Elsevier

Resuscitation

Volume 157, December 2020, Pages 83-88
Resuscitation

Simulation and education
Delivery of Automated External Defibrillators via Drones in Simulated Cardiac Arrest: Users' Experiences and the Human-Drone Interaction

https://doi.org/10.1016/j.resuscitation.2020.10.006Get rights and content

Abstract

Background

Survival after out-of-hospital cardiac arrest (OHCA) in the United States is approximately 10%. Automatic external defibrillators (AEDs) are effective when applied early, yet public access AEDs are used in <2% of OHCAs. AEDs are often challenging for bystanders to locate and are rarely available in homes, where 70% of OHCAs occur. Drones have the potential to deliver AEDs to bystanders efficiently; however, little is known about the human-drone interface in AED delivery.

Objectives

To describe user experiences with AED-equipped drones in a feasibility study of simulated OHCA in a community setting.

Methods

We simulated an OHCA in a series of trials with age-group/sex-matched participant pairs, with one participant randomized to search for a public access AED and the other to call a mock 9-1-1 telephone number that initiated the dispatch of an AED-equipped drone. We investigated user experience of 17 of the 35 drone recipient participants via semi-structured qualitative interviews and analyzed audio-recordings for key aspects of user experience.

Results

Drone recipient participants reported largely positive experiences, highlighting that this delivery method enabled them to stay with the victim and continue cardiopulmonary resuscitation. Concerns were few but included drone arrival timing and direction as well as bystander safety. Participants provided suggestions for improvements in the AED-equipped drone design and delivery procedures.

Conclusion

Participants reported positive experiences interacting with an AED-equipped drone for a simulated OHCA in a community setting. Early findings suggest a role for drone-delivered AEDs to improve bystander AED use and improve outcomes for OHCA victims.

Section snippets

INTRODUCTION

The majority (73%) of the 475,000 sudden cardiac arrests in the United States (US) each year occur outside of the hospital.1, 2 After an out-of-hospital cardiac arrest (OHCA), survival to hospital discharge in the United States (US) is 10.6%, and survival with good neurological function is 8.6%.1 When a bystander applies an automatic external defibrillator (AED) to a victim of OHCA prior to ambulance arrival, the chance of survival is nearly doubled (Fig. 1).3 However, the likelihood of

METHODS

Between March and June 2019, we conducted 35 OHCA simulation trials in five distinct zones outdoors across the University of North Carolina-Chapel Hill (UNC) campus.17 Each trial included a life-sized manikin (Laderal Resusci Anne) as the OHCA victim, accompanied by two participants, paired by sex and age (18-34, 35-49, 50-65 years). We randomized participants either to call a mock 9-1-1 telecommunicator who initiated the autonomous flight of a drone modified to carry a standard AED (Philips

RESULTS

We conducted 35 trials, 18 with female pairs and 17 with male pairs. These included 15, 11 and 9 trials across three age strata (18-34, 35-49, and 50-65 years), respectively. In seven of the 35 trials, only one participant was present and performed both roles as a caller and seeker sequentially. We conducted semi-structured qualitative interviews with 17 of the 35 participants that served in the drone-recipient role (Table 1). Analysis of the interviews focused on four key thematic domains: (1)

DISCUSSION

In this community-based OHCA simulation study, we found participants were overwhelmingly positive about their interactions with an AED-equipped drone. Many felt relieved and comforted in having life-saving equipment directly delivered, enabling them to stay with the victim and continue CPR. A few expressed concerns surrounding technical aspects of the AED-drone delivery system, including potential safety issues related to moving propellers. All expressed willingness to use an AED drone in a

Limitations

Our study was limited to a small sample of participants all affiliated with a university setting. Participants, therefore, may not reflect the general population. While informative, it is difficult to know how participants might feel or respond in a true OHCA event. Our simulation study was controlled, both in study design and in execution on the campus during daylight hours and in good weather, and limited to simulations conducted outdoors due to campus and Federal Aviation Administration

Conclusion

Overall, participants reported a positive experience interacting with an AED-equipped drone responding to a simulated OHCA, and all reported a willingness to use the system in a real-life OHCA emergency. AED drone delivery systems can be further improved to enhance both the user experience and delivery process by addressing the concerns noted by participants and considering their suggestions. Despite our study being a simulation, participants’ discomfort with performing CPR and using an AED

Funding

The project described was supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through Grant Award Number UL1TR002489. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of interest statement

All authors report no conflicts of interest.

CRediT authorship contribution statement

Jessica K. Zègre-Hemsey: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Writing - original draft, Writing - review & editing. Mary E. Grewe: Data curation, Formal analysis, Writing - review & editing. Anna M. Johnson: Data curation, Project administration, Writing - review & editing. Evan Arnold: Project administration, Writing - review & editing. Christopher J. Cunningham: Writing - review & editing. Brittany M. Bogle:

Acknowledgements

The authors thank all participants, the UNC Public Safety Department, and the UNC campus community. We are indebted to Bailey DeBarmore, Fola Omofoye, Michael Picinich, and Eugenia Wong for their time and contributions.

References (20)

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