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Huang C, Chien C, Ng C, Fang S, Wang M, Lin C, Chen C, Tsai L, Hsu K, Chiu SY. Effects of Dispatcher-Assisted Public-Access Defibrillation Programs on the Outcomes of Out-of-Hospital Cardiac Arrest: A Before-and-After Study. J Am Heart Assoc 2024; 13:e031662. [PMID: 38240326 PMCID: PMC11056141 DOI: 10.1161/jaha.123.031662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/12/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Public access defibrillation (PAD) programs have been implemented globally over the past decade. Although PAD can substantially increase the survival of cardiac arrest, PAD use remains low. This study aimed to evaluate whether drawing upon the successful experiences of dispatcher-assisted cardiopulmonary resuscitation programs would increase the use of PAD in dispatcher-assisted PAD programs. METHODS AND RESULTS This study using a before-and-after design was conducted in Taoyuan City using a local out-of-hospital cardiac arrest registry system and data of dispatcher performance derived from audio recordings. The primary outcomes were the rate of bystander PAD use, sustained return of spontaneous circulation, survival to discharge, and favorable neurological outcomes. The secondary outcomes were the performance of dispatchers in terms of PAD instruction and dispatcher-assisted cardiopulmonary resuscitation administration, the time interval indicators of dispatcher-assisted cardiopulmonary resuscitation. A total of 1159 patients were included and divided into 2 groups: the before-run-in group (502 patients) and the after-run-in group (657 patients). No significant difference was observed between the 2 groups in terms of baseline characteristics. The rate of PAD use in the after-run-in group significantly increased from 5.0% to 8.7% (P=0.015). The rate of favorable neurological outcomes increased from 4.4% to 5.9%, which was not a statistically significant difference. Compared with the before-run-in group, the rate of successful automated external defibrillator acquisition was 13.5% in the after-run-in group (P<0.001). CONCLUSIONS Implementing a dispatcher-assisted PAD protocol in a municipality setting significantly increased bystander PAD use without affecting dispatcher performance in out-of-hospital cardiac arrest recognition, cardiopulmonary resuscitation instruction, or dispatcher-assisted cardiopulmonary resuscitation time indicators.
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Affiliation(s)
- Chien‐Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Graduate Institute of Management, College of ManagementChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineNew Taipei City HospitalNew Taipei CityTaiwan
| | - Cheng‐Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineChang Gung Memorial Hospital Taipei BranchTaipeiTaiwan
- Graduate Institute of Management, College of ManagementChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineTon‐Yen General HospitalZhubeiTaiwan
- Institute of Epidemiology and Preventive Medicine, College of Public HealthNational Taiwan UniversityTaipeiTaiwan
- Department of NursingChang Gung University of Science and TechnologyTaoyuanTaiwan
- Department of Senior Service Industry ManagementMinghsin University of Science and TechnologyHsinchuTaiwan
| | - Chip‐Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineChang Gung Memorial Hospital Taipei BranchTaipeiTaiwan
- Department of NursingChang Gung University of Science and TechnologyTaoyuanTaiwan
| | - Shao‐Yu Fang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ming‐Fang Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Chi‐Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineTon‐Yen General HospitalZhubeiTaiwan
| | - Chen‐Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Emergency MedicineNew Taipei Municipal TuCheng Hospital and Chang Gung UniversityNew Taipei CityTaiwan
| | - Li‐Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Kuang‐Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of MedicineChang Gung UniversityTaoyuanTaiwan
- Department of Health Care Management, College of ManagementChang Gung UniversityTaoyuanTaiwan
- Research Center for Food and Cosmetic Safety, College of Human EcologyChang Gung University of Science and TechnologyTaoyuanTaiwan
- Department of Safety, Health and Environmental EngineeringMing Chi University of TechnologyNew Taipei CityTaiwan
| | - Sherry Yueh‐Hsia Chiu
- Department of Health Care Management, College of ManagementChang Gung UniversityTaoyuanTaiwan
- Division of Hepato‐Gastroenterology, Department of Internal MedicineKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
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Chatterjee NA, Rea TD. Shortening time to defibrillation in shockable cardiac arrest matters: how do we do it? Heart 2023; 109:1344-1345. [PMID: 37169552 DOI: 10.1136/heartjnl-2023-322465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Affiliation(s)
- Neal A Chatterjee
- Deparment of Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Thomas D Rea
- General Internal Medicine, University of Washington, Seattle, Washington, USA
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Kovoor JG, Bacchi S, Gupta AK, Stretton B, Page GJ, Kovoor P. Refining Automated External Defibrillator Signage to Improve Out-of-Hospital Cardiac Arrest Survival. Heart Lung Circ 2023; 32:e51-e52. [PMID: 37673552 DOI: 10.1016/j.hlc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Joshua G Kovoor
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia. http://www.twitter.com/josh.kovoor
| | - Stephen Bacchi
- Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia; Flinders University, Flinders Medical Centre, Adelaide, SA, Australia
| | - Aashray K Gupta
- University of Adelaide, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - Brandon Stretton
- University of Adelaide, Adelaide, SA, Australia; Queen Elizabeth Hospital, Adelaide, SA, Australia; Health and Information, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Gregory J Page
- Heart of the Nation, Sydney, NSW, Australia. http://www.twitter.com/GregPage_Yellow
| | - Pramesh Kovoor
- Heart of the Nation, Sydney, NSW, Australia; Health and Information, Adelaide, SA, Australia; University of Sydney, Westmead Hospital, Sydney, NSW, Australia.
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Scquizzato T, Gamberini L, D'Arrigo S, Galazzi A, Babini G, Losiggio R, Imbriaco G, Fumagalli F, Cucino A, Landoni G, Scapigliati A, Ristagno G, Semeraro F, Bertoncello F, Canalini A, Colelli S, Conti G, Giacometti M, Giuliani G, Graziano A, Mina A, Orazio S, Paoli A, Peratoner A, Pegani C, Roncarati A, Sabetta C, Savastano S, Stella F, Varutti R, Verginella F, Zuliani M. Incidence, characteristics, and outcome of out-of-hospital cardiac arrest in Italy: A systematic review and meta-analysis. Resusc Plus 2022; 12:100329. [DOI: 10.1016/j.resplu.2022.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
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Development and application of "Special defibrillator for teaching and training". Eur J Med Res 2022; 27:33. [PMID: 35236410 PMCID: PMC8889708 DOI: 10.1186/s40001-022-00657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background To provide an economical and practical defibrillator for first aid teaching and training, to reduce the cost of teaching and training, increase teaching and training equipment, provide trainees with more hands-on training sessions, and improve first aid capabilities. Methods Developing a special teaching defibrillator with the same structure and operation configuration as the clinical medical emergency defibrillator. The appearance, structure and operating accessories of the two defibrillators are the same. The difference between the defibrillator and the clinical medical emergency defibrillator are as follows: the clinical medical emergency defibrillator can be energized, and there are expensive electronic accessories and defibrillation accessories for charging and discharging in the machine. When discharging, the electrode plate has current discharged into the human body; the power plug of the “special defibrillator for teaching and training” is a fake plug. When the power is plugged in, no current enters the body and the machine. There are no expensive electronic accessories and defibrillation accessories for charging and discharging, and no current is discharged during discharge. Then compare the teaching effect of the special defibrillator for teaching and training and the clinical medical emergency defibrillator (including operation score and attitude after training). Results The scores of defibrillator operation in the experimental group of junior college students (87.77 ± 4.11 vs. 83.30 ± 4.56, P < 0.001) and the experimental group of undergraduate students (90.40 ± 3.67 vs. 89.12 ± 3.68, P = 0.011) were higher than those in the corresponding control group; The attitude of junior college students in the experimental group and undergraduate students in the experimental group after training was more positive than that of the corresponding control group (P < 0.05). Conclusions The special defibrillator for teaching and training can save the purchase cost of teaching equipment, increase teaching and training resources, and improve the trainee’s defibrillation ability, defibrillation confidence and defibrillation security.
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Heidet M, Tazarourte K, Mermet É, Freyssenge J, Mellouk A, Khellaf M, Lecarpentier É. Accessibilité aux soins en situation d’urgence : des déterminants complexes, un besoin d’outils novateurs. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Les délais d’accès aux soins sont directement associés au pronostic de nombreuses situations et pathologies urgentes telles que l’arrêt cardiaque extrahospitalier, l’accident vasculaire cérébral, l’infarctus du myocarde ou le traumatisme grave. Ils représentent ainsi un critère de qualité et d’efficacité du système préhospitalier. Or, les déterminants de l’accessibilité aux soins urgents, donc des délais de prise en charge préhospitalière jusqu’au soin définitif, sont multiples, intriquant notamment des dimensions organisationnelles, géographiques et socioéconomiques, captées par différentes définitions de l’accessibilité aux soins. La mesure de l’accessibilité aux soins urgents est donc complexe et nécessite l’emploi de méthodes spécifiques. Ses déterminants sont sujets à d’importantes disparités territoriales, tant sur le plan national que local, qui conduisent à de fortes inégalités de santé en situation urgente. L’organisation du système de soins préhospitaliers doit ainsi prendre en compte l’ensemble des définitions de l’accessibilité en vie réelle, afin de répondre à des objectifs de performance ajustés aux enjeux particuliers des pathologies traceuses les plus urgentes. Les prochaines évolutions organisationnelles et technologiques en médecine d’urgence devraient permettre de mieux appréhender les déterminants de l’accessibilité à toutes les phases de la prise en charge préhospitalière, vers un rééquilibrage de l’inadéquation entre les besoins réels et l’offre possible de soins urgents.
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Maximum expected survival rate model for public access defibrillator placement. Resuscitation 2021; 170:213-221. [PMID: 34883217 DOI: 10.1016/j.resuscitation.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
AIM Mathematical optimization of automated external defibrillator (AED) placement has demonstrated potential to improve survival of out-of-hospital cardiac arrest (OHCA). Existing models mostly aim to improve accessibility based on coverage radius and do not account for detailed impact of delayed defibrillation on survival. We aimed to predict OHCA survival based on time to defibrillation and developed an AED placement model to directly maximize the expected survival rate. METHODS We stratified OHCAs occurring in Singapore (2010-2017) based on time to defibrillation and developed a regression model to predict the Utstein survival rate. We then developed a novel AED placement model, the maximum expected survival rate (MESR) model. We compared the performance of MESR with a maximum coverage model developed for Canada that was shown to be generalizable to other settings (Denmark). The survival gain of MESR was assessed through 10-fold cross-validation for placement of 20 to 1000 new AEDs in Singapore. Statistical analysis was performed using χ2 and McNemar's tests. RESULTS During the study period, 15,345 OHCAs occurred. The power-law approximation with R2 of 91.33% performed best among investigated models. It predicted a survival of 54.9% with defibrillation within the first two minutes after collapse that was reduced by more than 60% without defibrillation within the first 4 minutes. MESR outperformed the maximum coverage model with P-value < 0.05 (<0.0001 in 22 of 30 experiments). CONCLUSION We developed a novel AED placement model based on the impact of time to defibrillation on OHCA outcomes. Mathematical optimization can improve OHCA survival.
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