Automated External Defibrillators and Survival After Nonresidential Out of Hospital Cardiac Arrest in a Small North American City

2017 ◽  
Vol 119 (12) ◽  
pp. 1979-1982 ◽  
Author(s):  
Anita Lwanga ◽  
Enrique Garcia-Sayan ◽  
Steven Lwanga ◽  
Erwin Karreman ◽  
Amira Mohamed
Keyword(s):  
Cardiac Arrest ◽  
North American ◽  
American City ◽  
Automated External Defibrillators ◽  
North American City ◽  
Hospital Cardiac Arrest

Abstract 25: Cost-Effectiveness of Public Automated External Defibrillators

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Lars W Andersen ◽  
Mathias J Holmberg ◽  
Asger Granfeldt ◽  
Lyndon P James ◽  
Lisa Caulley
Keyword(s):  
Public Health ◽  
Cardiac Arrest ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Automated External Defibrillators ◽  
The Us ◽  
Hospital Cardiac Arrest

Introduction: Despite a consistent association with improved outcomes, automated external defibrillators (AEDs) are used in only approximately 10% of public out-of-hospital cardiac arrest. One of the barriers towards increased use might be cost. The objective of this study was to provide a contemporary cost-effectiveness analysis on the use of public AEDs in the United States (US) to inform guidelines and public health initiatives. Methods: We compared the cost-effectiveness of public AEDs to no AEDs for out-of-hospital cardiac arrest in the US over a life-time horizon. The analysis assumed a societal perspective and results are presented as costs (in 2017 US dollars) per quality-adjusted life year (QALY). Model inputs were based on reviews of the literature. For the base case, we modelled an annual cardiac arrest incidence per AED of 20%. It was assumed that AED use was associated with a 52% relative increase in survival to hospital discharge with a favorable neurological outcome in those with a shockable rhythm. A probabilistic sensitivity analysis was conducted to account for joint parameter uncertainty. Consistent with recent guidelines from the American Heart Association, we used a willingness-to-pay threshold of $150,000 per QALY gained. Results: The no AED strategy resulted in 1.63 QALYs at a cost of $42,757. The AED strategy yielded an additional 0.26 QALYs for an incremental increase in cost of $13,793 per individual. The AED strategy yielded an incremental cost-effectiveness ratio of $53,797 per QALY gained. The yearly incidence of cardiac arrests occurring in the presence of an AED had minimal effect on the incremental cost-effectiveness ratio except at very low incidences. At an incidence of 1%, the incremental cost-effectiveness ratio was $101,040 per QALY gained. In sensitivity analyses across a plausible range of health-care and societal estimates, the AED strategy remained cost-effective. In the probabilistic sensitivity analysis, the AED strategy was cost-effective in 43%, 85%, and 91% of the scenarios at a threshold of $50,000, $100,000, and $150,000 per QALY gained, respectively. Conclusion: Public AEDs are a cost-effective public health intervention in the US. These findings support widespread dissemination of public AEDs.

Abstract 18: Analyzing Heart Rhythm During Chest Compressions in Out-of-Hospital Cardiac Arrest Patients Using New Algorithm for Automated External Defibrillators

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Corina de Graaf ◽  
Stefanie G Beesems ◽  
Ronald E Stickney ◽  
Paula Lank ◽  
Fred W Chapman ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Negative Impact ◽  
Pulseless Electrical Activity ◽  
Heart Rhythm ◽  
Chest Compressions ◽  
Study Region ◽  
Automated External Defibrillators ◽  
Conventional Analysis ◽  
Hospital Cardiac Arrest ◽  
Conventional Algorithm

Purpose: Automated external defibrillators (AED) prompt the rescuer to stop cardiopulmonary resuscitation (CPR) for ECG analysis. Any interruption of CPR has a negative impact on outcome. We prospectively evaluated a new algorithm (cprINSIGHT) which can analyse the ECG while rescuers continue CPR. Methods: We analysed data from patients with attempted resuscitation from OHCA who were connected to an AED with cprINSIGHT (Stryker Physio-Control LIFEPAK CR2) between June 2017 and June 2018 in the Amsterdam Resuscitation Study region. The first analysis in the CR2 is a conventional analysis; subsequent analyses use the cprINSIGHT algorithm. This algorithm classifies the rhythm as shockable (S), non-shockable (NS), or no decision. If no decision, the AED prompts for a pause in CPR and uses its conventional algorithm. The characteristics of the first 3 cprINSIGHT analyses (analyses 2-4) were analysed. Ventricular fibrillation (VF) cases were both coarse and fine VF with a lower threshold of 0.08 mV. Results: Data from 132 consecutive OHCA cases were analysed. The initial recorded rhythm was VF or pulseless ventricular tachycardia (VT) in 35 cases (27%), pulseless electrical activity in 34 cases (25%) and asystole in 63 cases (48%). In 114 cases (86%), 1 or more cprINSIGHT analyses were done. Analyses 2-4 covered 90% of all cprINSIGHT analyses. The analyzed rhythm was VF/VT in 12-17%, organised QRS rhythm in 29-35% and asystole in 51-56% (see table). cprINSIGHT reached a S or NS decision in 65-74% of cases, with a sensitivity of 90-100% and a specificity of 100%. When it reached no decision, the rhythm was asystole in 65-79% of analyses, VF/VT in 0-9% and QRS rhythm in 18-27%; conventional analysis followed. Chest compression fraction was 85-88%, CPR fraction was 99%. Conclusion: This new algorithm analysed the ECG without need for a pause in chest compressions 65-74% of the time and had 90-100% sensitivity and 100% specificity when it made a shock or a no shock decision.

P1702ARIADNA: first steps in the development of a collaborative initiative to create a map of automated external defibrillators and improve survival in out-of-hospital cardiac arrest in Spain

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Garcia-Izquierdo Jaen ◽  
C Martin-Munoz ◽  
V Orozco-Legaza ◽  
A Iniguez-Romo ◽  
M Anguita-Sanchez ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Social Engagement ◽  
Easy Access ◽  
Dissemination And Implementation ◽  
Spanish Society ◽  
Automated External Defibrillators ◽  
Final Version ◽  
The Future ◽  
Hospital Cardiac Arrest ◽  
Collaborative Initiative

Abstract Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Although some geographical variation in the incidence of OHCA can be found, clinical outcomes are globally poor, with an expected percentage of survival to hospital discharge below 10% worldwide. Up to 60% of public OHCAs present with ventricular tachycardia or ventricular fibrillation. Early OHCA recognition and early defibrillation are key elements to increase the chances of survival with a favorable neurological outcome. To make this possible, easy access to automated external defibrillators (AEDs) must be warranted. Public AED programs have been implemented worldwide and have shown a significant improvement in survival and better functional outcome after OHCA. However, installation of public-access AEDs without linking them to responders appears to be meaningless and might not improve survival. Ariadna is the first collaborative approach to improve survival in OHCA in Spain. Endorsed by the Spanish Society of Cardiology and the Spanish Red Cross, Ariadna is a smartphone app that aims to create a map of all available AEDs within the Spanish territory using GPS functions available on smartphones. This app is also directed at establishing the first national network of lay responders trained in cardiopulmonary resuscitation (CPR). In the future, this network will serve as an enhancing tool to provide a rapid response to OHCA under the coordination of the emergency medical services. Purpose To analyze the preliminary results in terms of dissemination and implementation of Ariadna in the first months after the release of the final version of the app. Methods Ariadna app is available for free on iOS and Android. Users can sign up as “seekers” to locate and validate AEDs within the Spanish territory. All AEDs are displayed on a map, including those pending validation. “Seekers” who provide proof of valid CPR training can become “responders” and agree to be alerted in case of OHCA nearby in the future. In this preliminary analysis, the number of registered users along with the amount of registered and validated AEDs were retrieved from the app database. Results The final version of app was released September, 8, 2018. Since then and until February 2019, Ariadna has recruited 10846 users. A total of 3975 AEDs have been registered, 1037 of which (26%) have received validation from at least a different user. These numbers represent a growth rate of 70 new users and 26 new AEDs every day. Ariadna App growth in numbers Conclusion Ariadna has experienced an exponential growth in the first months of functioning and is already helping raise awareness for cardiac arrest in Spain. This proves the social engagement and successful dissemination of this collaborative initiative. Every effort will be made to progressively increase the number of users and registered AEDs in order to link them to trained responders and finally improve survival in cardiac arrest. Acknowledgement/Funding Financial support from the Spanish Society of Cardiology

Competing scales in transnational networks: the impossible travel of Patrick Geddes' Cities Exhibition to America, 1911–1913

Urban History ◽  
2009 ◽  
Vol 36 (02) ◽  
pp. 202-222 ◽  
Author(s):  
PIERRE CHABARD
Keyword(s):  
North American ◽  
City Planning ◽  
Town Planning ◽  
Transnational Networks ◽  
American City ◽  
North American City ◽  
National Conference ◽  
Frederick Law Olmsted ◽  
The Many ◽  
City Planners

ABSTRACTAt the turn of the 1910s, a productive tension opposed two competing kinds of North American city planning actors: urban reformers (such as Benjamin Marsh, founder of the National Conference on City Planning (NCCP) in 1909) and professional city planners (such as Frederick Law Olmsted Jr, new director of the NCCP in 1911). Analysing the many unsuccessful attempts, between 1911 and 1913, to send the ‘Cities and Town Planning Exhibition’ – a British itinerant exhibition directed by the Scottish thinker and reformer Patrick Geddes (1854–1932) – to tour America, this article examines the transnational similarities and interactions between American and European urbanist milieux; the competing scales (municipal, national, international) in this dialogue; and the strategies of the professionalization of planning.

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