Availability and density of text-message alerted local rescuers and automated external defibrillators for early defibrillation in out-of-hospital cardiac arrest

Resuscitation ◽  
2016 ◽  
Vol 106 ◽  
pp. e9-e10
Author(s):  
Jolande Zijlstra ◽  
Remy Stieglis ◽  
Frank Riedijk ◽  
Martin Smeekes ◽  
Wim van der Worp ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Text Message ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
Hospital Cardiac Arrest

scholarly journals Improved ROSC rates in out-of-hospital cardiac arrest patients after introduction of a text message alert system for trained volunteers

2022 ◽  
Author(s):  
D. M. Oosterveer ◽  
M. de Visser ◽  
C. Heringhaus
Keyword(s):  
Cardiac Arrest ◽  
Multivariate Regression ◽  
Survival Rates ◽  
Text Message ◽  
Positive Association ◽  
Regression Analyses ◽  
Alert System ◽  
Automated External Defibrillators ◽  
Average Survival ◽  
Hospital Cardiac Arrest

Abstract Objective To evaluate whether a text message (TM) alert system for trained volunteers contributed to early cardiopulmonary resuscitation, the use of automated external defibrillators (AEDs), return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest (OHCA) patients in a region with above-average survival rates. Design Data on all OHCA patients in 2012 (non-TM group) were compared with those of all OHCA patients in 2018 (TM group). The association of the presence of a TM alert system with ROSC and survival was assessed with multivariate regression analyses. Results TM responders reached 42 OHCA patients (15.9%) earlier than the first responders or ambulance. They connected 31 of these 42 OHCA patients (73.8%) to an AED before the ambulance arrived, leading to a higher percentage of AEDs being attached in 2018 compared to the 2012 non-TM group (55% vs 46%, p = 0.03). ROSC was achieved more often in the TM group (61.0% vs 29.4%, p < 0.01). Three-month and 1‑year survival did not differ significantly between the two groups (29.3% vs 24.3%, p = 0.19, and 25.9% vs 23.5%, p = 0.51). Multivariate regression analyses confirmed the positive association of ROSC with the TM alert system (odds ratio 1.49, 95% confidence interval 1.02‑2.19, p = 0.04). Conclusion A TM alert system seems to improve the chain of survival; because TM responders reached patients early, AEDs were attached more often and more OHCA patients achieved ROSC. However, the introduction of a TM alert system was not associated with improved 3‑month or 1‑year survival in a region with above-average survival rates.

Abstract 109: Automated External Defibrillators Are Rarely Used for In-Hospital Cardiac Arrest in Denmark

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Mathilde Staerk ◽  
Kasper G Lauridsen ◽  
Kristian Krogh ◽  
Hans Kirkegaard ◽  
Bo Løfgren
Keyword(s):  
Cardiac Arrest ◽  
Hospital Setting ◽  
Spontaneous Circulation ◽  
Early Defibrillation ◽  
Automated External Defibrillators ◽  
Shockable Rhythm ◽  
Initial Rhythm ◽  
Rhythm Analysis ◽  
Hospital Cardiac Arrest ◽  
Cardiac Arrest Team

Introduction: Automated External Defibrillators (AEDs) are widely distributed in the pre-hospital setting and reported to reduce time to defibrillation and increase survival from out-of-hospital cardiac arrest. During in-hospital cardiac arrest (IHCA), AEDs may allow for early defibrillation before the cardiac arrest team arrives with a manual defibrillator. However, the effect of AEDs for IHCA remains unclear. This study aimed to investigate AED usage and contribution to defibrillation before cardiac arrest team arrival during IHCA. Methods: We obtained data on IHCAs in 2016 and 2017 from the Danish nationwide registry on IHCA (DANARREST). Data included information on initial rhythm, type of defibrillator, time to first rhythm analysis, time to arrival of the cardiac arrest team, time to first defibrillation, and return of spontaneous circulation (ROSC). Results: Of 4,496 IHCAs, AEDs were used in 421 resuscitation attempts (9%). Time registrations were excluded for 6 non-shockable IHCAs due to errors in registration. Of the 421 IHCAs, 82% (n=347) were non-shockable and 16% (n=68) were shockable (data missing for 6 IHCAs). ROSC was achieved in 46% (n=158) of patients with non-shockable rhythms and 59% (n=40) of patients with shockable rhythms. For IHCAs with a shockable rhythm and usage of an AED, rhythm analysis was performed before arrival of the cardiac arrest team in 50% (n=34) of cases and defibrillation with an AED were performed in 46% (n=27) of the cases. Patients with shockable rhythms defibrillated before arrival of the cardiac team, more often achieved ROSC compared to patients defibrillated after cardiac arrest team arrival (p=0.0024). Data regarding time registration are shown in the table. Conclusion: AEDs are used in approximately 1 of 10 resuscitation attempts in Danish hospitals and contribute to defibrillation before arrival of the cardiac arrest team in 1 of 14 cardiac arrest patients.

Outcomes and In-hospital Treatment of Out-of-Hospital Cardiac Arrest Patients Resuscitated From Ventricular Fibrillation by Early Defibrillation

2004 ◽  
Vol 79 (5) ◽  
pp. 613-619 ◽  
Author(s):  
T. Jared Bunch ◽  
Roger D. White ◽  
Bernard J. Gersh ◽  
Win-Kuang Shen ◽  
Stephen C. Hammill ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Treatment ◽  
Early Defibrillation ◽  
Hospital Cardiac Arrest

Abstract 01: Dispatching Lay Rescuers Through a Smartphone Application is Associated With Increased Bystander Defibrillation in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Linn Andelius ◽  
Carolina Malta Hansen ◽  
Freddy Lippert ◽  
Lena Karlsson ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Smartphone Application ◽  
Automated External Defibrillator ◽  
Early Defibrillation ◽  
Emergency Medical Dispatch ◽  
Capital Region ◽  
Electronic Survey ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest ◽  
External Defibrillator

Introduction: Survival after out-of-hospital cardiac arrest (OHCA) is dependent on early defibrillation. To increase bystander defibrillation in OHCAs, a first-responder program dispatching lay rescuers (Heart Runners) through a smartphone application (Heart Runner-app) was implemented in the Capital Region of Denmark. We investigated the proportion of Heart Runners arriving prior to the Emergency Medical Services (EMS) and rates of bystander defibrillation. Methods: The Capital Region of Denmark comprises 1.8 mil. inhabitants and 19,048 Heart Runners were registered. In cases of suspected OHCA, the Heart Runner-app was activated by the Emergency Medical Dispatch Center. Up to 20 Heart Runners < 1.8 km from the OHCA were dispatched to either start cardiopulmonary resuscitation (CPR) or to retrieve and use a publicly accessible automated external defibrillator (AED). Through an electronic survey, Heart Runners reported if they arrived before EMS and if they applied an AED. OHCAs where at least one Heart Runner arrived before EMS were compared with OHCAs where EMS arrived first. All OHCAs from September 2017 to May 2018, where Heart Runners had been dispatched, were included. Results: Of 399 EMS treated OHCAs, 78% (n=313/399) had a matching survey. A Heart Runner arrived before EMS in 47% (n=147/313) of the cases, and applied an AED in 41% (n=61/147) of these cases. Rate of bystander defibrillation was 2.5-fold higher compared to cases where the EMS arrived first (Table 1). Conclusions: By activation of the Heart Runner-app, Heart Runners arrived prior to EMS in nearly half of all the OHCA cases. Bystander defibrillation rate was significantly higher when Heart Runners arrived prior to EMS.

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.

Out of Hospital Cardiac Arrest

2018 ◽  
pp. 89-93
Author(s):  
Erik Rueckmann
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Evidence Based ◽  
Early Defibrillation ◽  
Key Factors ◽  
High Quality ◽  
Key Points ◽  
Neurologically Intact ◽  
Hospital Cardiac Arrest

The management of out-of-hospital, atraumatic cardiac arrest has changed over the past decade. This case details the evidence-based changes in care that optimize the chance of neurologically intact survival. The key factors include immediate, continuous, high-quality cardiopulmonary resuscitation with minimal interruptions, early defibrillation, and the use of capnography to assess resuscitative efforts. The orchestration of resuscitative efforts is a bundle of care that must all be met to provide the patient the best chance of survival. Furthermore, this case illustrates the key points of postarrest care and touches on termination of resuscitation. This chapter examines the case of emergency medical services call for an unresponsive patient in cardiac arrest on arrival.

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

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