Category: News

Using straight-line distance to estimate the proximity of public-access Automated External Defibrillators (AEDs) or volunteer first-responders to potential out-of-hospital cardiac arrests (OHCAs) does not reflect real-world travel distance. The difference between estimates may be an important consideration for bystanders and first-responders responding to OHCAs and may potentially impact patient outcome. Researchers mapped 4355 OHCA (01/04/2016-31/03/2017) and 2677 AEDs in London (UK), and 1263 OHCA (18/06/2017-17/06/2018) and 4704 AEDs in East Midlands (UK) using ArcGIS mapping software.

Real-world travel routes to the nearest AED were (median) 219 m longer (623 m vs 406 m) than straight-line estimates in London, and 211 m longer (568 m vs 357 m) in East Midlands. The identity of the nearest AED changed on 26% occasions in both areas when calculating real-world travel routes.

Calculating real-world travel routes increases the estimated travel distance and time for those responding to OHCAs. Calculating straight-line distance may overestimate the benefit of the community response to OHCA.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592858/

 

Drones are increasingly used in healthcare, and feasibility studies of deployment of Automated External Defibrillators (AED) in Out-of-hospital cardiac arrest (OHCA) have been conducted. Despite the potential contribution of drones to healthcare, regulatory barriers exist, including limits on flights beyond visual line-of-sight (BVLOS). The aim of this project was to deliver an AED BVLOS in Wales.

We completed six flights totalling 92km, 1:02.5 hours of flight time and four successful parachute payload drops. We conducted a successful end-to-end flight demonstration of an AED delivered via BVLOS by drone to a simulated OHCA and resuscitation by lay responder’s in a remote location; the final delivery of 4.5km was completed in 2:50 minutes.

We have delivered an AED by parachute, from fixed wing drone BVLOS in the UK in simulated OHCA. This project adds to the body of knowledge required for regulatory assurance on drone use BVLOS.

https://pubmed.ncbi.nlm.nih.gov/34780477/

Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. In residential areas 785 AEDs were placed and 5735 volunteer responders recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. Survival from OHCAs in residences increased from 26% to 39% [adjusted relative risk (RR) 1.5 (95% CI 1.03-2.0)]. Defibrillation by first responders in residences increased from 22% to 40% (p < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (p = 0.81). Time from emergency call to defibrillation decreased from median 11.7 min to 9.3 min; mean difference -2.6 (95% CI -3.5 – -1.6). Conclusion: Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.

https://pubmed.ncbi.nlm.nih.gov/34791171/

The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). This study performed a survey across Europe entitled “European Study about AED Use by Lay Rescuers” (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it. Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12–59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0–7.9%), reflecting the difference in OHCA survival. The study recommends the following to all the European countries and their governments:

• To issue a law that allow all citizens, including untrained ones, to use an AED in the case of a suspected OHCA and protecting them against any legal consequences.
• To make an AED map compulsory that includes all public AEDs and that is linked to the emergency medical system dispatch center.
• To implement FR systems, including both citizens trained in CPR and professional FRs (i.e., police officers, firefighters, off-duty medical personnel) possibly equipped with an AED, to increase the rate of defibrillation before the arrival of the EMS.
• To unify cardiac arrest registries among European countries to harmonize data collection and better comprehend the European strategies to implement an improved OHCA survival.

https://www.mdpi.com/2077-0383/10/21/5018/htm

Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence. This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England.

Methods: Details of the location of AEDs registered with English Ambulance Services were obtained from individual services or internet sources. Neighbourhood characteristics of lower layer super output areas (LSOA) were obtained from the Office for National Statistics. Comparisons were made between LSOAs with and without a registered AED.

Results: AEDs were statistically more likely to be in LSOAs with a lower residential but higher workplace population density, with people predominantly from a white ethnic background and working in higher socio-economically classified occupations (p<0.05). There was a significant correlation between AED coverage and the LSOA Index of Multiple Deprivation (IMD) (r=0.79, p=0.007), with only 27.4% in the lowest IMD decile compared to about 45% in highest. AED density varied significantly across the country from 0.82/km2 in the north east to 2.97/km2 in London.

Conclusions: In England, AEDs were disproportionately placed in more affluent areas, with a lower residential population density. This contrasts with locations where OHCAs have previously occurred. Future PAD programmes should give preference to areas of higher deprivation and be tailored to the local community.

https://pubmed.ncbi.nlm.nih.gov/34757059/

High-quality cardiopulmonary resuscitation (CPR) and early defibrillation with minimal peri-shock pauses are crucial for improving survival from cardiac arrest. This Dutch study describes layperson actions after shock delivery with AEDs and how voice prompts may affect post-shock pauses. We found significant differences in time to shock delivery. Overall, 15 participants (13%) removed the electrodes after shock delivery, 20 participants (17%) did not resume compressions, and major differences in post-shock pauses were observed. Importantly, our findings of removal of electrodes have not previously been reported. Removal of electrodes before starting compressions may prevent further rhythm checks and shock deliveries. As patients may require several shocks, this may decrease chance of survival. Importantly, future CPR training and public campaigns should emphasize to resume compressions and keeping electrodes attached for further rhythm check and defibrillation.

https://www.resuscitationjournal.com/article/S0300-9572(21)00439-1/fulltext

In the future, the Automatic External Defibrillator (AED) and the defibrillator will be able to do more than they do today. In time it will be possible, with the help of artificial intelligence, to say more about the condition of the resuscitated patient. Jos Thannhauser is affiliated with the Radboudumc and will received his PhD for his research on the use of AI in the AED and defibrillator. Cardiopulmonary resuscitation (CPR) involves alternating chest compressions and ventilations. Thannhauser: “During these breaths, a ‘smart’ defibrillator can calculate the ideal moment for a shock: immediately or, on the contrary, continue chest compressions for longer?” Research into the effectiveness of such an algorithm on the outcome of a resuscitation is ongoing in Italy. “My dissertation shows which requirements such an algorithm must meet so that it can actually be applied in practice. For example, the electrodes of the defibrillator must always be stuck to the patient in the same way,” explains Thannhauser. The ultimate goal is to build these algorithms into AEDs and defibrillators.

https://www.radboudumc.nl/en/news-items/2021/ai-helps-the-defibrillator-think

Sudden cardiac death (SCD), particular among elite footballers, has attracted much attention in recent times. In total, 118 football-related SCD were identified, a crude mortality rate of 0.41 per 100,000 population. All fatalities were males and the mean age was 35.5 years ± 10.4. Those aged 40-49 years recorded the highest mortality rate (0.67/100,000), three times the risk of those aged 50-59 years (RR = 3.1; 95%CI:1.5-6.4). Those aged 30-39 recorded the highest age-specific proportional mortality rate (0.86/1000 deaths). The highest risk occurred while playing football (n = 97; 82.2%), with another 15% of deaths (n = 18) occurring within 1 h of play. Almost all fatalities (n = 113; 95.8%) occurred during participation in recreational football. Conclusions: This study has identified football-related SCD most commonly occurs during recreational football among males aged 30-49 years. It is recommended males of this age participating in recreational football be encouraged to seek pre-participation heart health checks. Given the value of automated external defibrillators (AEDs) in responding to out-of-hospital cardiac arrest, future research should explore the feasibility and effectiveness of AEDs in preventing football-related SCD in Turkey including training of first responders in cardiopulmonary resuscitation and AED use.

https://pubmed.ncbi.nlm.nih.gov/34684142/

Swedish specialized drone services company successfully controlled the delivery of an automated external defibrillator (AED) from a distance of 800 kilometres – and to an entirely different country. The 1.6 km drone delivery of an AED flew a five-minute route to Helsinki, Finland, but was controlled by technicians 800KM away in Gothenburg, Sweden. The mission was the first UAV delivery of an AED piloted from a different country, and one of the few de facto cross-border drone operations in the European Union.

 

 

https://youtu.be/ukW18fJUaIo

Timely CPR on cardiac arrest patients with known or suspected COVID-19 should take precedence over resuscitators donning personal protective equipment (PPE), the American Heart Association (AHA) outlined in a guidance update. In resuscitation of adults and children, the healthcare provider is now instructed to give rapid chest compressions and to defibrillate as soon as possible without delay for application of masks or other PPE. “Delays due to mask retrieval may increase the risk of death for the patient from delayed CPR while providing little benefit to the provider,” according to the latest interim guidance. This is a departure from the initial COVID-specific guidance the AHA put out in March 2020, when the pandemic first took hold in the U.S. The older recommendation was that caregivers wear PPE before beginning any procedures on people with known or suspected COVID-19 and performing aerosol-generating procedures, such as CPR, in isolation rooms.

https://www.medpagetoday.com/emergencymedicine/emergencymedicine/95038