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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation. Circulation 2022; 145:e776-e801. [PMID: 35164535 DOI: 10.1161/cir.0000000000001013] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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Brooks SC, Clegg GR, Bray J, Deakin CD, Perkins GD, Ringh M, Smith CM, Link MS, Merchant RM, Pezo-Morales J, Parr M, Morrison LJ, Wang TL, Koster RW, Ong MEH. Optimizing outcomes after out-of-hospital cardiac arrest with innovative approaches to public-access defibrillation: A scientific statement from the International Liaison Committee on Resuscitation. Resuscitation 2022; 172:204-228. [PMID: 35181376 DOI: 10.1016/j.resuscitation.2021.11.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge. To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address. The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behavior change approaches, optimization of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors. We provide evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.
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Fortington LV, Bekker S, Finch CF. Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study. Emerg Med J 2020; 37:617-622. [PMID: 32546475 PMCID: PMC7525771 DOI: 10.1136/emermed-2019-208781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. METHODS This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. RESULTS Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. CONCLUSIONS This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.
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Affiliation(s)
- Lauren V Fortington
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sheree Bekker
- Department for Health, University of Bath, Bath, Somerset, UK
| | - Caroline F Finch
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Smith CM, Lim Choi Keung SN, Khan MO, Arvanitis TN, Fothergill R, Hartley-Sharpe C, Wilson MH, Perkins GD. Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 3:264-273. [PMID: 29044399 DOI: 10.1093/ehjqcco/qcx023] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 07/12/2017] [Indexed: 11/14/2022]
Abstract
Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543.
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Affiliation(s)
- Christopher M Smith
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | | | - Mohammed O Khan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry CV4 7AL, UK
| | | | - Rachael Fothergill
- London Ambulance Service NHS Trust, 18-20 Pocock Street, London SE1 0BW, UK
| | | | - Mark H Wilson
- Imperial College, Neurotrauma Centre, St Mary's Hospital, Praed Street, London W2 1NY, UK
| | - Gavin D Perkins
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
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Yoon CG, Jeong J, Kwon IH, Lee JH. Availability and use of public access defibrillators in Busan Metropolitan City, South Korea. SPRINGERPLUS 2016; 5:1524. [PMID: 27652097 PMCID: PMC5017999 DOI: 10.1186/s40064-016-3201-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/01/2016] [Indexed: 11/14/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is considered an important health issue worldwide, and early defibrillation is a key element for a favourable prognosis. In South Korea, public access defibrillation (PAD) programmes were initiated in 2007. However, the impact of PAD programmes on OHCA survival rates remains unclear. This study evaluated the deployment and maintenance status of public automatic external defibrillators (AED), including how frequently they were used, in Busan Metropolitan City, South Korea. Managers of possible AED sites were first contacted by telephone and asked to confirm the possession of an AED. AED suppliers were contacted for AED sales records to identify missing AED sites. AEDs located in ambulances and medical institutions were not included. Investigators visited confirmed AED sites and completed a checklist on AED maintenance and use. In total, 206 AEDs were located, indicative of an AED density of 0.268 AED/km2 and a prevalence of 6.07 per 100,000 in Busan Metropolitan City. We found that public AEDs had been used for resuscitation only 15 times, an average rate of use of once every 26.3 years. Our results indicate that AEDs in Busan Metropolitan City are underused according to the guidelines, and several are in low-priority locations. We believe that AED deployment based on cardiac arrest statistics is important to optimise layperson AED training and utilisation.
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Affiliation(s)
- Chang Guk Yoon
- Department of Emergency Medicine, Dong-A University Hospital, Busan, 49201 Republic of Korea
| | - Jinwoo Jeong
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, 49201 Republic of Korea
| | - In Ho Kwon
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, 49201 Republic of Korea
| | - Jae Hoon Lee
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, 49201 Republic of Korea
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Rumsfeld JS, Brooks SC, Aufderheide TP, Leary M, Bradley SM, Nkonde-Price C, Schwamm LH, Jessup M, Ferrer JME, Merchant RM. Use of Mobile Devices, Social Media, and Crowdsourcing as Digital Strategies to Improve Emergency Cardiovascular Care. Circulation 2016; 134:e87-e108. [DOI: 10.1161/cir.0000000000000428] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.
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Affiliation(s)
- Michael Ackerman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - Dianne L Atkins
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - John K Triedman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.).
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Mao RD, Ong MEH. Public access defibrillation: improving accessibility and outcomes. Br Med Bull 2016; 118:25-32. [PMID: 27034442 PMCID: PMC5127419 DOI: 10.1093/bmb/ldw011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Worldwide, out-of-hospital cardiac arrest (OHCA) remains a serious problem. Public access defibrillation (PAD) has been shown to be effective in improving survival in OHCA with good neurological outcome. SOURCES OF DATA Original articles, reviews and national/international guidelines. AREAS OF AGREEMENT Limitations to how much we can improve ambulance response times mean that the public have an essential role to play in OHCA survival. Training of laypersons in the use of automated external defibrillators (AEDs) has been shown to improve outcomes. Placement of AEDs should be related to underlying population demographics. AREAS OF CONTROVERSY Placements of AEDs face cost constraints. PAD programs also face challenges in the upkeep of AEDs. Concerns about legal liability for lay rescuers to act remain. GROWING POINTS Systematic programs should be in place to train the public in PAD. All AEDs should be listed in national registries and available for usage in an emergency. AREAS TIMELY FOR DEVELOPING RESEARCH 'Smart' technology is being developed to improve accessibility of AEDs.
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Affiliation(s)
- Renhao Desmond Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore
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Lijovic M, Bernard S, Nehme Z, Walker T, Smith K. Public access defibrillation—results from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation 2015; 85:1739-44. [PMID: 25449346 DOI: 10.1016/j.resuscitation.2014.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/12/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
Abstract
AIM To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). METHODS We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. RESULTS Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p < 0.001). First defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p < 0.001). Unadjusted survival to hospital discharge for bystander defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p < 0.05). Multivariable logistic regression analysis showed that first defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. CONCLUSION Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.
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Mobile Versus Fixed Deployment of Automated External Defibrillators in Rural EMS. Prehosp Disaster Med 2015; 30:152-4. [DOI: 10.1017/s1049023x1500014x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionThere is no consensus on where automated external defibrillators (AEDs) should be placed in rural communities to maximize impact on survival from cardiac arrest. In the community of Stokes County, North Carolina (USA) the Emergency Medical Services (EMS) system promotes cardiopulmonary resuscitation (CPR) public education and AED use with public access defibrillators (PADs) placed mainly in public schools, churches, and government buildings.Hypothesis/ProblemThis study tested the utilization of AEDs assigned to first responders (FRs) in their private-owned-vehicle (POV) compared to AEDs in fixed locations.MethodsThe authors performed a prospective, observational study measuring utilization of AEDs carried by FRs in their POV compared to utilization of AEDs in fixed locations. Automated external defibrillator utilization is activation with pads placed on the patient and analysis of heart rhythm to determine if shock/no-shock is indicated. The Institutional Review Board of Wake Forest University Baptist Health System approved the study and written informed consent was waived. The study began on December 01, 2012 at midnight and ended on December 01, 2013 at midnight.ResultsDuring the 12-month study period, 81 community AEDs were in place, 66 in fixed locations and 15 assigned to FRs in their POVs. No utilizations of the 66 fixed location AEDs were reported (0.0 utilizations/AED/year) while 19 utilizations occurred in the FR POV AED study group (1.27 utilizations/AED/year; P<.0001). Odds ratio of using a FR POV located AED was 172 times more likely than using a community fixed-location AED in this rural community.DiscussionPlacing AEDs in a rural community poses many challenges for optimal utilization in terms of cardiac arrest occurrences. Few studies exist to direct rural community efforts in placing AEDs where they can be most effective, and it has been postulated that placing them directly with FRs may be advantageous.ConclusionsIn this rural community, the authors found that placing AED devices with FRs in their POVs resulted in a statistically significant increase in utilizations over AED fixed locations.NelsonRD, BozemanW, CollinsG, BooeB, BakerT, AlsonR. Mobile versus fixed deployment of automated external defibrillators in rural EMS. Prehosp Disaster Med. 2015;30(2):1-3.
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Huig IC, Boonstra L, Gerritsen PC, Hoeks SE. The availability, condition and employability of automated external defibrillators in large city centres in the Netherlands. Resuscitation 2014; 85:1324-9. [DOI: 10.1016/j.resuscitation.2014.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/06/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
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Abstract
PURPOSE OF REVIEW Public access defibrillation programs have increased dramatically over the past 15 years. This review will focus on their effectiveness and operational characteristics and discuss the characteristics of successful programs, which can improve outcomes. RECENT FINDINGS Automated external defibrillators increase survival from cardiac arrest when used by a bystander. Recent studies show that the best outcomes are achieved when devices are placed in areas with a high frequency of cardiac arrest and there is ongoing supervision with emergency plans and cardiopulmonary resuscitation training. Programs are cost-effective under these circumstances, but become very inefficient when placed in areas of low risk. There are few adverse events related to the public access defibrillation programs and volunteers are not harmed. Unguided placement results in devices not being used and a decline in organizational structure of the program. As most cardiac arrests occur in the home, the impact on overall survival remains low. SUMMARY Automated external defibrillators are highly effective at reducing death from ventricular fibrillation and easy access in public areas is most effective. Placement must be prioritized based on public health impact and characteristics of the community.
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