The general public's ability to operate automated external defibrillator: A controlled simulation study

Economic evaluation of automated external defibrillator deployment in public settings for out-of-hospital cardiac arrest: a systematic review

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) is a major issue in aging populations. The use of automatic external defibrillators (AEDs) in public places improves cardiac arrest survival rates. The purpose of this study is to review economic evaluation studies of the use of AED technology in public settings for cardiac arrest resuscitation.

METHODS

Our search covered 1990-2021 and included PubMed, Cochrane Library, Embase, Scopus, and Web of Science. We included studies that analyzed cost-effectiveness, cost-utility and cost-benefit of the AED technology. Also, we performed the quality assessment of the studies through the checklist of quality assessment standard of health economic studies (QHES).

RESULTS

Our inclusion criteria were met by 25 studies. AEDs are found to be cost-effective in places with a high occurrence of cardiac arrest. In addition, proper integration of drones with AEDs into existing systems has the potential to significantly improve OHCA survival rates.

CONCLUSION

The present study found that putting AEDs in high-cardiac arrest and crowded areas reduces average costs. Despite this, the costs associated with acquiring and maintaining AEDs prevent their widespread use. Further research is needed to evaluate feasibility and explore innovative strategies for AED maintenance and accessibility.

Learning in a crisis moment: a randomized controlled trial in emergency bystander intervention

BACKGROUND

Opioid overdose is the leading cause of injury-related death in the United States. Individuals who overdose outside of clinical settings have more positive clinical outcomes when they receive naloxone, an opioid antagonist, from a bystander as an early intervention before emergency personnel arrive. However, there is a gap in knowledge about successful instantaneous learning and intervention in a real-life stressful environment. The objective of this study is to explore the efficacy of different instructional delivery methods for bystanders in a stressful environment. We aim to evaluate which methods are most effective for instantaneous learning, successful intervention, and improved clinical outcomes.

METHODS

To explore instantaneous learning in a stressful environment, we conducted a quantitative randomized controlled trial to measure how accurately individuals responded to memory-based survey questions guided by different instructional methods. Students from a large university in the Midwest (n = 157) were recruited in a public space on campus and accessed the six-question survey on their mobile devices. The intervention group competed the survey immediately while the research team created a distracting environment. The control group was asked to complete the survey later in a quiet environment.

RESULTS

The intervention group correctly answered 0.72 questions fewer than the control group (p = .000, CI [0.337, 1.103]). Questions Q1 and Q5 contained direct instructions with a verbal component and showed the greatest accuracy with over 90% correct for both stressful and controlled environments.

CONCLUSIONS

The variability in the responses suggests that there are environmental factors as well as instructional design features which influence instantaneous learning. The findings of this study begin to address the gap in knowledge about the effects of stress on instantaneous learning and the most effective types of instruction for untrained bystanders in emergency situations.

Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study

BACKGROUND

To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators (AEDs) more accurately and quickly.

METHODS

From June 1, 2018, to November 30, 2019, a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople (18-65 years old) without prior AED training. A self-instruction card was designed to illuminate key AED operation procedures. Subjects were randomly divided into the card (n=83) and control (n=82) groups with age stratification. They were then individually evaluated in the same simulated scenario to use AED with (card group) or without the self-instruction card (control group) at baseline, post-training, and at the 3-month follow-up.

RESULTS

At baseline, the card group reached a significantly higher proportion of successful defibrillation (31.1% vs. 15.9%, P=0.03), fully baring the chest (88.9% vs. 63.4%, P<0.001), correct electrode placement (32.5% vs. 17.1%, P=0.03), and resuming cardiopulmonary resuscitation (CPR) (72.3% vs. 9.8%, P<0.001). At post-training and follow-up, there were no significant differences in key behaviors, except for resuming CPR. Time to shock and time to resume CPR were shorter in the card group, while time to power-on AED was not different in each phase of tests. In the 55-65 years group, the card group achieved more skill improvements over the control group compared to the other age groups.

CONCLUSION

The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects. This could be a practical, cost-effective way to improve the AED skills of potential rescue providers among different age groups, including seniors.

Development of Low-Fidelity Virtual Replicas of Products for Usability Testing

Designers perform early-stage formative usability tests with low-fidelity prototypes to improve the design of new products. This low-tech prototype style reduces the manufacturing resources but limits the functions that can be assessed. Recent advances in technology enable designers to create low-fidelity 3D models for users to engage in a virtual environment. Three-dimensional models communicate design concepts and are not often used in formative usability testing. The proposed method discusses how to create a virtual replica of a product by assessing key human interaction steps and addresses the limitations of translating those steps into a virtual environment. In addition, the paper will provide a framework to evaluate the usability of a product in a virtual setting, with a specific emphasis on low-resource online testing in the user population. A study was performed to pilot the subject’s experience with the proposed approach and determine how the virtual online simulation impacted the performance. The study outcomes demonstrated that subjects were able to successfully interact with the virtual replica and found the simulation realistic. This method can be followed to perform formative usability tests earlier and incorporate subject feedback into future iterations of their design, which can improve safety and product efficacy.

Improve Cardiac Emergency Preparedness by Building a Team-Based Cardiopulmonary Resuscitation Educational Plan

Objective

To design an innovative team-based cardiopulmonary resuscitation (CPR) educational plan for multiple bystanders and evaluate whether it was associated with better teamwork and higher quality of resuscitation.

Methods

The team-based CPR plan defined the process for a three-person team, emphasize task allocation, leadership, and closed-loop communication. Participants qualified for single-rescuer CPR skills were randomized into teams of 3. The teamwork performance and CPR operation skills were evaluated in one simulated cardiac arrest scenario before and after training on the team-based CPR plan. The primary outcomes were measured by the Team Emergency Assessment Measure (TEAM) scale and chest compression fraction (CCF).

Results

Forty-three teams were included in the analysis. The team-based CPR plan significantly improved the team performance (global rating 6.7 ± 1.3 vs. 9.0 ± 0.7, corrected p < 0.001 after Bonferroni's correction). After implementing the team-based CPR plan, CCF increased [median 59 (IQR 48–69) vs. 64 (IQR 57–71%)%, corrected p = 0.002], while hands-off time decreased [median 233.2 (IQR 181.0–264.0) vs. 207 (IQR 174–222.9) s, corrected p = 0.02]. We found the average compression depth was significantly improved through the team-based CPR training [median 5.1 (IQR 4.7–5.6) vs. 5.3 (IQR 4.9–5.5) cm, p = 0.03] but no more significantly after applying the Bonferroni's correction (corrected p = 0.35). The compression depths were significantly improved by collaborating and exchanging the role of compression among the participants after the 6th min.

Conclusion

The team-based CPR plan is feasible for improving bystanders teamwork performance and effective for improving resuscitation quality in prearrival care. We suggest a wide application of the team-based CPR plan in the educational program for better resuscitation performance in real rescue events.