Availability and use of public access defibrillators in Busan Metropolitan City, South Korea

Bystander cardiopulmonary resuscitation, automated external defibrillator use, and survival after out-of-hospital cardiac arrest

INTRODUCTION

We aimed to investigate the association between bystander cardiopulmonary resuscitation (CPR) with and without automated external defibrillator (AED) use and neurological outcomes after out-of-hospital cardiac arrest (OHCA) in Korea.

METHODS

This cross-sectional study used a nationwide Korean OHCA registry between 2015 and 2019. Patients were categorised into no bystander CPR and bystander CPR with and without AED use groups. The primary outcome was good neurological recovery at discharge. We also analysed the interaction effects of place of arrest, response time, and whether the OHCA was witnessed.

RESULTS

In total, 93,623 patients were included. Among them, 35,486 (37.9%) were in the no bystander CPR group, 56,187 (60.0%) were in the bystander CPR without AED use group, and 1950 (2.1%) were in the bystander CPR with AED use group. Good neurological recovery was demonstrated in 1286 (3.6%), 3877 (6.9%), and 208 (10.7%) patients in the no CPR, bystander CPR without AED use, and bystander CPR with AED use groups, respectively. Compared to the no bystander CPR group, the adjusted odds ratio (95% confidence intervals) for good neurological recovery was 1.54 (1.45-1.65) and 1.37 (1.15-1.63) in the bystander CPR without and with AED use groups, respectively. The effect of bystander CPR with AED use was more apparent in OHCAs with witnessed arrest and prolonged response time (≥8 min).

CONCLUSION

Bystander CPR was associated with better neurological recovery compared to no bystander CPR; however, the benefits of AED use were not significant. Efforts to disseminate bystander AED availability and ensure proper utilisation are warranted.

Are there disparities in the location of automated external defibrillators in England?

Background

Early defibrillation is an essential element of the chain of survival for out-of-hospital cardiac arrest (OHCA). Public access defibrillation (PAD) programmes aim to place automated external defibrillators (AED) in areas with high OHCA incidence, but there is sometimes a mismatch between AED density and OHCA incidence.

Objectives

This study aimed to assess whether there were any disparities in the characteristics of areas that have an AED and those that do not in England.

Methods

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

Results

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

Conclusions

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

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study

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.

Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review

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.

Modeling a novel hypothetical use of postal collection boxes as automated external defibrillator access points

INTRODUCTION

Optimizing placement of Automated External Defibrillators (AED) can increase survival after an out-of-hospital cardiac arrest (OHCA). Using postal collection boxes (PCB) as locations for AEDs could potentially enhance accessibility and streamline maintenance. In this study, we modeled the hypothetical effects of deploying AEDs at PCB locations.

HYPOTHESIS

We hypothesized that PCB-AEDs would increase AED coverage overall and in residential areas, and reduce the distance from OHCA to an AED.

METHODS

AEDs in Pittsburgh, PA were identified by the University of Pittsburgh Resuscitation Logistics and Informatics Venture (n=747). PCB locations were obtained from the United States Postal Service (n=479). OHCA locations from 2009 to 2014 were obtained from the Pittsburgh site of the Resuscitation Outcomes Consortium. AED coverage assuming a ¼ mile radius around each AED was estimated for known AEDs, PCB-AEDs (hypothetical AED locations), and known AEDs augmented by PCB-AEDs, both overall and for residential and non-residential zones. Linear distance from each OHCA to the nearest AED was calculated and compared between the sets.

RESULTS

The set of known AEDs augmented with PCB-AEDs covered more of the city overall (55% vs 30%), as well as greater proportions of residential (62% vs 27%) and non-residential areas (45% vs 30%). The median distance from OHCA to AED was significantly shorter when known AEDs were augmented with PCB-AEDs (0.12mi vs 0.32mi; p=0.001).

CONCLUSION

Augmenting existing publicly accessible AEDs with AEDs deployed at PCBs can increase AED spatial coverage in both residential and non-residential areas, and reduce the distance from AED to OHCA.