ReviewDrones delivering automated external defibrillators: A new strategy to improve the prognosis of out-of-hospital cardiac arrest
Introduction
Out-of-hospital cardiac arrest (OHCA) is a global health concern. According to the International Liaison Committee for Resuscitation, the global annual incidence of OHCA treated by emergency medical services (EMS) ranges from 30.0 to 97.1 per 100,000 population, with discharge or 30-day survival rates ranging from 3.1 to 20.4%, and good neurological outcomes of 2.8 ± 18.2%.1 The annual incidence of OHCA in Europe ranges from 67 to 170 cases per 100,000 inhabitants with an average survival rate of 8% at discharge.2 In the United States, there are 76.5 cases per 100,000 people, with a 10.6% survival rate,3 and in Asia, there are 45.9 cases4 per 100,000 people with a reported survival rate of 3 ± 6%.5 Every minute after an OHCA event, the chance of survival reduces by 7–10% due to a lack of circulation to the brain,6 which causes neuronal damage. Consciousness is lost within seconds via the depletion of oxygen stores.7, 8, 9 After 4 min of sustained hypoxia, irreversible ischemic damage occurs in brain cells.10 High-quality cardiopulmonary resuscitation (CPR) must be initiated as soon as possible. Although CPR is less effective than physiological cardiac regulation of blood flow, the former improves outcomes; early defibrillation of shockable abnormal rhythms is key.11, 12 The presence of ventricular fibrillation or ventricular tachycardia in the first five minutes of cardiac arrest makes the heart more responsive to defibrillator shock. After this period, the depletion of the myocardial energy substrate makes defibrillation less effective. Therefore, an automated external defibrillator (AED) would ideally deliver the first shock 3–5 min after cardiac arrest13, 14; this increases the survival rate to 50–70%.15, 16 To increase defibrillation rates, many countries have established public access defibrillation (PAD) networks with static AEDs in public places. However, most OHCAs occur at home; while PAD is important, it does not address this fact. Consequently, drones, which have recently been commercialized (expanding from their initial military use to fields such as education, medicine, and rescue), have been considered.17, 18, 19 Drones could deliver AEDs in cities with complex road conditions and in remote rural areas for cardiac arrests at home and outdoors. Therefore, drones may solve issues unaddressed by traditional EMS.
Section snippets
Current status of OHCA resuscitation
If OHCA occurs, without timely and effective treatment, the patient will most likely die within a few minutes. Care for OHCA has improved with advances in science and technology. However, the prognosis of OHCA patients remains poor.
The six stages of the OHCA survival chain are EMS activation, high-quality CPR, electrical defibrillation, advanced cardiopulmonary resuscitation, post-resuscitation care, and recovery.20 If any stage is interrupted, the probability of a good prognosis decreases,
Drone overview
Drones, also known as unmanned aerial vehicles, are small, remotely controlled aircrafts that use global positioning systems to reach a designated destination.25 Drones are small, conveniently operated, and fast; their design and application have been gradually modernized,26, 27, 28 improving flight times, maximum payloads, and costs.26 Drone application is increasingly widespread, with companies such as Amazon and Domino currently engaged in research and development.18 The types of drones used
Application of drones in the medical industry
Medical resources often cannot be delivered to patients, given terrain and environmental factors, and some people may miss their best chance for treatment because they do not receive effective care. Drones could solve this problem. Additionally, drones can be used to avoid direct contact between healthcare workers and infected persons. In Xinchang County, China, drones were used to fight against COVID-19, reducing sample and quarantine supply times by 50%.25 Haidari et al. provided an
Drones and OHCA
OHCA accounts for almost half of all cardiovascular event deaths.33, 34, 35, 36, 37 AED-equipped drones may enhance EMS performance and the chance of early defibrillation.30, 38, 39, 40, 41 Studies related to the delivery of AED by drones in OHCA events are summarized in Table 2.
Weaknesses and proposals
Drone technology is currently thriving, and many parties are exploring drone use.38 However, drone delivery of AEDs is not currently used worldwide. Drone dispatch is complex. Problems and solutions to selected drones-related issues are summarized below.
Outlook
Drones have potential for the medical industry, especially for AED delivery in the event of OHCA. It is necessary to improve drone performance so that they can meet take-off standards in any situation. High-end drones can overcome extreme weather conditions and better adapt to the environment, thereby ensuring stability and improving the success rate of the entire delivery course. The maximum flight distance, speed, altitude, maximum acceleration, payload capacity, battery life, and ability to
Conclusion
Drones can fly quickly and directly to deliver AEDs within the time needed for patient resuscitation. Drones are promising and innovative tools that can maximize bystander access to interventions. Drones can comprehensively improve the service radius of first aid resources, address the restrictions of other transportation modes and barriers of spatial distance, and improve survival among cardiac arrest patients. Many studies have demonstrated that AED delivery by drones is feasible and
Author contributions
Liu X and Yuan Q guided the scope and background of the research and wrote the manuscript. Wang G participated in the literature search and manuscript editing. Bian Y, Xu F, and Chen Y critically revised the manuscript. All the authors have read and approved the final manuscript.
Funding
This study was supported by Key R&D Program of Shandong Province (2021ZLGX02), Youth Interdisciplinary Science Innovation Group Funding of Shandong University (2020QNQT004), Clinical Research Center of Shandong University (2020SDUCRCA006,2020SDUCRCB003,2020SDUCRCC018), Special Fund for Expert Construction Project of Taishan Scholar Climbing Program (tspd20181220), National Natural Science Foundation of China (81873950,82072144,81772036,81873953,82030059,81900435,81960420,81902350), Natural
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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