automated external defibrillators
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2022 ◽  
Vol 10 (2) ◽  
pp. 01-02
Author(s):  
Ashish Gujrathi

The modern technological advancements and facilities have made people welcome medical equipment to home. Most common home medical equipment include glucometer, automated external defibrillators, blood glucose monitors, blood pressure monitors, halter monitors, mobility devices, weighing scale and so on. These equipment can provide safe, convenient, cost-effective, and suitable treatments to patients at home.


Author(s):  
D. M. Oosterveer ◽  
M. de Visser ◽  
C. Heringhaus

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.


Author(s):  
Korakot Apiratwarakul ◽  
Takaaki Suzuki ◽  
Ismet Celebi ◽  
Somsak Tiamkao ◽  
Vajarabhongsa Bhudhisawasdi ◽  
...  

Abstract Introduction: Motorcycles can be considered a new form of smart vehicle when taking into account their small and modern structure and due to the fact that nowadays, they are used in the new role of ambulance to rapidly reach emergency patients in large cities with traffic congestion. However, there is no study regarding the measuring of access time for motorcycle ambulances (motorlances) in large cities of Thailand. Study Objective: This study aims to compare access times to patients between motorlances and conventional ambulances, including analysis of the use of automated external defibrillators (AEDs) installed on motorlances to contribute to the sustainable development of public health policies. Methods: A cross-sectional study was conducted on all motorlance operations in Emergency Medical Services (EMS) at Srinagarind Hospital, Thailand from January 2019 through December 2020. Data were recorded using a national standard operation record form for Thailand. Results: Two hundred seventy-one motorlance operations were examined over a two-year period. A total of 52.4% (N = 142) of the patients were male. The average times from dispatch to vehicle (motorlance and traditional ambulance) being en route (activation time) for motorlance and ambulance in afternoon shift were 0.59 minutes and 1.45 minutes, respectively (P = .004). The average motorlance response time in the afternoon shift was 6.12 minutes, and ambulance response time was 9.10 minutes at the same shift. Almost all of the motorlance operations (97.8%) were found to have no access to AED equipment installed in public areas. The average time from dispatch to AED arrival on scene (AED access time) was 5.02 minutes. Conclusion: The response time of motorlances was shorter than a conventional ambulance, and the use of AEDs on a motorlance can increase the chances of survival for patients with cardiac arrest outside the hospital in public places where AEDs are not available.


2021 ◽  
Author(s):  
Tae Youn Kim ◽  
Yun-kyoung Jung ◽  
Sun Hwa Yoon ◽  
Sun Ju Kim ◽  
Kyoung-chul Cha ◽  
...  

Abstract Objective This study aimed to assess the maintenance status and availability of publicly installed automated external defibrillators (AEDs). Methods Public AEDs installed in Seoul 2013 to 2017 were included. An inspector checked the maintenance status and availability of AEDs annually using a checklist. Results A total of 23,619 AEDs were inspected for 5 years. Access to AEDs was improved, including reduced obstacles around AEDs (from 9.3% in 2013 to 0.8% in 2017) and increased AED signs (from 34.3% in 2013 to 91.2% in 2017). The number of AEDs in normal operation (from 94.0% in 2013 to 97.5% in 2017), with normal battery charge (from 95.6% in 2013 to 96.8% in 2018), and electrode availability increased (from 97.1% in 2013 to 99.0% in 2017). However, the rate of electrode validity decreased (from 90.0% in 2013 to 87.2% in 2017). Non-ready-to-use AEDs and AEDs with limited 24-h availability accounted for 15.4% and 44.1% of the total number of AEDs, respectively. Conclusions Although most AEDs had a relatively good maintenance status, a significant proportion of public AEDs was not available for 24-h use. Invalid electrodes and limited 24-h accessibility were the main reasons that limited the 24-h availability of public AEDs.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Li (Danny) Liang ◽  
Benjamin Leung ◽  
Timothy Chan ◽  
Jennie Helmer ◽  
Garth Meckler ◽  
...  

Background: While pediatric out-of-hospital cardiac arrests (OHCAs) are relatively uncommon, they have a much higher number of potential years of life lost per event. School-located public access automated external defibrillators (AED) may be beneficial to school-aged OHCAs, but also other OHCAs within the school and in the surrounding community. We sought to identify the incidence of OHCAs within and nearby schools in British Columbia (BC), to estimate the number that may benefit from school-located AEDs. Methods: We used prospectively-collected data from the BC OHCA Registry from 2013 to 2018. We examined the addresses of all OHCAs to determine those occurring in public primary and secondary schools. We geo-plotted all OHCAs to identify the number of OHCAs within walking distance of a school. Assuming an average pedestrian speed for AED retrieval of 1.8 m/second, we calculated the number of school-vicinity OHCAs for which a bystander could retrieve an AED prior to a 6.5 minute emergency medical system response interval, assuming that AEDs would be located on the exterior of a school building. Results: There were a total of 401,423 children enrolled at 824 schools annually in the study footprint. Of a total of 12,480 EMS-treated OHCAs (220 aged < 18 years), 20 were in in schools, of which 4 were <18 years of age. Of school located OHCAs, 14 (70%) had initial shockable rhythms, 4 (20%) had an AED applied (of whom 3 survived), and 10 (50%) survived. Of the four school-located pediatric OHCAs, three were witnessed (75%), two had initial shockable rhythms (50%), and two (50%) survived until hospital discharge. A total of 1128/12,480 (9%) OHCAs were within retrieval distance of a school, corresponding to 0.228 per school per year (95% CI 0.201-0.255 year-to-year) , which is above current thresholds for cost-effectiveness. Conclusion: Outcomes of school-located OHCAs are encouraging, especially those with AED application. While the incidence of school-located OHCAs is low, a substantial proportion of OHCAs occur within a retrievable distance to a school, and thus accessible external school-located AEDs may improve overall OHCA outcomes of a community.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
K.H. Benjamin Leung ◽  
Brian Grunau ◽  
May K Lee ◽  
Jane Buxton ◽  
Jennie Helmer ◽  
...  

Introduction: Use of bystander-administered naloxone may lead to improved likelihood of recovery from opioid overdose. We sought to determine the accessibility of public access naloxone kits on nearby opioid overdose incidents if placed at public transit stops, compared to placing kits outside pharmacies or with existing public access automated external defibrillators (PADs). Methods: We included all incidents in Metro Vancouver, British Columbia responded to by British Columbia Emergency Health Services coded as a drug overdose with naloxone administered on-scene (Dec. 2014 to Aug. 2020). We geo-coded all public transit bus stops and used a mathematical optimization model to select bus stops where publicly accessible naloxone kits could be placed to maximize accessibility (defined as ≤100 m walking distance) to opioid overdoses. We evaluated accessibility on out-of-sample OHCAs using five-fold cross validation and compared against two baseline policies: placing publicly accessible naloxone kits at all pharmacies identified by the College of Pharmacists of British Columbia, and placing kits at all PADs identified by the British Columbia AED Registry. Statistical analysis was conducted using McNemar’s test. Results: We identified 14,318 opioid overdoses, 8,972 bus stops, 736 pharmacies, and 425 PADs. Accessibility of public naloxone kits for opioid overdose locations was 5.1% when placed at all pharmacies and 3.5% when placed with all existing PADs. Optimized naloxone kit placement using bus stops as candidate locations resulted in significantly higher accessibility than both pharmacy and PAD-based placement at 14.8% with 10 optimized locations (P<0.001), increasing to 36.7% with 500 locations (P<0.001). Conclusion: Optimizing placement of public access naloxone kits at select public transit locations can provide significantly higher accessibility to opioid overdose locations compared to placement at pharmacies or at existing PAD locations.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mads Christian Tofte Gregers ◽  
Linn Andelius ◽  
Carolina Malta Hansen ◽  
Astrid Rolin Kragh ◽  
Christian Torp-Pedersen ◽  
...  

Introduction: Multiple citizen responder (CR) programs worldwide which dispatch laypersons to out-of-hospital cardiac arrest (OHCA) to perform cardiopulmonary resuscitation (CPR) and use of automated external defibrillators (AEDs) were affected by the COVID-19 outbreak in 2020, but little is known about how the pandemic affected CR activation and initiation of bystander CPR and defibrillation. In Denmark, the CR program continued to run during lockdown but with the recommendation to perform chest-compression-only CPR in contrast to standard CPR including ventilations. We hypothesized that bystander interventions as CPR and AED usage decreased during the first COVID-19 lockdown in two regions of Denmark in the spring of 2020. Methods: All OHCAs from January 1, 2020 to June 30, 2020 with CR activation from the Danish Cardiac Arrest Registry and the National Citizen Responder database. Bystander CPR, AED usage, and CRs’ alarm acceptance rate during the national lockdown from March 11, 2020 to April 20, 2020 were compared with the non-lockdown period from January 1, 2020 to March 10, 2020 and from April 21 to June 30, 2020. Results: A total of 6,120 CRs were alerted in 443 (23/100.000 inhabitants) cases of presumed OHCA of which 256 (58%) were confirmed cardiac arrests. Bystander CPR remained equally high in the lockdown period compared with non-lockdown period (99% vs. 92%, p=0.07). Likewise, there was no change in bystander defibrillation (9% vs. 14%, p=0.4). There was a slight increase in the number of CRs who accepted an alarm (7 per alarm, IQR 4) during lockdown compared with non-lockdown period (6 per alarm, IQR 4), p=0.0001. The proportion of patients achieving return of spontaneous circulation at hospital arrival was also unchanged (lockdown 23% vs non-lockdown 23%, p=1.0) (Table 1). Conclusion: Bystander initiated resuscitation rates did not change during the first COVID-19 lockdown in Denmark for OHCAs where CRs were activated through a smartphone app.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Shirin Hajeb Mohammadalipour ◽  
Alicia Cascella ◽  
Matt Valentine ◽  
Ki Chon

Survival from out-of-hospital cardiac arrests depends on an accurate defibrillatory shock decision during cardiopulmonary resuscitation (CPR). Since chest compressions induce severe motion artifact in the electrocardiogram (ECG), current automatic external defibrillators (AEDs) do not perform CPR during the rhythm analysis period. However, performing continuous CPR is vital and dramatically increases the chance of survival. Hence, we demonstrate a novel application of a deep convolutional neural network encoder-decoder (CNNED) method in suppressing CPR artifact in near real-time using only ECG data. The encoder portion of the CNNED uses the frequency and phase contents derived via time-varying spectral analysis to learn distinct features that are representative of both the ECG signal and CPR artifact. The decoder portion takes the results from the encoder and reconstructs what is perceived as the motion artifact removed ECG data. These procedures are done via multitude of training of CNNED using many different arrhythmia contaminated with CPR. In this study, CPR-contaminated ECGs were generated by combining clean ECG with CPR artifacts from 52 different performers. ECG data from CUDB, VFDB, and SDDB datasets which belong to the Physionet’s Physiobank archive were used to create the training set containing 89,984 14-second ECG segments. The performance of the proposed CNNED was evaluated on a separate test set comprising of 23,816 CPR-contaminated 14-second ECG segments from 458 subjects. The results were evaluated by two metrics: signal-to-noise ratio (SNR), and Defibtech’s AED rhythm analysis algorithm. CNNED resulted in the increase of the mean SNR value from -3 dB to 5.63 dB and 6.3 dB for shockable and non-shockable rhythms, respectively. Comparing Defibtech’s AED rhythm classifier before and after applying CNNED on the CPR-contaminated ECG, the specificity improved from 96.57% to 99.31% for normal sinus rhythm, and from 91.5% to 96.57% for other non-shockable rhythms. The sensitivity of shockable detection also increased from 67.68% to 87.76% for ventricular fibrillation, and from 62.71% to 81.27% for ventricular tachycardia. These results indicate continuous and accurate AED rhythm analysis without stoppage of CPR using only ECG data.


Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Julie Kjoelbye ◽  
Linn Andelius ◽  
Enrico Baldi ◽  
Angelo Auricchio ◽  
Marieke Blom ◽  
...  

Introduction: Though deployment of Automated External Defibrillators (AEDs) is increasing rapidly, AEDs are often deployed in an un-strategic manner. Consequently, little is known about the association between AED density, AED coverage of out-of-hospital cardiac arrest (OHCA), and bystander defibrillation across different countries. This study aimed to investigate the differences in AED densities (AEDS/100,000 inhabitants/1,000 km2), the AED coverage of OHCAs, and bystander defibrillation across Europe. Hypothesis: AED density is directly associated with degree of bystander defibrillation across Europe. Methods: The study is a European Sudden Cardiac Arrest network towards Prevention, Education, New Effective Treatment (ESCAPE-NET) project. We included data from Ticino (Switzerland), Lombardy (Italy), and The Capital Region (Denmark) from 2019, covering over 3.7 million inhabitants. AED accessibility was defined as the AED being accessible 24/7 or not and AED coverage was defined as the OHCA being covered by an AED within 100, 250 and 500 meters. AED coverages were calculated the same way by all participants using a free software program (QGIS). Results: AED densities were: 87.3 for Ticino, 15.2 for Lombardy, and 139.4 for The Capital Region. The percentages of OHCAs covered by any AED and by 24/7 accessible AEDs are shown in Figure 1. The calculated AED density per 1% bystander defibrillation (for the percentage of OHCAs bystander defibrillated within 100, 250 and 500m of an AED) were 34.9, 17.5 and 15.6 for Ticino, 76.0, 50.7 and 38.0 for Lombardy and 19.4, 12.6 and 11.2 for The Capital Region. Conclusion: We found great variation in both AED coverage and 24/7 AED accessibility across regions, as well as marked differences in bystander defibrillation according to local AED density. Other factors like geographical differences in the regions, optimal AED placement and citizen responder programs for AED use might explain the observed differences.


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