to OHCAs. We evaluated models on the estimated first response interval assuming that drones were integrated with existing OHCA response. We compared median response intervals with historical response, as well as across drone base locations.

Results: A total of 1,610 OHCAs were included in the study with a historical median response interval of 6.4 minutes (IQR 5.0-8.6). All drone-integrated response systems significantly reduced the median response interval to 4.2-5.4 minutes (all P<0.001), with grid-based stations using 5 drones resulting in the lowest response interval (4.2 minutes). Median response times between drone base location types differed by 6-16 seconds, all comparisons of which were statistically significant (all P<0.02).

Conclusion: Integrating drone-delivered AEDs into OHCA response may reduce first response intervals, even with a small quantity of drones. Implementing drone response with only one emergency service resulted in similar response metrics regardless of the emergency service hosting the drone base and was competitive with unrestricted drone base locations.

https://pubmed.ncbi.nlm.nih.gov/35314210/