Abstract 13228: Out-of-Hospital Cardiac Arrest Coverage by Volunteer Citizen Responders and Automated External Defibrillators in Denmark

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Nanna B Christensen ◽  
Fredrik Folke ◽  
Louise Kollander Jakobsen ◽  
Anne J Jørgensen ◽  
Julie Kjoelbye ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Time Of Day ◽  
High Density ◽  
Successful Implementation ◽  
Automated External Defibrillators ◽  
Pilot Data ◽  
Hospital Cardiac Arrest ◽  
M 14

Introduction: High density of citizen responders (CR) and automated external defibrillators (AEDs) may increase chances for early bystander defibrillation in out-of-hospital cardiac arrest (OHCA). We aimed to assess coverage using current CR and AED positions applied on historical OHCAs in Denmark. Methods: Non-EMS witnessed OHCAs from the Danish cardiac arrest registry with known location (2016-2019) and AEDs registered with the Danish AED network (November 2020) were included. Locations of all CRs registered with the national CR program were identified (Wed, December 2, 2020) at 12pm (noon) and 12am (midnight). Since pilot data showed 25% of alerted CRs accepted the alarm, we investigated OHCA CR coverage defined ≥4 CR within <1800m (1969 yd), <500m (547 yd) and <200m (219 yd), and OHCA CR + AED coverage as ≥4 CR and 1 AED <1800m, <500m and <200m. We compared OHCA coverage during daytime and nighttime. Results: A total of 18,128 OHCAs (median age 73 years, 63.4% male) were included. A total of 22,418 AEDs (386/100,000 inhabitants) were available at 12pm, 65% were accessible 24/7. A total of 34,033 CR (586 CR/100,000 inhabitants) were available at 12am and 33,938 were available at12pm. During daytime, a median of 29 AEDs and 37 CRs were <1800m of historical OHCAs. Most OHCAs were covered by CRs and AEDs <1800m decreasing with shorter distances with little difference according to time of day (Figure 1). Conclusion: Following the implementation of a nationwide AED network and a citizen responder program, most historical OHCAs (85%) were < 1800m of CRs and AEDs at midnight with a slight decrease during daytime (82%). A decrease in CR and AED coverage were observed for 500m (59%) and 200 m (14%), with little difference according to time of day. During daytime a median of 29 AEDs and 37 CRs were < 1800m of historical OHCAs. Our results indicate successful implementation of a national AED registry and CR program with great potential for improving bystander defibrillation.

scholarly journals Is Distance to the Nearest Registered Public Automated Defibrillator Associated with the Probability of Bystander Shock for Victims of Out-of-Hospital Cardiac Arrest?

2018 ◽  
Vol 33 (2) ◽  
pp. 153-159 ◽  
Author(s):  
Joel Neves Briard ◽  
Luc de Montigny ◽  
Dave Ross ◽  
François de Champlain ◽  
Eli Segal
Keyword(s):  
Cardiac Arrest ◽  
Urban Areas ◽  
Prehospital Care ◽  
Time Of Day ◽  
Publication Type ◽  
Cross Sectional ◽  
Automated External Defibrillators ◽  
Life Saving ◽  
Sectional Analysis ◽  
Hospital Cardiac Arrest

AbstractIntroductionRapid access to defibrillation is a key element in the management of out-of-hospital cardiac arrests (OHCAs). Public automated external defibrillators (PAEDs) are becoming increasingly available, but little information exists regarding the relation between the proximity to the arrest and their usage in urban areas.MethodsThis study is a retrospective, observational, cross-sectional analysis of non-traumatic OHCA during a 24-month period in the greater Montreal area (Quebec, Canada). Using logistic regression, bystander shock odds are described with regards to distance from the OHCA scene to the nearest PAED, adjusted for prehospital care arrival delay and time of day, and stratifying for type of location.ResultsOut of a total of 2,443 OHCA victims identified, 77 (3%) received bystander PAED shock, 622 (26%) occurred out-of-home, and 743 (30%) occurred during business hours. When controlling for time (business hours versus other hours) and minimum response delay for prehospital care arrival, a marginal negative association was found between bystander shock and distance to the nearest PAED in logged meters (aOR=0.80; CI, 0.64-0.99) for out-of-home cardiac arrests. No significant association was found between distance and bystander shock for at-home arrests. Out-of-home victims had significantly higher odds of receiving bystander shock up to 175 meters of distance to a PAED inclusively (aOR=2.52; CI, 1.07-5.89).ConclusionFor out-of-home cardiac arrests, proximity to a PAED was associated with bystander shock in the greater Montreal area. Strategies aiming to increase accessibility and use of these life-saving devices could further expand this advantage by assisting bystanders in rapidly locating nearby PAEDs.Neves BriardJ, de MontignyL, RossD, de ChamplainF, SegalE. Is distance to the nearest registered public automated defibrillator associated with the probability of bystander shock for victims of out-of-hospital cardiac arrest?Prehosp Disaster Med. 2018;33(2):153–159.

Abstract 12132: Diurnal Variation in Citizen Responder and Automated External Defibrillation Coverage of Out-of-Hospital Cardiac Arrest in Denmark According to Area Types

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Nanna B Christensen ◽  
Fredrik Folke ◽  
Julie Kjoelbye ◽  
Louise Kollander Jakobsen ◽  
Anne J Jørgensen ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Time Of Day ◽  
High Density ◽  
Geographical Information ◽  
Residential Areas ◽  
High Coverage ◽  
Automated External Defibrillation ◽  
Working Day ◽  
Leisure Facilities ◽  
Hospital Cardiac Arrest

Introduction: Following the implementation of the Danish AED network and a nationwide citizen responder (CR) program for out-of-hospital cardiac arrest (OHCA), CR and AED coverage for OHCAs according to area types has not been investigated. We aimed to assess AED and CR coverage of historical OHCAs according to area types in daytime (12pm) and nighttime (12am). Methods: We included non-EMS witnessed OHCAs from the Danish Cardiac Arrest Registry (2016-2019) and AEDs registered with the Danish AED network (November 2020) available at 12am (n=22,418) and 12pm (n=14,734). Exact locations of CRs who were registered with the national CR program by December 2020 were identified on a normal working day (Wednesday, December 2, 2020) at 12am and 12pm (representing day- and nighttime location). OHCAs, AEDs, and CRs were identified and geocoded using a geographical information system. Urban Atlas was used to categorize areas into subgroups using satellite images; high density residential areas, low density residential areas, public and industrial sites, nature, sport and leisure facilities, transportation (e.g. airport and railway stations), and fast transit roads. Results: A total of 10,126 OHCAs (63.0% male, median age 73 years). We mapped 14,119 AEDs (12 pm) and 24,372 CR (12 pm) in Urban Atlas. Most OHCAs in all area types were covered by >= 1 AED. A greater variation was observed in CR coverage when compared to AED coverage, according to area type. Little difference in coverage of both AED and CR according to time of day was observed. (Figure 1) Conclusion: The highest CR and AED coverage were observed in high density residential areas, transportation sites, public and industrial areas, and sport and leisure facilities, which is where most OHCAs occurred. These findings indicate a high coverage of citizen responders and AEDs in Denmark.

scholarly journals Factors influencing the intentions of nurses and respiratory therapists to use automated external defibrillators during in-hospital cardiac arrest: a qualitative interview study

CJEM ◽  
2016 ◽  
Vol 20 (1) ◽  
pp. 68-79 ◽  
Author(s):  
Jessica Andrews ◽  
Christian Vaillancourt ◽  
Jan Jensen ◽  
Ann Kasaboski ◽  
Manya Charette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Social Influences ◽  
Qualitative Interviews ◽  
Control Beliefs ◽  
Successful Implementation ◽  
Automated External Defibrillators ◽  
Respiratory Therapists ◽  
Qualitative Interview Study ◽  
Intent To Use ◽  
Hospital Cardiac Arrest

AbstractObjectivesNurses and respiratory therapists are seldom allowed to use automated external defibrillators (AED) during in-hospital cardiac arrest. This can result in significant time delays before defibrillation occurs and lower survival for cardiac arrest victims. We sought to identify barriers and facilitators to AED use by nurses and respiratory therapists.MethodsWe conducted semi-structured qualitative interviews with a purposeful sample of nurses and respiratory therapists. We developed the interview guide based on the constructs of the theory of planned behaviour, which elicits salient attitudes, social influences, and control beliefs potentially influencing the intent to use an AED. Interviews were recorded, transcribed verbatim, and analysed until achieving data saturation. Two independent reviewers performed inductive analyses to identify emerging categories and themes, and ranked them by frequency of the number of participants stating the topic.ResultsDemographics for the 24 interviewees include mean age 40.5, 79.2% female, 87.5% performed cardiopulmonary resuscitation (CPR), 29.2% defibrillated a patient. Identified attitudes pertained to the timeliness of defibrillation, patient survival, simplicity of AED use, accuracy of rhythm recognition, and harm to self or others. Social influences consisted of physician and hospital administration support of AED use. Control beliefs included training on AED use, policy allowing AED use, familiarity with AED, and task burden during resuscitation.ConclusionsMost nurses and respiratory therapists intended to use an AED if permitted to do so by a medical directive. Successful implementation would require educational initiatives focusing on safety and efficacy of AEDs, support from physicians and hospital administrators, and additional training on AED use.

scholarly journals Optimal Installation Locations for Automated External Defibrillators in Taipei 7-Eleven Stores: Using GIS and a Genetic Algorithm with a New Stirring Operator

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Chung-Yuan Huang ◽  
Tzai-Hung Wen
Keyword(s):  
Genetic Algorithm ◽  
Cardiac Arrest ◽  
Time Of Day ◽  
Residential Areas ◽  
Automated External Defibrillators ◽  
Fire Stations ◽  
Survival Potential ◽  
Hospital Cardiac Arrest ◽  
Allocation Strategies ◽  
External Defibrillator

Immediate treatment with an automated external defibrillator (AED) increases out-of-hospital cardiac arrest (OHCA) patient survival potential. While considerable attention has been given to determining optimal public AED locations, spatial and temporal factors such as time of day and distance from emergency medical services (EMSs) are understudied. Here we describe a geocomputational genetic algorithm with a new stirring operator (GANSO) that considers spatial and temporal cardiac arrest occurrence factors when assessing the feasibility of using Taipei 7-Eleven stores as installation locations for AEDs. Our model is based on two AED conveyance modes, walking/running and driving, involving service distances of 100 and 300 meters, respectively. Our results suggest different AED allocation strategies involving convenience stores in urban settings. In commercial areas, such installations can compensate for temporal gaps in EMS locations when responding to nighttime OHCA incidents. In residential areas, store installations can compensate for long distances from fire stations, where AEDs are currently held in Taipei.

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

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