AED

Automatic External Defibrillator Articles

 


 
Resuscitation. 2008 Jun 16.

A national scheme for public access defibrillation in England and Wales: Early results.

Department of Primary Care and Public Health, (Medical Statistics), School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom; Prehospital Emergency Research Unit, School of Medicine, Cardiff University, Lansdowne Hospital, Sanitorium Road, Cardiff CF11 8PL, United Kingdom; The Resuscitation Council (UK), 5th Floor, Tavistock House North, Tavistock Square, London WC1H 9HR, United Kingdom.

BACKGROUND: Automated external defibrillators (AEDs) operated by lay persons are used in the UK in a National Defibrillator Programme promoting public access defibrillation (PAD). METHODS: Two strategies are used: (1) Static AEDs installed permanently in busy public places operated by those working nearby. (2) Mobile AEDs operated by community first responders (CFRs) who travel to the casualty. RESULTS: One thousand five hundred and thirty resuscitation attempts. With static AEDs, return of spontaneous circulation (ROSC) was achieved in 170/437 (39%) patients, hospital discharge in 113/437 (26%). With mobile AEDs, ROSC was achieved in 110/1093 (10%), hospital discharge in 32 (2.9%) (P<0.001 for both variables). More shocks were administered with static AEDS 347/437 (79%) than mobile AEDs 388/1093 (35.5%) P<0.001. Highly significant advantages existed for witnessed arrests, administration of shocks, bystander CPR before arrival of AED and short delays to start CPR and attach AED. These factors were more common with static AEDs. For CFRs, patients at home did less well than those at other locations for ROSC (P<0.001) and survival (P=.006). Patients at home were older, more arrests were unwitnessed, fewer shocks were given, delays to start CPR and attach electrodes were longer. CONCLUSIONS: PAD is a highly effective strategy for patients with sudden cardiac arrest due to ventricular fibrillation who arrest in public places where AEDs are installed. Community responders who travel with an AED are less effective, but offer some prospect of resuscitation for many patients who would otherwise receive no treatment. Both strategies merit continuing development.

 

 

Circulation. 2008 May 13;117(19):2510-4. Epub 2008 May 5

Hands-on defibrillation: an analysis of electrical current flow through rescuers in direct contact with patients during biphasic external defibrillation.

Emory University Hospital, Cardiac Electrophysiology Department, 1364 Clifton Rd NE, Suite F424, Atlanta, GA 30322, USA. michael.lloyd@emoryhealthcare.org

BACKGROUND: Brief interruptions in chest compressions reduce the efficacy of resuscitation from cardiac arrest. Interruptions of this type are inevitable during hands-off periods for shock delivery to treat ventricular tachyarrhythmias. The safety of a rescuer remaining in contact with a patient being shocked with modern defibrillation equipment has not been investigated. METHODS AND RESULTS: This study measured the leakage voltage and current through mock rescuers while they were compressing the chests of 43 patients receiving external biphasic shocks. During the shock, the rescuer's gloved hand was pressed onto the skin of the patient's anterior chest. To simulate the worst case of an inadvertent return current pathway, a skin electrode on the rescuers thigh was connected to an electrode on the patient's shoulder. In no cases were shocks perceptible to the rescuer. Peak potential differences between the rescuer's wrist and thigh ranged from 0.28 to 14 V (mean 5.8+/-5.8 V). The average leakage current flowing through the rescuer's body for each phase of the shock waveform was 283+/-140 microA (range 18.9 to 907 microA). This was below several recommended safety standards for leakage current. CONCLUSIONS: Rescuers performing chest compressions during biphasic external defibrillation are exposed to low levels of leakage current. The present findings support the feasibility of uninterrupted chest compressions during shock delivery, which may enhance the efficacy of defibrillation and cardiocerebral resuscitation.

 


 

Resuscitation. 2008 May;77(2):216-9.
 

Safety of fully automatic external defibrillation by untrained lay rescuers in the presence of a bystander.

Department of Anaesthesiology and Intensive Care Medicine, Liège University Hospital, Liege, Belgium. tony.hosmans@chu.ulg.ac.be

OBJECTIVE: Automated external defibrillators (AEDs) are becoming increasingly available in public places to be used by citizens in case of cardiac arrest. Most AEDs are semi-automatic (SAEDs), but some are fully automatic (FAEDs) and there is ongoing debate and concern that they may lead to inadvertent shocks to rescuers or bystanders because the timing of the shock is not controlled by the rescuer. We therefore compared the behaviour of untrained citizens using an FAED or an SAED in a simulated cardiac arrest scenario. DESIGN AND PARTICIPANTS: One hundred and seventy-six laypeople were randomised to use an FAED or an SAED (Lifepak CR+, Medtronic, Redmond, USA) in a simulated cardiac arrest scenario on a manikin (Ambu, Denmark) where a bystander was touching the victim's upper arm. Each rescuer's performance was recorded on video and analysed afterwards using a modified Cardiff Score. The rescuer or the bystander was considered unsafe if either of them touched the victim during shock delivery. RESULTS: Eleven cases could not be analysed because of technical problems. Fifteen participants violated the protocol making further analysis impossible. Of the remaining 150 participants, 68 used the FAED and 82 used the SAED. The rescuers were safe in 97/150 (65%) cases, without a difference between FAED and SAED. The bystander was safe in 25/68 (37%) cases in the FAED group versus 19/82 (23%) in the SAED group (p=0.07). Combined safety of both rescuer and bystander was observed in 23/68 (34%) cases in the FAED group versus 15/82 (18%) in the SAED group (p=0.03). CONCLUSIONS: Safety was not compromised when untrained lay rescuers used an FAED compared with an SAED. The observation of overall safer behaviour by FAED users in the presence of bystanders may be related to the additional instructions provided by the FAED, and the reduced interaction of the rescuer with the bystander when using the SAED


 
Resuscitation. 2008 Mar;76(3):419-24. Epub 2007 Oct 31.

Public access resuscitation program including defibrillator training for laypersons: a randomized trial to evaluate the impact of training course duration.

Division of Cardiology of the Vivantes Hospital Klinikum Am Urban/Im Friedrichshain, Berlin, Germany. dietrich.andresen@vivantes.de

BACKGROUND: Time to cardiopulmonary resuscitation (CPR) is a main determinant of survival after out-of-hospital cardiac arrest. Only widespread implementation of training courses for laypersons can decrease response time. METHODS AND RESULTS: In this prospective randomized trial, we evaluated how laypersons retained CPR skills and skills in using the automated external defibrillator (AED). A total of 1095 volunteers were randomly assigned to receive CPR/AED-training courses of 2h (375 persons), 4h (378 persons) or 7h (342 persons) duration. Courses were held in accordance with the guidelines for CPR. All trainees were tested immediately after the initial class in a standardized test scenario using an AED and a manikin. Either at 6 or at 12 months, retests were given to 164 and 206 volunteers, respectively. In 479 volunteers, retesting was completed at both 6- and 12-month intervals. At the immediate tests, the 7-h training group showed a slightly higher rate of correct responses (7h: 96%, 4h: 94%, 2h: 92%) (p<0.001). Skill retention decreased significantly in the three groups and was lowest after 12 months if no 6-month retests were done. In trainees who did undergo retesting at 6 months, skills did not deteriorate at 12 months. There were no significant differences between the three groups (overall correct responses: 2h: 72%, 4h: 73%, 7h: 74%) (ns). CONCLUSIONS: A 2-h class is sufficient to acquire and retain CPR and AED skills for an extended time period provided that a brief re-evaluation is performed after 6 months.

 


 
Acad Emerg Med. 2007 Jul;14(7):624-8. Epub 2007 May 31.

Can untrained laypersons use a defibrillator with dispatcher assistance?

Department of Anesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland. heini.harve@helsinki.fi

OBJECTIVES: Automated external defibrillators (AEDs) provide an opportunity to improve survival in out-of-hospital cardiac arrest by enabling laypersons not trained in rhythm recognition to deliver lifesaving therapy. This study was performed to examine whether untrained laypersons could safely and effectively use these AEDs with telephone-guided instructions and if this action would compromise the performance of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation out-of-hospital cardiac arrest. METHODS: Fifty-four conscripts without previous medical education were recruited from the Western Command in Finland. For this study, the participants were divided at random to form teams of two persons. The teams were randomized to dispatcher-assisted CPR with or without AED operation during a simulated ventricular fibrillation out-of-hospital cardiac arrest. The time interval from collapse to first shock, hands-off time, and the quality of CPR were compared between the two groups. RESULTS: The quality of CPR was poor in both groups. The use of an AED did not increase the hands-off time or the time interval to the first compression. Sixty-four percent of the teams in the AED group managed to give the first defibrillatory shock within 5 minutes. CONCLUSIONS: The quality of dispatcher-assisted CPR is poor. Dispatcher assistance in defibrillation by a layperson not trained to use an AED seems feasible and does not compromise the performance of CPR.

 


 

Resuscitation. 2007 Apr;73(1):131-6.

Comparison of hands-off time during CPR with manual and semi-automatic defibrillation in a manikin model.

Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway. morten@pytte.no

BACKGROUND: Rhythm analysis with current semi-automatic external defibrillators (AEDs) requires mandatory interruptions of chest compressions that may compromise the outcome after cardiopulmonary resuscitation (CPR). We hypothesised that interruptions would be shorter when the defibrillator was operated in manual mode by trained and certified ambulance personnel. MATERIALS AND METHODS: Sixteen pairs of ambulance personnel operated the defibrillator (Lifepak((R))12) in both semi-automatic (AED) and manual (MED) mode in a randomised, cross-over manikin CPR study, following the ERC 2000 Guidelines. RESULTS: Median time from last chest compression to shock delivery (with interquartile range) was 17s (13, 18) versus 11s (6, 15) (mean difference (95% CI) 6s (2, 10), p=0.004). Similarly, median time from shock delivery to resumed chest compressions was 25s (22, 26) versus 8s (7, 12) (median difference 13s, p=0.001) in the AED and MED groups, respectively. While sensitivity for identifying ventricular fibrillation (VF) in both modes and specificity in the AED mode were 100%, specificity was 89% in manual mode. Thus, some unwarranted shocks resulting in hands-off time (time without chest compressions) were given in manual mode. However, mean hands-off-ratio (time without chest compressions divided by total resuscitation time) was still lower, 0.2s (0.1, 0.3) versus 0.3s (0.28, 0.32) in manual mode, mean difference 0.10s (0.05, 0.15), p=0.001. CONCLUSION: Paramedics performed CPR with less hands-off time before and after shocks on a manikin with manual compared to semi-automatic defibrillation following the 2000 Guidelines. However, 12% of the shocks given manually were inappropriate.


 

Resuscitation. 2007 Mar;72(3):444-50.

Retention of skills in medical students following minimal theoretical instructions on semi and fully automated external defibrillators.

Department of Anaesthesiology, University Hospital Aachen, Germany. sbeckers@ukaachen.de

AIM OF THE STUDY: There is consent that the use of automated external defibrillators (AED) by laypersons improves survival rates in case of cardiac arrest, but no evident consensus exists on the content and duration of training for this purpose. Acceptance of the implementation of Public Access Defibrillation programmes will depend on practical and target-oriented training concepts. The aim of this prospective randomised interventional study was to evaluate long-term effects of a specific, minimal training programme on using semiautomatic and fully automatic AEDs in simulated cardiac arrest. MATERIALS AND METHODS: In a mock cardiac arrest scenario 59 medical students with no specific previous medical education were tested during their first semester at medical school. Students who passed any medical emergency training were excluded. The subjects were evaluated before and after attending specified instructions of 15 min duration and after a period of 6 months. Main end points were time to first shock, electrode-positioning and safety throughout the procedure. RESULTS: Mean time to first shock without prior instructions was 77.7+/-17.05 s. After instruction there was a significant improvement to 56.5+/-9.5 s (p<or=0.01) and after 6 months this time had only slightly elongated (59.9+/-8.9 s; p<or=0.01). Initially, correct electrode placement was observed in 84.4%. No difference was found immediately and 6 months after instructions (93.2% and 98.3%). All individuals performed safely. CONCLUSION: First year medical students with minimal instruction are able to use semiautomatic as well as fully automatic AED sufficiently fast and safe without prior training. A significant improvement in time to first shock can


 

Acad Emerg Med. 2006 Jun;13(6):659-65. Epub 2006 Apr 24. Links

Automated external defibrillator program does not impair cardiopulmonary resuscitation initiation in the public access defibrillation trial.

Center for Policy & Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health Sciences University, Portland, OR 97239-3098, USA. hedgesj@ohsu.edu

OBJECTIVES: To evaluate whether automated external defibrillator (AED) training and AED availability affected the response of volunteer rescuers and performance of cardiopulmonary resuscitation (CPR) in presumed out-of-hospital cardiac arrest (OOH-CA) during the multicenter Public Access Defibrillation Trial. METHODS: The Public Access Defibrillation Trial recruited 1,260 facilities in 24 North American regional sites to participate in a trial addressing survival from OOH-CA when AED training and availability were added to a volunteer-based emergency response team. Volunteers at each facility were trained to perform either CPR alone (CPR) or CPR in conjunction with AED use (CPR+AED) according to randomized assignments. This study reports the frequency of response and initiation of CPR actions (chest compressions and/or ventilations) by volunteers in the CPR and CPR+AED study groups. RESULTS: A total of 314 presumed OOH-CA episodes occurred in CPR facilities, and 308 occurred in CPR+AED facilities. The volunteers were matched well for age, gender, and other features. Overall, ventilations (23.1% vs. 13.1%), chest compressions (24.4% vs. 12.1%), and both actions (19.8% vs. 10.5%; all p < 0.05) were more commonly performed in OOH-CA cases in the CPR+AED group. However, when only OOH-CA cases with volunteers responding were analyzed, the rates of CPR actions were similar. In the subgroup of CPR+AED cases with a responding volunteer, the AED was turned on for only 47% of cases. Volunteers initiated a CPR action more commonly when the AED was turned on (60.7% vs. 39.3%; p = 0.003). CONCLUSIONS: In the Public Access Defibrillation Trial, rates of CPR actions for presumed OOH-CA victims were low but similar for CPR and CPR+AED responding volunteer rescuers. Factors associated with volunteer response, CPR action initiation, and AED activation warrant further investigation.

 


 
Acad Emerg Med. 2006 Mar;13(3):254-63.
 

How well are cardiopulmonary resuscitation and automated external defibrillator skills retained over time? Results from the Public Access Defibrillation (PAD) Trial.

School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6096, USA. briegel@nursing.upenn.edu

BACKGROUND: The current standard for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) retraining for laypersons is a four-hour course every two years. Others have documented substantial skill deterioration during this time period. OBJECTIVES: To evaluate 1) the retention of core CPR and AED skills among volunteer laypersons and 2) the time required to retrain laypersons to proficiency as a function of time since initial training. METHODS: This was an observational follow-up study evaluating CPR and AED skill retention and testing/retraining time up through 17 months after initial training. The study took place at 1,260 facilities recruited by 24 North American clinical research centers, and included 6,182 volunteer laypersons participating in the Public Access Defibrillation (PAD) Trial. Training to proficiency in either CPR only (N = 2,426) or CPR+AED (N = 3,756) was followed by testing/retraining provided three to 17 months later. Retraining was done in brief, one-on-one, individualized, interactive sessions. The outcome studied was instructors' global assessments of performance of CPR and AED skill adequacy, i.e., whether CPR actions would likely result in perfusion (yes/no) and whether AED actions would result in a shock through the heart (yes/no). RESULTS: For global CPR performance, 79%, 73%, and 71% of volunteers tested for the first time since initial training three to five, six to 11, and 12 to 17 months after initial training, respectively, were judged by their instructors as having adequate performance (p < 0.001, chi-square for linear trend). For global AED performance, 91%, 86%, and 84% of volunteers, respectively, were judged as having adequate performance (p < 0.001). The mean (+/- standard deviation) times required to test and retrain volunteers to proficiency were 5.7 (+/- 4.0) minutes for CPR skills and 7.7 (+/- 4.6) minutes for CPR+AED skills. CONCLUSIONS: Among PAD Trial volunteer laypersons participating in a simulated resuscitation, the proportions of volunteers judged by instructors to have adequate CPR and AED skills demonstrated small declines associated with longer intervals between initial training and subsequent testing. However, based on instructors' judgment, large majorities of volunteers still retained both CPR and AED core skills through 17 months after initial training. Furthermore, individual testing and retraining for CPR and AED skills were usually accomplished in less than 10 minutes per volunteer. Additional research is essential to identify training and evaluation techniques that predict adequate CPR and AED skill performance of laypersons when applied to an actual cardiac arrest.

 


 
Am Heart J. 2005 Nov;150(5):927-32.
 

Predictors of cardiopulmonary resuscitation and automated external defibrillator skill retention.

School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-6096, USA. briegel@nursing.upenn.edu

BACKGROUND: Few data exist regarding the retention of cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills over time in relationship to characteristics of lay volunteer responders, training, or risk of exposure to victims. The purpose of this study was to describe the characteristics associated with adequate CPR and AED skill retention. METHODS AND RESULTS: Skill retention was tested 3 to 18 months (mean 6.9 +/- 3.5 months) after initial training. Instructors judged adequacy of performance of essential CPR or AED skills and provided an overall assessment (adequate/inadequate), which was used as the outcome. Data on 7261 laypersons trained in CPR (4358 also received AED training) in 24 sites across the United States and Canada were available from the Public Access Defibrillation (PAD) Trial. Characteristics of the volunteers, classes, and facilities were evaluated as predictors of performance adequacy. Adjusting for site, intervention assignment (CPR-only or CPR + AED), and time since initial training, volunteer characteristics associated with adequate CPR performance were age (OR 0.78 per 10-year increment), male sex (OR 1.44), minority (OR 0.62), married (OR 1.35), prior emergency experience (OR 1.66), prior CPR class (OR 1.68), prior advanced training (OR 1.59), and extracurricular CPR training (OR 1.91) (all P < .05). Characteristics associated with AED performance included age (OR 0.69), college education (OR 1.34), and native language other than English (OR 0.51) (all P < .05). CONCLUSIONS: Certain subgroups of lay volunteers may need targeted outreach programs in CPR and AED use, classes with longer training time, more practice, or more intense retraining to maintain their CPR and/or AED skills.

 


 

Acad Emerg Med. 2005 Aug;12(8):688-97. Links

Implementation of community-based public access defibrillation in the PAD trial.

Department of Emergency Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1620, New York, NY 10029, USA. lynne.richardson@mssm.edu

BACKGROUND: The Public Access Defibrillation (PAD) Trial was a randomized, controlled trial designed to measure survival to hospital discharge following out-of-hospital cardiac arrest (OOH-CA) in community facilities trained and equipped to provide PAD, compared with community facilities trained to provide cardiopulmonary resuscitation (CPR) without any capacity for defibrillation. OBJECTIVES: To report the implementation of community-based lay responder emergency response programs in 1,260 participating facilities recruited for the PAD Trial in the United States and Canada. METHODS: This was a descriptive study of the characteristics of participating facilities, volunteers, and automated external defibrillator (AED) placements compiled by the PAD Trial, and a qualitative study of factors that facilitated or impeded implementation of emergency lay responder programs using focus groups of PAD Trial site coordinators. RESULTS: The PAD Trial enrolled 1,260 community facilities (14.8% residential), with 20,400 lay volunteers (mean +/- standard deviation = 13.4 +/- 10.7 per facility) trained to respond to OOH-CA. The 598 locations randomized to receive AEDs required 2.7 +/- 1.8 AEDs per facility. Volunteer attrition was high, 36% after two years. Barriers to recruitment and implementation included identification of appropriate "at-risk" facilities, lack of interest or fear of litigation by a facility key decision maker, lack of motivated potential volunteer responders, training and retraining resource requirements, and lack of an existing communication/response infrastructure. CONCLUSIONS: These data indicate that implementation of community-based lay responder programs is feasible in many types of facilities, although these programs require substantial resources and commitment, and many barriers to implementation of effective PAD programs exist.

 


 

Circulation. 2005 Jun 21;111(24):3336-40.

Lay rescuer automated external defibrillator ("public access defibrillation") programs: lessons learned from an international multicenter trial: advisory statement from the American Heart Association Emergency Cardiovascular Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Council on Clinical Cardiology.

Lay rescuer automated external defibrillator (AED) programs may increase the number of people experiencing sudden cardiac arrest who receive bystander cardiopulmonary resuscitation (CPR), can reduce time to defibrillation, and may improve survival from sudden cardiac arrest. These programs require an organized and practiced response, with rescuers trained and equipped to recognize emergencies, activate the emergency medical services system, provide CPR, and provide defibrillation. To determine the effect of public access defibrillation (PAD) programs on survival and other outcomes after SCA, the National Heart, Lung, and Blood Institute, the American Heart Association (AHA), and others funded a large prospective randomized trial. The results of this study were recently published in The New England Journal of Medicine and support current AHA recommendations for lay rescuer AED programs and emphasis on planning, training, and practice of CPR and use of AEDs. The purpose of this statement is to highlight important findings of the Public Access Defibrillation Trial and summarize implications of these findings for healthcare providers, healthcare policy advocates, and the AHA training network.

 


 

Am J Cardiol. 2005 Jun 15;95(12):1484-6

Effectiveness of automated external defibrillators in high schools in greater Boston.

New England Cardiac Arrhythmia Center, Cardiology Division, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.

A program using a strategy of donating a single automatic external defibrillator to 35 schools in the Boston area resulted in compliance with American Heart Association guidelines on automatic external defibrillator placement and training and 2 successful resuscitations from sudden cardiac arrest. Participating schools indicated a high degree of satisfaction with the program.

 


 

Crit Care. 2005 Apr;9(2):R110-6.

Minimal instructions improve the performance of laypersons in the use of semiautomatic and automatic external defibrillators.

Department of Anaesthesiology, University Hospital Aachen, Aachen, Germany. sbeckers@ukaachen.de

INTRODUCTION: There is evidence that use of automated external defibrillators (AEDs) by laypersons improves rates of survival from cardiac arrest, but there is no consensus on the optimal content and duration of training for this purpose. In this study we examined the use of semiautomatic or automatic AEDs by laypersons who had received no training (intuitive use) and the effects of minimal general theoretical instructions on their performance. METHODS: In a mock cardiac arrest scenario, 236 first year medical students who had not previously attended any preclinical courses were evaluated in their first study week, before and after receiving prespecified instructions (15 min) once. The primary end-point was the time to first shock for each time point; secondary end-points were correct electrode pad positioning, safety of the procedure and the subjective feelings of the students. RESULTS: The mean time to shock for both AED types was 81.2 +/- 19.2 s (range 45-178 s). Correct pad placement was observed in 85.6% and adequate safety in 94.1%. The time to shock after instruction decreased significantly to 56.8 +/- 9.9 s (range 35-95 s; P < or = 0.01), with correct electrode placement in 92.8% and adequate safety in 97%. The students were significantly quicker at both evaluations using the semiautomatic device than with the automatic AED (first evaluation: 77.5 +/- 20.5 s versus 85.2 +/- 17 s, P < or = 0.01; second evaluation: 55 +/- 10.3 s versus 59.6 +/- 9.6 s, P < or = 0.01). CONCLUSION: Untrained laypersons can use semiautomatic and automatic AEDs sufficiently quickly and without instruction. After one use and minimal instructions, improvements in practical performance were significant. All tested laypersons were able to deliver the first shock in under 1 min.


 

J Cardiovasc Nurs. 2004 Nov-Dec;19(6):384-9.Click here to read Links

Public defibrillation: increased survival from a structured response system.

Clinical Trial Center, University of Washington, Seattle, Wash., USA. jlpowell@u.washington.edu

The Public Access Defibrillation (PAD) trial was a prospective, randomized, controlled study designed to compare the number of persons surviving to hospital discharge after experiencing an out-of-hospital cardiac arrest (OOH-CA) among "community units" randomized to receive cardiopulmonary resuscitation (CPR) only or CPR plus an automated external defibrillator (AED). In 24 centers across the United States and Canada, 993 community units, composed of 1260 individual facilities, trained more than 19,000 layperson responders in CPR-only or CPR+AED. Survival to hospital discharge in the CPR+AED arm was double that of the CPR-only arm (30 vs 15, P = .03; RR = 2.0, 95% CI [1.07-3.77]). Intense focus on facility infrastructure, including responder recruitment and training, communication, evaluation, and oversight, was necessary for implementing the emergency response systems for the trial. Use of an AED within this structured response system can increase the number of survivors to hospital discharge after OOH-CA. Trained nonmedical responders can use AEDs safely and effectively.


 

Resuscitation. 2004 Oct;63(1):43-8.

Automated external defibrillation by untrained deaf lay rescuers.

Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy. sandroni@rm.unicatt.it

INTRODUCTION: The use of automated external defibrillators (AEDs) by lay rescuers can reduce the time to defibrillation, improving survival after out-of-hospital cardiac arrest. However, some people have hearing defects that can prevent them from understanding the AED verbal prompts. Moreover, even rescuers with normal hearing function may not easily understand the AED verbal prompts when operating in a noisy environment. This study was designed to assess the capability of rescuers to defibrillate effectively using an AED which included visual prompts. METHODS AND RESULTS: Nine deaf employees with no previous experience in basic life support (BLS) or defibrillation were asked to defibrillate a manikin following the text prompts of a Heartstart FR2+ AED. Subjects were tested before and after a 6 h BLS-AED course carried out with the help of a sign language interpreter. Before training, seven out of nine deaf subjects (78%) were able to defibrillate, eight out of nine subjects (89%) placed the pads correctly, and the mean time to defibrillation was 101.3 +/- 28.4 s. After the course, all subjects were able to complete the defibrillation sequence and place the pads correctly. The mean post-course time to defibrillation was 47.8 +/- 5.4 s (P < 0.001). None of the nine subjects touched the manikin during charging of the defibrillator and shock delivery before or after the course. CONCLUSIONS: This study demonstrates that untrained deaf rescuers can use AEDs appropriately providing that the defibrillator has visual instructions. Training improves defibrillator use and reduces time to defibrillation.


 

Prehosp Emerg Care. 2004 Jul-Sep;8(3):284-91.

Automated external defibrillator use by untrained bystanders: can the public-use model work?

Interface Analysis Associates, Morgan Hill, California 95037, USA. andre@interface-analysis.com

OBJECTIVE: For automated external defibrillators (AEDs) to be practical for broad public use, responders must be able to use them safely and effectively. This study's objective was to determine whether untrained laypersons could accurately follow the visual and voice prompt instructions of an AED. METHODS: Each of four different AED models (AED1, AED2, AED3, and AED4) was randomly assigned to a different group of 16 untrained volunteers in a simulated cardiac arrest. Four usability indicators were observed: 1) number of volunteers able to apply the pads to the manikin skin, 2) appropriate pad positioning, 3) time from room entry to shock delivery, and 4) safety in terms of touching the patient during shock delivery. RESULTS: Some of the 64 volunteers who participated in the study failed to open the pad packaging or remove the lining, or placed the pads on top of clothing. Fifty-percent of AED2 pads and 44% of AED3 pads were not placed directly on the manikin skin compared with 100% of AED1 and AED4 pads. Adjacent pad displacements that potentially could affect defibrillation efficacy were observed in 6% of AED1, 11% of AED2, 0% of AED3, and 56% of AED4 usages. Time to deliver a shock was within 3.5 minutes for all AEDs, although the median times for AED1 and AED4 were the shortest at 1.6 and 1.7 minutes, respectively. No significant volunteer contact with the manikin occurred during shock delivery. CONCLUSIONS: This study demonstrated that the AED user interface significantly influences the ability of untrained caregivers to appropriately place pads and quickly deliver a shock. Avoiding grossly inappropriate pad placement and failure to place AED pads directly on skin may be correctable with improvements in the AED instruction user interface.


 

Resuscitation. 2004 Jan;60(1):17-28. Links

Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study.

Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust and University of Wales Colleges of Medicine, Finance Building, Lansdowne Hospital, Sanatorium Road, Cardiff CF 11 8 PL, UK. malcolm.woollard@emergency-research.co.uk

This prospective study evaluated the acquisition and retention of skills in cardio-pulmonary resuscitation (CPR) and the use of the automated external defibrillator (AED) by lay volunteers involved in the Department of Health, England National Defibrillator Programme. One hundred and twelve trainees were tested immediately before and after and initial 4-h class; 76 were similarly reassessed at refresher training 6 months later. A standardised test scenario that required assessment of the casualty, CPR and the use of on AED was evaluated using recording manikin data and video recordings. Before training only 44% of subjects delivered a shock. Afterwards, all did so and the average delay to first shock was reduced by 57 s. All trainees placed the defibrillator electrodes in an "acceptable" position after training, but very few did so in the recommended "ideal" position. After refresher training 80% of subjects used the correct sequence for CPR and shock delivery, yet a third failed to perform adequate safety checks before all shocks. The trainees self-assessed AED competence score was 86 (scale 0-100) after the initial class and their confidence that they would act in a real emergency was rated at a similar level. Initial training improved performance of all CPR skills, although all except compression rate had deteriorated after 6 months. The proportion of subjects able to correctly perform most CPR skill was higher following refresher training that after the initial class. Although this course was judged to be effective in teaching delivery of counter-shocks, the need was identified for more emphasis on positioning of electrodes, pre-shock safety checks, airway opening, ventilation volume, checking for signs of a circulation, hand positioning, and depth and rate of chest compressions.


 

 
Resuscitation. 2003 Nov;59(2):225-33.

AED use in businesses, public facilities and homes by minimally trained first responders.

Philips Medical Systems, 2301 5th Avenue, Suite 200, Seattle, WA 98121, USA. dawn.jorgenson@philips.com

BACKGROUND: Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated. In addition, minimally trained responders were asked if they had encountered any safety problems associated with the AED. METHODS: We conducted a telephone survey of businesses and public facilities (2683) and homes (145) owning at least one AED for at least 12 months. Use was defined as an AED taken to a medical emergency thought to be a SCA, regardless of whether the AED was applied to the patient or identified a shockable rhythm. RESULTS: Of owners that participated in the survey, 13% (209/1581) of businesses and 5% (4/73) of homes had responded with the AED to a suspected cardiac arrest. Ninety-five percent of the businesses/public facilities offered training that specifically covered AED use. The rate of use for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per year. In-depth interviews were conducted with lay responders who had used the AED in a suspected cardiac arrest. In the four cases where the AED was used solely by a lay responder, all four patients survived to hospital admission and two were known to be discharged from the hospital. There were no reports of injury or harm. CONCLUSIONS: This survey demonstrates that AEDs purchased by businesses and homes were frequently taken to suspected cardiac arrests. Lay responders were able to successfully use the AEDs in emergency situations. Further, there were no reports of harm or injury to the operators, bystanders or patients from lay responder use of the AEDs.


 


 

Resuscitation 2000 Apr;44(2):97-104

Cardiac arrest outcomes at the Melbourne Cricket Ground and shrine of remembrance using a tiered response strategy-a forerunner to public access defibrillation.

Wassertheil J, Keane G, Fisher N, Leditschke JF

St John Ambulance Australia, Melbourne, Victoria. JWassertheil@phcn.vic.gov.au

 

The provision of medical, paramedical and first aid services at major public events is an important concern for pre-hospital emergency medical care providers. Patient outcomes of a cardiac arrest response strategy employed at the Melbourne Cricket Ground (MCG) and the Shrine of Remembrance by St John Ambulance Australia volunteers are reported. Twenty-eight consecutive events occurring between December 1989 and December 1997 have been analysed. Included are three cardiac arrests managed at ANZAC day parades utilising the same response strategy by the same unit. The incidence of cardiac arrest at the MCG was 1:500000 attendances. Of the 28 patients, 24 (86%) left the venue alive and 20 (71%) were discharged home from hospital. In all cases the initial rhythm was ventricular fibrillation (VF). All 26 patients (93%) who were defibrillated by St John teams had this intervention within 5 min from the documented time of collapse. One patient in VF spontaneously reverted during CPR. Of the eight fatalities, four died at the scene. At major public venues and events, a co-ordinated emergency life support provision strategy, tailor made for the venue, is necessary for the delivery of prompt CPR, timely defibrillation and advanced life support.

 


 

Prehosp Emerg Care 2000 Oct-Dec;4(4):314-7

Automated external defibrillators in long-term care facilities are cost-effective.

Foutz RA, Sayre MR

Department of Emergency Medicine, University of Cincinnati College of Medicine, Ohio 42567-0769, USA.

 

OBJECTIVE: To assess the cost per life saved of equipping long-term care facilities (LTCFs) with automated external defibrillators (AEDs). METHODS: Outcomes for cardiac arrests within LTCFs were retrieved for 1994 to 1997 from a comprehensive out-of-hospital cardiac arrest registry in a mid-sized U.S. city. The total expense for all LTCFs to obtain and maintain AEDs and to educate and maintain staff skill was estimated for a theoretical four-year period. The cost per life saved to the time of hospital discharge was calculated based on an estimated survival rate of 25% of patients found in ventricular fibrillation (VF) with placement of AEDs in LTCFs. A sensitivity analysis that varied survival rates and costs was conducted. RESULTS: Over four years, there were 160 actual arrests in 43 LTCFs, with a hospital discharge survival rate of 2/160. Twenty of 160 presented to emergency medical services in VF. Training costs for four years were $1,225 per AED. Purchase and maintenance expenses for one AED over four years were $3,941. Placing AEDs in LTCFs would cost $87,837 per life saved if 25% of patients found in VF survived to hospital discharge. Sensitivity analysis using survival rates of 5%, 15%, and 35% established the cost per life saved at $439,184, $146,395, and $62,741, respectively. When costs were calculated at one-half and twice the estimated expense, the cost per life saved was $43,918 and $175,674, respectively. CONCLUSION: Placing AEDs in LTCFs is cost-effective at $87,837 per life saved, if a hospital discharge survival rate of 25% of patients in VF can be achieved.

 


 

Circulation. 1999 Oct 19;100(16):1703-7.

Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator.

Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA.

BACKGROUND: Survival after out-of-hospital cardiac arrest (OHCA) is strongly influenced by time to defibrillation. Wider availability of automated external defibrillators (AEDs) may decrease response times but only with increased lay use. Consequently, this study endeavored to improve our understanding of AED use in naive users by measuring times to shock and appropriateness of pad location. We chose sixth-grade students to simulate an extreme circumstance of unfamiliarity with the problem of OHCA and defibrillation. The children's AED use was then compared with that of professionals. METHODS AND RESULTS: With the use of a mock cardiac arrest scenario, AED use by 15 children was compared with that of 22 emergency medical technicians (EMTs) or paramedics. The primary end point was time from entry onto the cardiac arrest scene to delivery of the shock into simulated ventricular fibrillation. The secondary end point was appropriateness of pad placement. All subject performances were videotaped to assess safety of use and compliance with AED prompts to remain clear of the mannequin during shock delivery. Mean time to defibrillation was 90+/-14 seconds (range, 69 to 111 seconds) for the children and 67+/-10 seconds (range, 50 to 87 seconds) for the EMTs/paramedics (P<0.0001). Electrode pad placement was appropriate for all subjects. All remained clear of the "patient" during shock delivery. CONCLUSIONS: During mock cardiac arrest, the speed of AED use by untrained children is only modestly slower than that of professionals. The difference between the groups is surprisingly small, considering the naïveté of the children as untutored first-time users. These findings suggest that widespread use of AEDs will require only modest training.

 


 

Br J Gen Pract 1999 Apr;49(441):297-8

The role of automated external defibrillators in rural general practice.

Hanley K, Dowling J, Bury G, Murphy A

University College Galway, Republic of Ireland.

 

In a questionnaire survey (100% response rate) investigating the availability and use of automated external defibrillators (AEDs), it was found that the success rate (number discharged alive) compared favourably with pre-hospital defibrillation by other providers, and that AEDs aided the management of dysrhythmias not commonly seen in general practice. With appropriate training they are useful in rural general practice.  

 


 

Prehosp Emerg Care 1999 Oct-Dec;3(4):303-5

Public-access defibrillation: where do we place the AEDs?

Gratton M, Lindholm DJ, Campbell JP

University of Missouri-Kansas City School of Medicine and Department of Emergency Medicine, Truman Medical Center 64108, USA. mgratton@cctr.umkc.edu

 

BACKGROUND: Many prehospital cardiac arrests occur in public places. Even the best EMS systems have a finite response time. Therefore, it has been recommended that automated external defibrillators (AEDs) be placed in public areas for immediate access by trained members of the general public. OBJECTIVE: To determine the locations of multiple cardiac arrests in order to plan for placement of public-access AEDs. METHODS: Retrospective review of all primary cardiac arrests in calendar year 1997. Cardiac arrests in which resuscitation was not attempted (DOA), traumatic cases, pediatric cases, and those due to "other" causes were excluded. Location of the cardiac arrest was obtained from the ambulance run ticket. The EMS system is an urban, Midwestern, all-ALS, public-utility model system with fire department first responders that transports approximately 58,000 patients annually. RESULTS: There was scene response to 922 cardiac arrests. 377 DOAs and 219 nonprimary cardiac arrests were excluded. There were 326 primary cardiac arrests. Sixteen locations had more than one cardiac arrest: 11 locations had two cardiac arrests, four locations had three cardiac arrests, and one location had four cardiac arrests. The airport, an airline overhaul facility, a casino, and two hotels each had two cardiac arrests; the other locations of multiple cardiac arrests were in nursing homes. The professional sports stadiums had no cardiac arrests. CONCLUSIONS: Since very few locations had more than one cardiac arrest, it may be difficult to identify high-yield public places in which to place an AED. Nursing homes may want to consider AED availability.

 


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