Automated External Defibrillators (AED)

The recommendations for electrical therapies described in this section are designed to improve survival from SCA and life-threatening arrhythmias. Whenever defibrillation is attempted, rescuers must coordinate high-quality CPR with defibrillation to minimize interruptions in chest compressions and to ensure immediate resumption of chest compressions after shock delivery. The high first-shock efficacy of newer biphasic defibrillators led to the recommendation of single shocks plus immediate CPR instead of 3-shock sequences that were recommended prior to 2005 to treat VF. Further data are needed to refine recommendations for energy levels for defibrillation and cardioversion using biphasic waveforms.

To explore the automated external defibrillator (AED) configuration optimization strategy in line with the characteristics of the rapidly developing cities by analyzing the actual coverage of AED in Bao'an District based on the real world data of out-of-hospital cardiac arrest (OHCA) in Bao'an District, Shenzhen City. The data of cardiac arrest database registered in Bao'an District of Shenzhen City from March 1, 2019 to February 29, 2020 were included in a retrospective observational study. The AED coverage of public and non-public areas was analyzed by calculating the minimum distance between the occurrence place of each OHCA event and the nearest AED. The minimum distance ≤ 100 m was set as AED coverage, and the minimum distance > 100 m was set as non-AED coverage. It was assumed that one AED was configured for each OHCA hotspot area, then the AED coverage changes were analyzed. Based on the actual situation that the AED in schools, governments, sports venues, subways, tourist attractions and parks of public areas in Bao'an District could not be obtained at any time within 24 hours, it was assumed that all AED in the public areas could be obtained at any time within 24 hours, the impact of AED available at any time on AED coverage was analyzed. A total of 525 cases of OHCA were enrolled. The highest incidence of OHCA was found in residential and industrial areas [54.5% (286/525) and 14.3% (75/525), respectively]. There were 252 AED in Bao'an District, Shenzhen, and 115 OHCA events occurred within the coverage area of AED. Even if all AED met the ideal state that could be obtained at any time within 24 hours, the coverage rate was only 21.9% (115/525). The AED coverage rate of the public areas and non-public areas was 31.6% (37/117) and 19.1% (78/408) respectively, with uneven distribution, and the AED coverage rate of non-public areas was low. Assuming that the residential community and industrial zone with more than 2 OHCA cases were respectively equipped with one AED, the coverage rate of AED in the non-public areas increased from 19.1% (78/408) to 28.2% (115/408), basically meeting the requirement that AED could be obtained at any time when OHCA events occurred. Some AED in the public areas of Bao'an District were not available at any time within 24 hours. If the ideal state that all AED in the public area could be obtained at any time within 24 hours could be achieved, the AED coverage rate of all regions increased from 16.8% (88/525) to 21.9% (115/525), the AED coverage rate of the public areas increased from 29.1% (34/117) to 31.6% (37/117), the AED coverage rate of the non-public areas increased from 13.2% (54/408) to 19.1% (78/408). AED configuration in Bao'an District was unevenly distributed, and the coverage rate of AED in non-public areas was low. The allocation strategy for AED in fast-growing cities like Shenzhen should be as follows: on the premise of ensuring AED availability for 24 hours, priority should be given to covering the number of AED in the non-public areas including residential communities and industrial zones; AED is available in the public areas for 24 hours.

Automated external defibrillators (AEDs) play a key role in the community resuscitation of persons with cardiac arrest and are of proven clinical benefit. Although AEDs are complex medical devices designed to function during life-threatening emergencies, little is known about their reliability. To determine the number and rate of AED recalls and safety alerts, to identify trends in these rates, and to identify the types of malfunctions prompting AED and AED accessory advisories. Analysis of weekly US Food and Drug Administration (FDA) Enforcement Reports between January 1996 and December 2005 was performed to identify all recalls and safety alerts (collectively referred to as "advisories") involving AEDs and AED accessories. Confirmed AED device malfunctions were identified by reviewing AED-related adverse events reported to the FDA. Number of AEDs and AED accessories subject to FDA recall or safety alert between January 1996 and December 2005; annual AED advisory rates; and number of confirmed fatal AED-related device malfunctions reported to the FDA. During 2.78 million AED device-years of observation, 52 advisories (median [25th and 75th percentiles], 4.5 [3.0 and 5.0] per year) affecting 385,922 AEDs and AED accessories were issued. The mean (SE) annual number of AEDs affected by advisories was 5.1 (1.5) devices per 100 AED device-years. Overall, 21.2% of AEDs distributed during the study period were recalled, most often because of electrical or software problems. The AED advisory rate did not significantly increase during the study period, although the annual number of AED advisories (P for trend =.02) and AED advisory devices (P for trend = .01) did increase. Confirmed fatal AED-related device malfunctions occurred in 370 patients. Automated external defibrillators and AED accessory advisories occur frequently and affect many devices. Actual AED malfunctions do occur occasionally, although the number of observed malfunctions is small compared with the number of lives saved by these important devices. As the prevalence of AEDs continues to increase, the number of devices affected by advisories can also be expected to increase. Efforts should be directed at developing a reliable system to locate and repair potentially defective devices in a timely fashion.

Attitudes toward automated external defibrillator use in Japan

AimTo describe the temporal development of automated external defibrillator (AED) deployment in Denmark according to type of AED location and accessibility.MethodsWe collected information on all AEDs registered in the nationwide...

PurposeTo explore strategies for optimizing Automated External Defibrillator (AED) configuration in urban areas of China and improving the treatment conditions for out-of-hospital cardiac arrest (OHCA) patients.Material and MethodsTaking Dongcheng District, Beijing as the research object, spatial data such as administrative divisions, transportation road networks, AED configuration points, and points of interest in key public places, as well as non-spatial data such as population statistics, were collected. Service area analysis and location-allocation models were used to analyze the current status of AED configuration and explore optimization strategies for AED deployment.ResultsAs of September 2024, a total of 86 AEDs had been configured in Dongcheng District, and their service area covered 13.74% of the district. The combined service area of AEDs and hospitals covered 82.62% of the district. After achieving the goal of full AED coverage in key public places in the future, AED service area will cover 34.80% of the district, and the combined service area of AEDs and hospitals will cover 85.92% of the district. According to the optimization plan proposed in this study, an additional 218 AEDs are needed in Dongcheng District, bringing the total number of AEDs to 519. At this point, AED service area will cover 50.62% of the district, and the combined service area of AEDs and hospitals will cover 97.28%.ConclusionThe AED configuration optimization strategy proposed in this study is highly reasonable, and relevant government agencies can refer to this framework to optimize the AED deployment in urban areas. Additionally, technologies such as the Internet of Things and drones can be leveraged to establish urban AED search and delivery platforms, further enhancing the accessibility and utilization rate of AED to achieve optimal treatment outcomes for OHCA patients and save more lives.

AED use in businesses, public facilities and homes by minimally trained first responders

Introduction: Automated external defibrillators (AEDs) are an important link in the chain of survival following out-of-hospital cardiac arrest (OHCA). While the use of AEDs are clearly beneficial for OHCA in adults, there are few data on the overall use and outcomes of public AED use in children. Hypothesis: AED use is uncommon in children and associated with neurologically favorable survival. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years of age, public arrests, and non-traumatic OHCA from January 1, 2013 through December 31, 2017. Neurologically favorable survival was defined as a Cerebral Performance Category Scale of 1 or 2 at hospital discharge. Results: Of 971 public pediatric OHCA (66% male, 32% white), AEDs were used by bystanders in 117 (10.3%). AEDs were used among 2.3% of children aged ≤ 1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p<0.001). AED use was similar among white (11.1%), black (9.1%), and Hispanic children (8.1%) (p=0.84). AED use was more common with the provision of bystander CPR (19.1%) vs no bystander CPR (0.9%), witnessed arrests (16.0%) vs unwitnessed arrests (4.7%), and arrests with a shockable rhythm (23.6%) vs a nonshockable rhythm (6.3%) (p<0.001 for all). Overall, adjusted neurologically favorable survival was 29.1% (95% CI 22.7%, 35.5%) when a bystander used an AED compared to 23.7% (95% confidence interval [CI] 21.1%, 26.3%) for no bystander AED use (p=0.11). There was a significant interaction with age and race/ethnicity. AEDs were associated with neurologically favorable survival among children aged 12-18 years (p=0.04) but not associated with neurologically favorable survival in children ≤ 1 year (p=0.43), 1-5 years (p=0.16) or 6-11 years (0.41). AEDs were also associated with neurologically favorable survival in white children (p=0.01) but not with black (p=0.97) or Hispanic children (p=0.06). Conclusions: AED use is uncommon in children suffering OHCA but is associated with improved neurologically favorable survival. The benefit of AEDs was evident mostly for adolescents and white children. Further study is needed to understand these disparities in AED use and outcomes after AED use.

BackgroundEarly cardiopulmonary resuscitation (CPR) and defibrillation with Automated External Defibrillators (AEDs) by the public at an out-of-hospital cardiac arrest (OHCA) increases patient survival, but AEDs are infrequently used. Using drones to deliver AEDs may be one way to increase uptake, but there is limited understanding about what members of the public think about this. The aim of the study was to explore public attitudes towards drone AED delivery for OHCA.MethodsWe conducted 14 remote, semi-structured interviews with real-life OHCA bystanders. Participants were recruited via social media, a UK cardiac arrest survivor charity and the Welsh Ambulance Services University NHS Trust. We analysed data using the Theoretical Domains Framework and mapped findings to the Capability, Opportunity and Motivation model of Behaviour (COM-B) to identify perceived barriers and facilitators to the retrieval and use of drone-delivered AEDs. We used The Behaviour Change Wheel to identify potential interventions to optimise use of drone-delivered AEDs.ResultsParticipants experienced varying levels of physical and social opportunities in relation to (un)available AEDs and (in)appropriate support from the call-handler, affecting the likelihood of them performing CPR and/or using an AED effectively. Most participants were unsure about how to use an AED, and none knew how a drone-delivered AED system would work in practice. Many participants questioned whether they would possess sufficient capability and motivation to retrieve and/or operate a drone-delivered AED during a time-critical emergency. There were five key themes for potential interventions: incorporating information about drone-delivered AED use into pre-existing training programmes and materials; ensuring drone use complies with specific regulatory and/or legislative requirements; making the drone-delivered AED easy to identify and access; optimising call-handler scripts to incorporate drone-delivered AED use; providing social support via a robust co-responder model to complement drone-delivered AED use.ConclusionsParticipants accepted drone-delivered AEDs for OHCA, but were unsure if it would be effective. They identified several issues that we addressed through the development of a comprehensive intervention framework. A comprehensive call-handler script that incorporates drone-delivered AED use and support for bystanders was the most salient potential intervention for future testing by relevant stakeholders.

There have been few studies on the effectiveness of bystander automated external defibrillator (AED) use in out-of-hospital cardiac arrest. The objective of this study was to determine whether actual use of onsite or dispatched AED reduces the time to first shock compared with no AED use and thereby improves survival. We performed a population-based cohort study of 2833 consecutive patients with a nontraumatic out-of-hospital cardiac arrest before emergency medical system arrival between 2006 and 2009. The primary outcome, neurologically intact survival to discharge, was compared by use of multivariable logistic regression analysis. An onsite AED had been applied in 128 of the 2833 cases, a dispatched AED in 478, and no AED in 2227. Onsite AED use reduced the time to first shock from 11 to 4.1 minute. Neurologically intact survival was 49.6% for patients treated with an onsite AED compared with 14.3% without an AED (unadjusted odds ratio, 5.63; 95% confidence interval, 3.91-8.10). The odds ratio remained statistically significant after adjustment for confounding (odds ratio, 2.72; 95% confidence interval, 1.77-4.18). Dispatched AED use reduced the time from call to first shock to 8.5 minutes. Neurologically intact survival was 17.2% for patients treated with a dispatched AED (unadjusted odds ratio, 1.07; 95% confidence interval, 0.82-1.39). Every year, onsite AEDs saved 3.6 lives per 1 million inhabitants; dispatched AEDs saved 1.2 lives. The use of an onsite AED leads to a doubling of neurologically intact survival. In our system, the survival benefit of dispatched AED use was much smaller than that of onsite AED use.

AP-452680-2 GEOSPATIAL ANALYSIS OF BYSTANDER-INITIATED AUTOMATED EXTERNAL DEFIBRILLATOR UTILIZATION IN A LARGE US COMMUNITY

Recently, a student died of idiopathic ventricular fibrillation in a school where an automated external defibrillator (AED) had been installed. The tragedy could not be prevented because the only AED in the school was installed in the teachers' office, far from the school ground where the accident took place. This prompted establishment of a multiple AED system in schools. The aim of this study was to analyze the efficacy of the multiple AED system to prevent sudden death in school-aged children. Assumed accident sites consisted of the school ground, gymnasium, Judo and Kendo hall, swimming pool, and classrooms on the first and the fourth floor. Multiple AED were installed in the teachers' office, gymnasium, some classrooms, and also provided as a portable AED in a rucksack. The time from the accident site to the teachers' office for single AED, and from the accident site to the nearest AED for multiple AED, was calculated. The AED retrieval time was significantly shorter in 55 elementary schools and in 29 junior high schools when multiple AED were installed compared with single AED. Except for the classroom on the fourth floor, the number of people who took >120s to bring the AED to the accident site was lower when multiple AED were installed compared with the single AED. Multiple AED provided in appropriate sites can reduce the time to reach the casualty and hence prevent sudden death in school-aged children.

Automated external defibrillators (AEDs) have the potential to save lives when used during cardiac arrest. While most cardiac arrests occur at home, there is limited evidence for AED use in private homes. To determine whether AEDs in private homes are effective and cost-effective. This cohort study used observational data from the Cardiac Arrest Registry to Enhance Survival in the US from January 2017 to December 2024 to determine the effectiveness of AEDs when used for cardiac arrests in private homes. A difference-in-difference approach was used to determine the causal relationship between AED application and survival to hospital discharge. A decision-analytic model was then created to evaluate the cost-effectiveness of purchasing an AED in a private home in the US. Application of an AED. Survival to hospital discharge and cost-effectiveness. Of 582 536 included patients, 359 809 (61.8%) were male, and the median (IQR) age was 65 (52-76) years. Survival was better with AED application compared with no AED application in patients with a shockable rhythm (risk ratio, 1.26; 95% CI, 1.01-1.57) but not in those with a nonshockable rhythm (risk ratio, 1.00; 95% CI, 0.68-1.46). Results were consistent in the difference-in-difference analysis. The incremental cost-effectiveness ratio for an AED in a private home was $4 481 659 per quality-adjusted life-year. At a cost-effectiveness threshold of $200 000 per quality-adjusted life-year, AEDs in private homes would be considered cost-effective at a yearly cardiac arrest incidence per person above 1.3% or at an AED cost less than $65 (not including bystander training cost). In this study, AEDs in private homes were effective at improving outcomes for patients with cardiac arrest and a shockable rhythm. Given the relative rarity of cardiac arrest at a given home, general purchase of AEDs for individual private homes cannot be considered cost-effective at the current pricing of AEDs.

Automated external defibrillators (AEDs) from community first responder systems (CFR-system) are important to achieve early defibrillation in out-of-hospital cardiac arrest (OHCA). It is unclear how far community first responders (CFR) can travel to fetch and connect an AED to achieve this goal. This study aims to evaluate the relation of the distance between OHCA and the dispatched CFR-system AED and speed of AED-connection. Within the Dutch prospective ARREST registry, OHCA patients from 2016 to 2021 with a connected CFR AED were identified. The location of each connected AED was retrieved. Straight-line distances between patient and AED-location were calculated using Google Maps. Time intervals between emergency-call and AED-connection were compared according to straight-line distances and degree of urbanization. Out of 3231 OHCAs with the CFR-system activated, 2037 (63%) patients had an AED connected before emergency medical services arrival, of which 426 by a CFR. Exact AED-locations were known in 387 OHCA (study population). Overall, the AEDs connected by a CFR where located within 949m straight-line distance of the OHCA. AEDs connected within 6, 8, or 10min of the emergency-call, were located within 506m, 796m and 838m straight-line distance, respectively. In 44% of these cases, the CFR connected an AED to which he/she was not referred to, but taken from another address, which significantly impacted the maximal distance covered: 773m for CFR-system referred AEDs versus 1126m for not CFR-system referred (p=0.001). To facilitate early AED-connection (≤6min), any address should have a CFR-system AED located within approx. 500m.

BackgroundBasic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation.MethodsUsing a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times.ResultsThe time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds.ConclusionsVoice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0123-1) contains supplementary material, which is available to authorized users.