Recalls and Safety Alerts Affecting Automated External Defibrillators

<p><strong>Background</strong>: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death and is regarded as a significant public health issue. Immediate treatment with an automated external defibrillator (AED) increases OHCA patient survival potential. For AEDs to be used and fulfil their lifesaving potential, they need to be in close proximity to the victim and accessible at the time of a cardiac arrest. The current paper sheds light upon an optimized location-allocation method achieving full coverage with immediate accessibility in an urban context given a limited number of available AEDs for deployment using GIS. The case study is the Region of Western Macedonia (RWM) in Greece for a pilot AED placement program for the Governance of RWM. The focus of the current study is the capital city of RWM, Kozani. The initial number of the defibrillators (120) that are needed to be distributed is very small and cannot cover the needs for every major city or rural area in the region. Out of the 120 AEDs, the challenge is to find the minimum required number of AEDs to allocate in the city providing full coverage and accessibility. This paper focuses only on one city, however, the same methodology was applied to allocate AEDs in the other selected cities of the region. The rural dimension and methodology are not in the scope of this paper. <br> <strong>Methods</strong>: Road network data, spatio-temporal analysis of accessibility network, digital elevation model, land uses, population density, seasonal fluctuations and socio-demographic variables were used. GIS algorithms such as spatial analysis, kernel density, hot spot analysis, maximal covering location problem (MCLP) tests, proximity algorithms, buffer zoning, were a few of the tests made in order to find the most efficient positions and maximize coverage keeping in mind that access to an AED until defibrillation time must not exceed the time range of five minutes. <br> <strong>Results</strong>: optimised sites and allocated AEDs in urban areas we managed to achieve full city coverage with 17 AEDs. In every part of the city, people can have access to a nearby AED with its critical radius of less than or equal to 250m achieving defibrillation in the critical period of 5 minutes. The results are promising for the establishment and expansion of optimised AED deployment in cities. <br> <strong>Conclusions</strong>: The progress of the project must be monitored and there are still unresolved problems that need to be tackled to provide a robust allocation of future defibrillators. Further research to enhance our understanding on public access defibrillation and optimize the accessibility and functionality of the medical health care services is needed. A network of engaged and informed citizens ready to act is required for a successful public access defibrillation program.</p>

Survival after Public Access Defibrillation in Stockholm, Sweden – A striking success

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.

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.

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.

Introduction: Opioid-related overdoses have been steadily increasing over the past decade in the United States. Naloxone is used by first responders to revive overdose victims, but results may be improved by increasing access to and usage of naloxone by bystanders. Automated External Defibrillators (AEDs) are pervasive, recognizable, and publicly accessible. Co-locating naloxone kits with AEDs could increase public naloxone access and usage. However, the impact of co-locating naloxone kits with AEDs is not known. Objectives: We sought to evaluate the impact of co-locating naloxone kits with AEDs in a simulation study centered on Allegheny County, Pennsylvania. Methods: Naloxone administration frequency (N = 3,650) at the zip-code level from March 2016 to March 2017 was provided by the Allegheny County Health Department. AED point locations (N = 1,653) were obtained from the University of Pittsburgh's Resuscitation Logistics and Informatics Venture. Zip-code level geospatial analyses were conducted using QGIS and STATA to determine the correlation between AED count and naloxone administrations. AED naloxone kit (N-AED) coverage, based on a maximum “walking-distance” radius of 200 m, was estimated at a zip-code level using the QGIS buffer tool and a custom MATLAB script. Potential impact of N-AEDs was estimated assuming uniform spatial distribution of naloxone administrations. Results: The median (IQR) AED coverage based on a 200 m access radius per zip code was 4% (0–7). The median (IQR) number of naloxone administrations per zip code was 27(7-55). A total of 82 zip codes had data for both AED locations and naloxone administrations. The correlation between number of AEDs and naloxone administrations per zip code was 0.20. Overall, 16% of naloxone administrations were estimated to be covered by an N-AED. Conclusion: Using these limited methods, co-locating naloxone with AEDs is not likely to have a standalone impact on preventing overdose fatalities.

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...

Background: Cardiac arrests that occur in schools are infrequent, but high-profile events. Many states have enacted school specific legislation regarding automated external defibrillators (AEDs) placement, CPR training and emergency response plans (EAP). Objective/Aim: To characterize out-of-hospital cardiac arrests (OHCA) that occur in K-12 schools; and, assess the relationship of U.S. state AED and CPR laws to outcomes of in school cardiac arrests. Methods: A retrospective review of in school OHCA was completed with data from the National EMS Information System (NEMSIS) 3.4 database, calendar years 2017-2018. Study subjects were non-traumatic OHCA occurring prior to EMS arrival on K-12 school grounds. Additionally, we conducted a search of Westlaw (Thomson Reuters) to identify current school specific AED, CPR and EAP laws for all 50 states, and created a structured taxonomy for these laws. Datasets were linked by an honest broker and the K-12 school CPR and AED provisions were compared to state legislation. Results: During the study period, there were 454 cases of in school cardiac arrest out of the 25.3 million incidents submitted to NEMSIS. We excluded 140, thus leaving 314 arrests for analysis. The average age was 46.7 (SD=24.1), most were over 18 years old (79.4%), and male 221 (70.4%). Bystander CPR (BCPR) was performed in 240 (76.4%) of cases, bystander AEDs were used in 160 (51.0%) cases, and 107 (34.1%) patients received an AED shock. State AED and CPR laws required student CPR training in 78%, school AED placement in 46%, teacher CPR certification in 14%, and school specific cardiac emergency response plans in 32%. We found no increase in BCPR or AED placement in states with school CPR, AED or EAP legislation. These findings persisted regardless of patient age, school type, or legislative mandate (all P > 0.05). Conclusion: Despite the perceived benefit of legislation supporting CPR and AED use in schools, we identified no improved provision of BCPR or AED use in schools in states with such legislation. Given the high proportions of BCPR and AED in states with and without statutes, we believe this data suggests that non-legislative initiatives, which exist in many states, may be an important driver of emergency cardiac care in K-12 schools.

Out-of-hospital cardiac arrest (OHCA) is a significant public health challenge. Early defibrillation is crucial to manage fatal arrhythmias. The use of automated external defibrillators (AEDs) is a promising tool in enhancing survival. Progetto Vita (PV) in our city pioneered the first community-based AED project in Europe. We present survival data spanning 23 years for all OHCA cases. A total of 6996 OHCAs were recorded. Among these, 156 case were managed by PV volunteers (PV-group). The PV-group managed a significantly higher proportion of shockable rhythms than the EMS group (69.9% vs. 10.9%). Mean time to arrival was shorter (5.7 vs. 10.2 minutes), and survival rates better (46.2% vs. 2.9%, overall). Survival rates declined with time. However, a higher proportion of patients in the PV-group demonstrated favorable neurological outcomes, even up to 9 minutes from the call. Over the study period, the increasing number of AEDs in fixed public places coincided with a substantial rise in ventricular fibrillation survival in the PV-group patients (22% for 2003–2012 to 73% for 2013–2022, p<0.001). Table 2 shows independent predictors of survival. In conclusion our simplified AED-focused training has shown higher survival rates and emerges as a highly successful strategy in a small city.Figure 1 Independent predictors of survival

Attitudes toward automated external defibrillator use in Japan

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