Teaching Life-Saving Manoeuvres in Primary School

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.

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

Introduction: AHA recommends that automated external defibrillators (AEDs) be made available in public areas with high likelihood of a sudden cardiac arrest (SCA). Only 18 US states have regulations requiring AEDs in schools and the legislation varies. There is no comprehensive evaluation of the epidemiology of sudden death in schools. School nurses are often the only healthcare providers within a school. New York State (NYS) enrolls almost 3.5 million students with New York City (NYC) being the largest school system in the US; legislation requires AEDs in all public but not in private schools. Purpose: Our aims were threefold: to gain epidemiologic data on SCAs in NYS schools, to evaluate the availability and utilization of AEDs, and to identify factors affecting deployment of AEDs. Methods: Electronic surveys were sent to school nurse members of the NYS Association of School Nurses and NYC school nurses. We also conducted structured interviews with a representative sample of NYS school nurses. Results: Nurses representing 750 public schools and 116 private schools responded, a response rate of 36.4%. There were 71 SCA events, with majority affecting adults on school grounds 41 (58%). AEDs were deployed in 59 (73%). Short term survival occurred in 50 (69%) with 40 (56%) returning to regular activity. While not required to have AEDs available, most private schools had them 69(60%). There were 21 (30%) SCA events in private schools with 8 (11%) occurring in private schools with no AEDs. Of these, 6 (75%) had a negative outcome. Interviews revealed that staff attitude, fear, and training adequacy were factors influencing AED utilization. Conclusions: AEDs in schools improve survival outcomes. There has been no comprehensive evaluation of SCA events in US schools and no uniformity in AED legislation among states. While focus is on students, NYS data suggests that attention should also encompass adult SCAs in schools. Comparisons of AED utilization and SCA outcomes in states with and without AED legislation will be of interest, and may have health policy implications.

Resuscitation highlights in 2011

Cardiopulmonary Resuscitation During the Coronavirus Crisis: Important Updates for the Cardiothoracic and Vascular Anesthesia Community

Part 6: Defibrillation

A sudden cardiac arrest (SCA) occurs when the heart abruptly stops beating; because of the nature of SCA, capturing data in the out-of-hospital setting from actual bystander response is difficult. Current technologies such as virtual reality (VR) allow the creation of scenarios programmed for heightened realism. No studies have used an immersive VR system to observe lay bystander response. We sought to characterize lay bystander response to an unannounced simulated VR SCA event during a multisensory scenario. Using a VR wearable device combined with a cardiopulmonary resuscitation (CPR) recording manikin, we created a 3-minute multisensory SCA scenario that allowed for the observation of lay bystander response. Subjects were unaware of the nature of the emergency event but were told to respond how they would to an emergency situation. Subject's ability to proceed through the American Heart Association's Chain of Survival and their CPR quality were recorded. Frequencies and percentages were calculated using descriptive statistics. Between June 2016 and June 2017, 119 lay subjects were enrolled. Of those, 92% asked for 911 to be called, 81% attempted CPR, 13% requested an automated external defibrillator (AED), and 6% used the AED; 82% stated that they felt as if they were at a real SCA event. Cardiopulmonary resuscitation data were collected (n = 81), the mean CC rate was 93.5 ± 22.4 cpm, and the mean CC depth was 38.4 ± 13.8 mm. In our unannounced, immersive VR SCA observational study of lay bystanders, most subjects attempted CPR, although the majority did not use an AED.

Funding Acknowledgements Type of funding sources: None. Introduction Sudden cardiac arrest is the leading cause of premature death. Effective cardiopulmonary resuscitation (CPR) and early defibrillation substantially improve survival rates. This has also been replicated in schools, with excellent outcome data in schools who advocated CPR certification together with the availability of onsite automated external defibrillator (AED). Most entities now encourage AED installation in schools. Objectives As a follow up to the BEAT-IT cardiac screening program performed across all secondary schools in 2017/2018, the main aim of this study was to evaluate the availability of AEDs in schools across the Maltese archipelago. Information on staff CPR certification was also evaluated. Methodology One school administrator in all secondary schools across Malta and Gozo (n=54) were asked to complete an online questionnaire. All data was kept anonymous. Data was tabulated. Categorical variables were presented as percentages. Statistical analysis was performed with SPSS v23. Results Most schools (n=40, 74.1%) complied, the majority from the northern harbour region (n=15, 37.5%). Student gender in most schools was mixed (n=23, 57.5%). Two schools (5%) reported a cardiac arrest in one of their pupils over the previous 10 years, one happening during school hours. A minority (n=3, 7.5%) strongly disagreed that preventing sudden cardiac death (SCD) in schools is important. Only 1 (2.5%) had never heard of an AED. Some schools (n=3, 7.5%) did not have an AED on school premises. The majority had one AED (n=1, 75.0%). Most schools service their AED regularly (n=34, 94.4%). The majority had an AED only on one floor (n=35, 97.2%). Most AEDs were installed in easily accessible areas (n=35, 97.2%), yet the location was not subjected to a risk assessment prior to installation in a significant proportion (n=17, 47.2%). Defibrillators in a third of schools (n=11, 30.6%) were not close to sporting facilities, an area traditionally recognized as a high risk location. Most schools do not organise onsite CPR certification courses (n=21, 52.5%). Some staff are certified in CPR (n=35, 87.5%), a fifth having more than 5 certified individuals (n=8, 20.0%). The majority have also undergone recertification (n=28, 70.0%). Most were strongly in favour of a systematic cardiac screening program in schools (n=28, 70.0%). Conclusion A significant proportion of schools have experienced a cardiac arrest in one of its pupils (5.0%), implying this is an important health concern. Yet some still disagree that SCD prevention in schools is important (7.5%). Despite the majority having an AED on site, a substantial proportion did not have a risk assessment prior to installation (47.2%). Only a small proportion of staff members are certified in CPR. Most schools do not organise on-site CPR courses (52.5%). More education and awareness about cardiac arrest in students and CPR certification is necessary.

Basic life support (BLS) is one of the most efficient ways to improve out-of-hospital cardiac arrest (OHCA) victims’ outcomes. Resuscitation initiated by a random witness of OHCA is essential to increase the chances of survival. To assess the impact of BLS training in cardiac patients on knowledge about first aid for OHCA. The study group consisted of 68 participants who completed a questionnaire prior to BLS training. Forty-three of them then filled out the same questionnaire again after the BLS course. Participants’ knowledge was assessed with a self-designed questionnaire, which comprised 41 questions divided into six domains, namely legal aspects, resuscitation technique, resuscitation algorithm, knowledge about using an automated external defibrillator (AED), “calling for help” knowledge and identifying sudden cardiac arrest. The average score before the BLS course was lower compared with final results (43.8% ± 15.6% vs. 68.6% ± 22.7% [% of max. score], p = 0.001). The best scores, both before and after the BLS course, were gained in the “calling for help” knowledge (79.5% ± 33.5% vs. 80.4% ± 17.4% [% of max. score], p = 0.5) and “knowledge about using AEDs” domains (62.4% ± 35.2% vs. 74.7% ± 29.3% [% of max. score], p = 0.1). Patients who completed first aid courses gained better scores in the “knowledge about using an AED” domain (93.3% ± 14.9% vs. 58.6% ± 35.4% [% of max. score], p = 0.02). No differences between the other domains and overall scores were reported (total score: 48% ± 12% vs. 42% ± 17.5% [% of max. score], p = 0.5). General knowledge about BLS is poor. BLS training in cardiac patients improves knowledge about first aid for OHCA. Education and hands-on training are crucial to improve outcomes.

Automated external defibrillator use in out-of-hospital cardiac arrest: Current limitations and solutions

Effects of a mandatory basic life support training programme on the no-flow fraction during in-hospital cardiac resuscitation: An observational study

BackgroundCardiopulmonary resuscitation (CPR) increases the probability of survival of a person with cardiac arrest. Repeating training helps staff retain knowledge in CPR and in use of automated external defibrillators (AEDs). Retention of knowledge and skills during and after training in CPR is difficult and requires systematic training with appropriate methodology. The aim of this study was to determine the effect of basic life-support (BLS) training on the attitudes of health-care providers toward initiating CPR and on use of AEDs, and to investigate the factors that influence these attitudes.MethodsA quasi-experimental study was conducted in two groups: health-care providers who had just attended a BLS–AED course (post-BLS group, n = 321), and those who had not (pre-BLS group, n = 421). All participants had previously received BLS training. Both groups were given a validated questionnaire to evaluate the status of life-support education and certification, attitudes toward use of CPR and AED and concerns regarding use of CPR and AED. Multiple linear regression analyses were applied to identify significant predictors of the attitude and concern scores.ResultsOverall positive attitudes were seen in 53.4% of pre-BLS respondents and 64.8% of post-BLS respondents (χ2 = 9.66, p = 0.002). Positive attitude was significantly predicted by the recent completion of BLS training (β = 5.15, p < 0.001), the number of previous BLS training courses (β = 2.10, p = 0.008) and previous exposure to cardiac-arrest cases (β = 3.44, p = 0.018), as well as by low concern scores, (β = −0.09, p < 0.001). Physicians had significantly lower concern scores than nurses (β = −10.45, p = 0.001). Concern scores decreased as the duration of work experience increased (t = 2.19, p = 0.029).ConclusionsRepeated educational programs can improve attitudes toward CPR performance and the use of AEDs. Training that addressed the concerns of health-care workers could further improve these attitudes.

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.

Reaching the public via a multi media campaign as a first step to nationwide public access defibrillation

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.