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Rea TD, Kudenchuk PJ. The Details Matter for Defibrillator Pad Placement and Cardiac Arrest Resuscitation. JAMA Netw Open 2024; 7:e2431630. [PMID: 39250159 DOI: 10.1001/jamanetworkopen.2024.31630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Affiliation(s)
- Thomas D Rea
- Department of Medicine, University of Washington, Seattle
- Emergency Medical Services Division of Public Health-Seattle and King County, Seattle, Washington
| | - Peter J Kudenchuk
- Department of Medicine, University of Washington, Seattle
- Emergency Medical Services Division of Public Health-Seattle and King County, Seattle, Washington
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Remote synchronous usability testing of public access defibrillators during social distancing in a pandemic. Sci Rep 2022; 12:14575. [PMID: 36028561 PMCID: PMC9411842 DOI: 10.1038/s41598-022-18873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.
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Kulangareth NV, Magtibay K, Massé S, Krishnakumar Nair, Dorian P, Nanthakumar K, Umapathy K. An In-Silico model for evaluating the directional shock vectors in terminating and modulating rotors. Comput Biol Med 2022; 146:105665. [DOI: 10.1016/j.compbiomed.2022.105665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/03/2022] [Accepted: 05/19/2022] [Indexed: 11/27/2022]
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Kulangareth NV, Umapathy K. Effect of Shock Vector Orientation in Modulating and Terminating Rotors - a Simulation Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:5488-5491. [PMID: 34892367 DOI: 10.1109/embc46164.2021.9630733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The main treatment option for Ventricular Fibrillation (VF), especially in out-of-hospital cardiac arrests (OHCA) is defibrillation. Typically, the survival-to-discharge rates are very poor for OHCA. Existing studies have shown that rotors may be the sources of arrhythmia and ablating them could modulate or terminate VF. However, tracking rotors and ablating them is not a feasible solution in a OHCA scenario. Hence, if the sources (or rotors) can be regionally localized non-invasively and this information can be used to direct the orientation of the shock vectors, it may aid the termination of rotors and defibrillation success. In this work, using computational modeling, we present our initial results on testing the effect of shock vector orientation on modulating (or) terminating rotors. A combination of Sovilj's and Aliev Panfilov's monodomain cardiac models were used in inducing rotors and testing the effect of shock vector magnitude and direction. Based on our simulation results on an average with four experimental trials, a shock vector directed in the perpendicular direction along the axis of the rotor terminated the rotor with 16% lesser magnitude than parallel direction and 38% lesser magnitude than in oblique direction.Clinical Relevance- A rotor localization dependent defibrillation strategy may aid the defibrillation protocol procedures to improve the survival rates. Based on the four experimental trials, the results indicate shock vectors oriented perpendicular to the axis of the rotors were efficient in modulating or terminating rotors with lower magnitude than other directions.
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Paré D, L'Écuyer JB, Mercier É. Association Between Pad Placement and the Return of Spontaneous Circulation for Defibrillation During Ventricular Fibrillation: A Systematic Review. J Innov Card Rhythm Manag 2021; 12:4533-4535. [PMID: 34234986 PMCID: PMC8225305 DOI: 10.19102/icrm.2021.120607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/08/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- David Paré
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Julien Blais L'Écuyer
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, Québec, Canada
| | - Éric Mercier
- VITAM - Centre de recherche en santé durable de l'Université Laval, Québec, Québec, Canada
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Stærk M, Vammen L, Andersen CF, Krogh K, Løfgren B. Basic life support skills can be improved among certified basic life support instructors. Resusc Plus 2021; 6:100120. [PMID: 34223379 PMCID: PMC8244352 DOI: 10.1016/j.resplu.2021.100120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background A correct visual skill demonstration is important when learning cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator (AED). Basic life support (BLS) instructors are expected to master and demonstrate CPR/AED skills correctly. The aim of this study was to evaluate certified BLS instructors’ competencies in demonstrating CPR and the use of an AED. Methods Certified BLS instructors demonstrated CPR and the use of an AED on a resuscitation manikin. Skills were evaluated using data collected from the manikin and video recordings and compared to resuscitation guidelines. Further, instructors completed questionnaires on resuscitation guidelines and rating of their own CPR/AED skills. Results Overall, we analyzed data from 125 instructors. Of all chest compressions, only 22% were within guideline recommendations regarding depth. Instructors performed chest compressions with excessive depth (mean depth 64 mm (7.3)) and a mean rate of 115 min−1 (10.8). Only 25% of instructors placed the left AED electrode correctly (median distance 7.6 cm (5.0;10.5)), while the right AED electrode usually was placed correctly (median distance 2.9 cm (1.5;4.0), 85% placed correctly). Nearly half of the instructors failed to state correct answers regarding how to diagnose a cardiac arrest and where to place the AED electrodes. Despite their performance, instructors rated their BLS skills as good. Conclusion Certified BLS instructors’ have poor CPR/AED skills and several important knowledge gaps on CPR/AED guidelines in contrast to instructors’ self-reported skills. This highlights a need for improving BLS instructor education, including continuous faculty development to ensure optimal learning conditions for BLS course participants.
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Affiliation(s)
- Mathilde Stærk
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Education and Research, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lauge Vammen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Fuchs Andersen
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Education and Research, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Kristian Krogh
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark.,Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Can Mobile Videocall Assist Laypersons' Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4069749. [PMID: 33163534 PMCID: PMC7604583 DOI: 10.1155/2020/4069749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/08/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022]
Abstract
Objective To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. Results There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of "Power on AED" and "Correctly attaches pads" than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. Conclusions Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.
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Dong XJ, Zhang L, Yu YL, Shi SX, Yang XC, Zhang XQ, Tian S, Myklebust H, Li GH, Zheng ZJ. The general public's ability to operate automated external defibrillator: A controlled simulation study. World J Emerg Med 2020; 11:238-245. [PMID: 33014220 DOI: 10.5847/wjem.j.1920-8642.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Automated external defibrillators (AEDs) enable laypeople to provide early defibrillations to patients undergoing cardiac arrest, but scant information is available on the general public's ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age. METHODS From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants' AED skills were assessed individually pre-training, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process. RESULTS Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defibrillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defibrillations increased significantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defibrillations, which was significantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test. CONCLUSIONS The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.
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Affiliation(s)
- Xue-Jie Dong
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Yue-Lin Yu
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Shu-Xiao Shi
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Chen Yang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Qian Zhang
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuang Tian
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | | | - Guo-Hong Li
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Jie Zheng
- School of Public Health, Peking University, Beijing, China
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9
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Shocking insights on double defibrillation: How, when and why not? Resuscitation 2019; 140:209-210. [DOI: 10.1016/j.resuscitation.2019.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022]
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Foster AG, Deakin CD. Accuracy of instructional diagrams for automated external defibrillator pad positioning. Resuscitation 2019; 139:282-288. [PMID: 31063839 DOI: 10.1016/j.resuscitation.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/04/2019] [Accepted: 04/21/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Correct defibrillation pad positioning optimises the chances of successful defibrillation. AEDs have pictoral representation to guide untrained bystanders in correct pad positioning. There is a wide variation in this pictoral guidance and evidence suggests that correct anatomical pad placement is poor. We reviewed all currently available diagrams and assessed the resultant pad placement achieved by untrained bystanders following these instructions. METHODS Twenty untrained bystanders were presented with a total of 27 different pad placement diagrams (including one designed by the researchers) in a random sequence and were asked to apply them to the chest of an adult manikin. The lateral/medial and cranial/caudal position in relation to the optimal position recommended by the European Resuscitation Council guidelines was then measured for each pair of pads. RESULTS Overall, the sternal pad was placed an average of 6.0 mm cranial to, and 3.2 mm medial to, the optimal position. The apical pad was placed an average of 78.2 mm caudal to, and 59.3 mm medial to, the optimal position. The pad position diagram we designed and assessed out performed existing diagrams. CONCLUSION All current defibrillation pad diagrams fail to achieve accurate defibrillation pad placement. A clearer, more effective diagram, such as the one we designed, is urgently needed to ensure bystander defibrillation is effective as possible.
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Affiliation(s)
- Alexander G Foster
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - Charles D Deakin
- Dept of Anaesthetics, University Hospital Southampton, SO16 6YD, UK; South Central Ambulance Service NHS Foundation Trust, Otterbourne, SO21 2RU, UK.
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Stærk M, Bødtker H, Lauridsen KG, Løfgren B. Automated external defibrillation training on the left or the right side - a randomized simulation study. Open Access Emerg Med 2017; 9:73-79. [PMID: 29066936 PMCID: PMC5605125 DOI: 10.2147/oaem.s140220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Correct placement of the left automated external defibrillator (AED) electrode is rarely achieved. AED electrode placement is predominantly illustrated and trained with the rescuer sitting on the right side of the patient. Placement of the AED electrodes from the left side of the patient may result in a better overview of and access to the left lateral side of the thorax. This study aimed to investigate if training in automated external defibrillation on the left side compared to the right side of a manikin improves left AED electrode placement. Methods Laypeople attending basic life support training were randomized to learn automated external defibrillation from the left or right side of a manikin. After course completion, participants used an AED and placed AED electrodes in a simulated cardiac arrest scenario. Results In total, 40 laypersons were randomized to AED training on the left (n=19 [missing data =1], 63% female, mean age: 47.3 years) and right (n=20, 75% female, mean age: 48.7 years) sides of a manikin. There was no difference in left AED electrode placement when trained on the left or right side: the mean (SD) distances to the recommended left AED electrode position were 5.9 (2.1) cm vs 6.9 (2.2) cm (p=0.15) and to the recommended right AED electrode position were 2.6 (1.5) cm vs 1.8 (0.8) cm (p=0.06), respectively. Conclusion Training in automated external defibrillation on the left side of a manikin does not improve left AED electrode placement compared to training on the right side.
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Affiliation(s)
- Mathilde Stærk
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Henrik Bødtker
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus
| | - Kasper G Lauridsen
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus.,Clinical Research Unit.,Department of Internal Medicine, Randers Regional Hospital, Randers
| | - Bo Løfgren
- Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus.,Department of Internal Medicine, Randers Regional Hospital, Randers.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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