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Stewart JA. Automated external defibrillators in the hospital: A case of medical reversal. Am J Emerg Med 2017; 36:871-874. [PMID: 29162440 DOI: 10.1016/j.ajem.2017.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022] Open
Abstract
Automated external defibrillators (AEDs) emerged in the 1980s as an important innovation in pre-hospital emergency cardiac care (ECC). In the years since, the American Heart Association (AHA) and the International Liaison Committee for Resuscitation (ILCOR) have promoted AED technology for use in hospitals as well, resulting in the widespread purchase and use of AED-capable defibrillators. In-hospital use of AEDs now appears to have decreased survival from cardiac arrests. This article will look at the use of AEDs in hospitals as a case of "medical reversal." Medical reversal occurs when an accepted, widely used treatment is found to be ineffective or even harmful. This article will discuss the issue of AEDs in the hospital using a conceptual framework provided by recent work on medical reversal. It will go on to consider the implications of the reversal for in-hospital resuscitation programs and emergency medicine more generally.
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DeLuca LA, Simpson A, Beskind D, Grall K, Stoneking L, Stolz U, Spaite DW, Panchal AR, Denninghoff KR. Analysis of Automated External Defibrillator Device Failures Reported to the Food and Drug Administration. Ann Emerg Med 2012; 59:103-11. [DOI: 10.1016/j.annemergmed.2011.07.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/08/2011] [Accepted: 07/12/2011] [Indexed: 11/16/2022]
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Fisher J, Anzalone B, McGhee J, Sylvia B, Ullman EA. Lack of Early Defibrillation Capability and Automated External Defibrillators in Nursing Homes. J Am Med Dir Assoc 2007; 8:413-5. [PMID: 17619041 DOI: 10.1016/j.jamda.2007.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the availability of early defibrillation and automated external defibrillators in nursing homes in selected cities. DESIGN A standardized telephone survey was conducted of all skilled nursing facilities to characterize early defibrillation capabilities. SETTING The study involved nursing homes in Philadelphia, Omaha, Seattle, and Boston. PARTICIPANTS All skilled nursing facilities not physically attached to hospitals in the selected cities based on listings from the Centers for Medicare and Medicaid Services as of January 2004. MEASUREMENTS Each site was queried as to whether or not they had an automated external defibrillator (AED), if they were physically freestanding facilities, if a manual defibrillator was present, and if staff were present 24 hours a day to use the defibrillator. Early defibrillation was defined as the presence of either a manual defibrillator or AED in addition to 24-hour trained staff availability. RESULTS There were 126 nursing homes identified from the Medicare listing and 81% (102) responded to our phone survey. After exclusion of non-freestanding facilities, 90 nursing homes (71.4%) were available for analysis. Overall, 16.7% (95% CI 8.8-24.5) of nursing homes reported early defibrillation capabilities via manual defibrillator or AEDs; 6.7% (95% CI 1.4-11.9) of nursing homes reported AEDs; 10.0% (95% CI 3.7-16.3) of nursing homes reported manual defibrillators. Nursing homes in Seattle had a higher rate of early defibrillation capability than the other 3 cities. CONCLUSION Despite the fact that nursing homes have been identified as locations with multiple cardiac arrests, the early defibrillation capabilities and prevalence of AEDs in this setting remains low. AEDs may play a role in improving survival from cardiac arrest in nursing homes. The placement of AEDs in nursing homes needs further consideration and study.
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Affiliation(s)
- Jonathan Fisher
- Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Nelson KL, Mills W, Umbel S, Crosson JE, Shaffner DH, Hunt EA. Lightning, sudden cardiac death, simulation and an automated external defibrillator: the perfect storm. Resuscitation 2007; 74:567-71. [PMID: 17459560 DOI: 10.1016/j.resuscitation.2007.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Revised: 02/04/2007] [Accepted: 02/05/2007] [Indexed: 11/21/2022]
Abstract
This is a report of an 11-year-old boy who had sudden cardiac death after a lightning strike while playing lacrosse at summer camp. The camp staff had performed weekly drills to prepare for various medical emergencies and quickly activated their "Emergency Activation System". The child received immediate cardiopulmonary resuscitation (CPR) and was defibrillated with an automated defibrillator (AED) within 3 min of becoming pulseless and was ultimately resuscitated after being defibrillated three times. A community ambulance with a defibrillator on board did not arrive until several minutes after the on-site team had achieved return of spontaneous circulation. In this report, we describe the clinical course of this patient; briefly review lightning injuries, other causes of sudden cardiac death in children and use of AEDs. Finally, we review how simulation has been used in this case and others as a mechanism to ensure preparedness for medical emergencies. This child is alive and well today because of these well-trained camp counselors. Their system of using simulation to maintain emergency readiness serves as an example for lay and professional medical providers alike.
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Affiliation(s)
- Kristen L Nelson
- Johns Hopkins School of Medicine, Department of Anesthesiology & Critical Care Medicine, Division of Pediatric Anesthesiology & Critical Care Medicine, United States.
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Lucas J, Davila AA, Waninger KN, Heller M. Cardiac arrest on the links: are we up to par? Availability of automated external defibrillators on golf courses in southeastern Pennsylvania. Prehosp Disaster Med 2006; 21:112-4. [PMID: 16771002 DOI: 10.1017/s1049023x00003459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES A growing number of golfers are senior citizens, and it may be predicted that the number of golf-related medical emergencies, including the incidence of cardiac arrest, will increase. This study was designed to survey the level of preparedness of golf courses in southeastern Pennsylvania to respond to cardiac arrest among their members. METHODS A telephone survey of all of the 180 golf courses in the area was conducted to determine their type (public/private), volume in rounds per year, presence of automated external defibrillator (AED) devices, number of employees, and percentage of employees with cardiopulmonary resuscitation (CPR) training. Participants also were asked to estimate the time needed to reach the farthest point on their course in order to estimate a maximum time to the application of an AED device. RESULTS A total of 131 of 180 golf courses completed the survey (53 private, 78 public) for an overall response rate of 73%. Private courses reported a greater average number of employees with CPR training [private = 9.1, public = 3.6; p = 0.001] and in AED presence [public = 9%, private = 58.5%; p = 0.0001]. Public courses support a higher volume of play than do private courses [public = 32,000, private = 24,000; p = 0.001], yet have far fewer employees [public=25, private=44; p = 0.004]. The longest time necessary to reach the most remote point on the course was between four and five minutes in all courses. Analysis was performed using the Student's t-test and Pearson's Chi-square as appropriate. CONCLUSION Neither public nor private golf courses are well equipped to respond to cardiac arrest, but outcomes on public courses likely are to be far worse.
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Affiliation(s)
- John Lucas
- Department of Emergency Medicine, Saint Luke's Hospital, Bethlehem, Pennsylvania 18017-3560, USA
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Myers JB, French D, Webb W. Lack of integration of automated external defibrillators with EMS response may reduce lifesaving potential of public-access defibrillation. PREHOSP EMERG CARE 2005; 9:339-43. [PMID: 16147487 DOI: 10.1080/10903120590961969] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Automated external defibrillators (AEDs) used for public-access defibrillation (PAD) allow for rapid defibrillation, particularly if the AEDs are incorporated into an organized response plan. This project was undertaken to determine how many PAD AEDs were in North Carolina, how many were properly registered, and how many were integrated into the emergency medical services (EMS) response. METHODS Data were collected for this prospective, descriptive study via phone survey, e-mail survey, and/or direct personal interview. Four sources were utilized: 1) state office of EMS AED registration database, 2) AED sales representatives, 3) county EMS agency representatives, and 4) American Heart Association (AHA) training center instructors and regional faculty. The primary endpoint was determining the proportion of AEDs placed in unregistered locations. RESULTS The state EMS office provided the state registry of AED locations. One-hundred percent of state-recognized AED vendors and county EMS agencies provided data. Twelve of 55 (22%) AHA personnel provided data. Eight hundred eighty-one unique locations were identified. Although AED sales are required by law to be registered, the office of EMS database contained only 99 of the 552 (18%) unique PAD locations identified by the study. CONCLUSIONS A large number of unregistered AEDs are being placed in communities. AEDs placed as part of an organized PAD program improve the rates of survival from sudden cardiac death. In the absence of registration, it is difficult to determine the extent to which these AEDs are part of an organized PAD program.
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Affiliation(s)
- J Brent Myers
- Department of Emergency Medicine, University of North Carolina School of Medicine, Chapel Hill, USA.
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Abstract
This article describes emergency medical services (EMS) systems in Connecticut, beginning with a historical perspective. The discussion of statewide oversight of the EMS system includes legislative and regulatory mandates as well as recent external reviews of the system. Medical oversight of EMS care and services is provided by sponsor hospitals rather than individual medical directors. Most of the 169 cities and towns in the State maintain or contract for local EMS, and have traditionally resisted regionalization. This snapshot of the EMS system in Connecticut can serve as a reference for comparison of EMS systems in other jurisdictions.
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Richardson LD, Gunnels MD, Groh WJ, Peberdy MA, Pennington S, Wilets I, Campbell V, Van Ottingham L, McBurnie MA. Implementation of community-based public access defibrillation in the PAD trial. Acad Emerg Med 2005; 12:688-97. [PMID: 16079421 DOI: 10.1197/j.aem.2005.03.525] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Lynne D Richardson
- Department of Emergency Medicine, Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1620, New York, NY 10029, USA.
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Coris EE, Miller E, Sahebzamani F. Sudden cardiac death in division I collegiate athletics: analysis of automated external defibrillator utilization in National Collegiate Athletic Association division I athletic programs. Clin J Sport Med 2005; 15:87-91. [PMID: 15782052 DOI: 10.1097/01.jsm.0000152715.12721.fa] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine current outcomes of automated external defibrillator (AED) interventions in sports medicine programs in National Collegiate Athletic Association (NCAA) division I athletics. DESIGN Qualitative scripted telephone interview with all positive responders to prior NCAA division I-wide study on AED utilization and implementation. SETTING NCAA division I sports medicine programs. Head athletic trainers were the main data source. PARTICIPANTS All positive responders to a previously published study on AED implementation in the NCAA division I sports medicine community. Positive responders were those that indicated that they had used their departmental AEDs in a sudden cardiac death (SCD) scenario. MAIN OUTCOME MEASUREMENTS Survival to hospital discharge was the main outcome sought. When available, additional outcomes were time to defibrillation, time to notification of athletic training staff, EMS response time, location of event, and sudden cardiac victim type (i.e., student, coach, fan). RESULTS Sixteen departments that previously reported having had an SCD event at their institution responded to this follow-up telephone survey. Twenty percent of AED uses were attributed to student athletes, with 33% of utilizations for athletic department staff and 47% for fans. Defibrillation was actually administered in 53% of AED unit applications. Time to shock was an average of 3.4 minutes, with average EMS response time of 8.2 minutes for those events without EMS on site. Reported survival to hospital discharge in this university athletic department setting for SCD was 0% for students, 75% for staff, 57% for fans, and 61% overall. CONCLUSIONS The results of this study demonstrate the need for NCAA division 1 athletic sports medicine programs to examine, and possibly expand, the traditional scope of practice of caring primarily for student athletes to include the larger community of sports participants comprised of athletes, departmental staff, and spectators. Athletic department AED programs were extremely successfully at increasing survival of SCD far above national prehospital standards, mainly in the nonathletic population. Further study is also necessary in the realm of AED placement, maintenance, and training of staff.
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Affiliation(s)
- Eric E Coris
- Department of Family Medicine, Division of Sports Medicine, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 13, Tampa, FL 33612, USA.
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Motyka TM, Winslow JE, Newton K, Brice JH. Method for determining automatic external defibrillator need at mass gatherings. Resuscitation 2005; 65:309-14. [PMID: 15919567 DOI: 10.1016/j.resuscitation.2004.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 09/27/2004] [Accepted: 09/27/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES A method for determining the number of automatic external defibrillators (AEDs) required for a 3-min response at mass gatherings has been described previously. Our study sought to modify the method, replicate it, then validate the results. METHODS Emergency medical technicians (EMTs) were timed walking defined courses in a football stadium. Velocities were obtained for a horizontal distance and ascending/descending upper and lower decks. This was replicated in a basketball arena. To validate, actual response times were compared to predicted times for predetermined distances in each venue. Predicted response times were calculated using the second standard deviation velocities as the most pessimistic. Numbers of AEDs needed were calculated using predicted response times for each venue's longest distance. RESULTS Average velocities in m/s (football) were horizontal 1.7, lower deck 1.6 ascending and 1.4 descending, upper deck 1.0 ascending and 1.1 descending. Average velocities (basketball) were horizontal 1.7, lower deck 1.2 ascending and descending, upper deck 0.9 ascending and descending. In the validation phase, every EMT completed the four predetermined courses within the predicted intervals. Predicted response times were 363 s for the longest football stadium distance, and 187 s for the basketball arena. For a 3-min (180 s) response, the number of AEDs required can be calculated. CONCLUSION This method was easily replicated and appears to be useful for determining the number of AEDs at mass gatherings. The number of AEDs needed for any desired response interval can be calculated using the predicted response time for the longest distance within an arena.
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Affiliation(s)
- Tracy M Motyka
- University of North Carolina Hospitals, Chapel Hill, NC, USA
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Atkins DL, Kenney MA. Automated external defibrillators: safety and efficacy in children and adolescents. Pediatr Clin North Am 2004; 51:1443-62. [PMID: 15331293 DOI: 10.1016/j.pcl.2004.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although children do not suffer from ventricular fibrillation (VF) as frequently as adults, it does occur in 10% to 20% of pediatric cardiac arrests. The technology is available to recognize and treat ventricular fibrillation in children as quickly as we can for adults. This article discusses the evidence to support automated external defibrillator use in young children. As this technology gains increased acceptance, resuscitation rates and outcomes for VF in children should approach those that are seen in adults.
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Affiliation(s)
- Dianne L Atkins
- Division of Pediatric Cardiology, Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, University of Iowa, Iowa City, IA 52242, USA.
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Coris EE, Sahebzamani F, Walz S, Ramirez AM. Automated external defibrillators in National Collegiate Athletic Association Division I Athletics. Am J Sports Med 2004; 32:744-54. [PMID: 15090393 DOI: 10.1177/0363546503261694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. METHODS Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. RESULTS Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. CONCLUSIONS Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit acquisition and implementation with knowledge of the surrounding emergency medical service system, geography of their individual sports medicine facilities, numbers and relative risk of their athletes, and budgetary constraints.
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Affiliation(s)
- Eric E Coris
- Department of Family Medicine, University of South Florida College of Medicine, Tampa, Florida 33612, USA.
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Jorgenson DB, Skarr T, Russell JK, Snyder DE, Uhrbrock K. AED use in businesses, public facilities and homes by minimally trained first responders. Resuscitation 2003; 59:225-33. [PMID: 14625114 DOI: 10.1016/s0300-9572(03)00214-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Dawn B Jorgenson
- Philips Medical Systems, 2301 5th Avenue, Suite 200, Seattle, WA 98121, USA.
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Cardiac Arrhythmias. Fam Med 2003. [DOI: 10.1007/978-0-387-21744-4_77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Very early defibrillation, within the first few minutes of VF cardiac arrest, results in significantly improved survival rates [1,10-12,34]. Most EMS systems cannot consistently provide defibrillation within the first few minutes following cardiac arrest. Defibrillation within the first few minutes following collapse is potentially achievable through the use of AEDs and PAD [9-14,62]. The delivery of defibrillation with AEDs has been made more efficient through the use of impedance-compensated defibrillation, larger pad sizes, and biphasic waveforms [34]. The technology is simple and easy to use. Preliminary cost-effectiveness analysis indicates that PAD and first-responder defibrillation are economically as attractive as other interventions in cardiac arrest [44]. Effective PAD requires significant investment in time, energy, informed planning, and rigorous quality improvement; however, the benefits are enormous. Reported VF survival rates can approach 50% or higher [11,12,62]. PAD provides the potential opportunity to transform cardiac arrest into a survivable event for most victims by making the community the ultimate coronary care unit.
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Affiliation(s)
- Alexander L Sommers
- Department of Emergency Medicine, Medical College of Wisconsin, Froedtert Hospital East, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
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