Effect of Optimized Versus Guidelines‐Based Automated External Defibrillator Placement on Out‐of‐Hospital Cardiac Arrest Coverage: An In Silico Trial
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Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out-of-hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7-accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100-m route distance based on Copenhagen's road network of an available AED after it was placed ("OHCA coverage"). Estimated impact on bystander defibrillation and 30-day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30-day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines-based approach to AED placement.Keywords:
Automated external defibrillator
Although sudden cardiac death is rare in sports, having an automated external defibrillator (AED) available facilitates early defibrillation and increases the chance of survival for an athlete in cardiac arrest. The decision to buy an AED involves many factors, and physicians and other personnel who work with athletes should be familiar with the use of such devices given their increasing availability and the widespread acceptance of the principle of early defibrillation.
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Background; Automated external defibrillator(AED) represent a major breakdown to permit more widespread application of the principle of early defibrillation. Many mcent efforts to improve emergency medical services(EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. AED is major innovation for the prehospital care of ventricular fibrillation cardiac arrest patients. The purpose of this study is to evaluate the course of initial training to three different groups(nurses, firefighters, and EMT trainee) to use AED, Method: We studies the efficacy of education of AED to 33 nurses, 15 EMT trainee, and 16 firefighters. Training lasted 75 mins and included 45 mins an overview of defibrillation, protocols for using the AED, and operation of the AED(Laerdal Heartstart 3000), 15 mins demonstraion. A check list was used to grade the performance of cardiopulmonary resuscitation, operation of the AED, and the time required to deliver the first three defibrillations. Result: There were no statistically significant differences in performance and time required to deliver an electrical countershock among the groups(p=0.4). To the second test, 92% of all group completed all steps successfully. The step most often failed was the preparing of the AED for defibrillation. Conclusion: In nurses, EMT trainee, and firefighters, it is both feasible and effective to train AED use irrespective of the degree of the trainee.
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Sudden cardiac death occurs with great frequency, and the treatment of out-of hospital cardiac arrest continues to evolve. Although early initiation of cardiopulmonary resuscitation remains essential, early defibrillation has been shown to be the most important determinant of survival. The development of the automated external defibrillator (AED), a portable, lightweight, accurate, and easy-to-use defibrillator, is revolutionizing the approach to prehospital care by extending the role of delivering defibrillation to layperson first-responders. The American Heart Association is promoting public access defibrillation programs in which laypersons, including police, firefighters, security guards, and flight attendants use AEDs in an effort to reduce time to defibrillation. The authors review current AED technology, examine the data on AED accuracy, review the clinical experience of AED public access defibrillation programs, and explore the future role of the AED in the effort to improve survival from sudden cardiac arrest.
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