Clinical paperUse and coverage of automated external defibrillators according to location in out-of-hospital cardiac arrest
Introduction
Cardiac arrest means abrupt cessation of cardiac activity and will inevitably lead to death if not treated immediately. Out of-hospital cardiac arrest (OHCA) is a major public health concern and annually strikes approximately 700,000 people in Northern America and Europe combined.1 Early cardiopulmonary resuscitation (CPR) and defibrillation within the first minutes with an automated external defibrillator (AED) may increase survival to more than 50%.2, 3 In recent years, AEDs have gained widespread dissemination in many communities4, 5 and in Denmark several national initiatives have been undertaken to increase bystander AED use, including the establishment of a national AED-network.6 Bystander defibrillation, however, remains low ranging from 1 to 5%.5, 6, 7, 8 Prior studies have indicated that to increase AED use, AEDs must be placed in close proximity to the site of cardiac arrest,8, 9, 10 they must be available at all times10, 11, 12 and bystanders must be aware of AED locations and be willing to use them.13 Also, the most optimal AED placement appears to be in public places with high pedestrian traffic.12, 14 Indeed, AEDs are recommended to be placed in public places with high likelihood of OHCA that can be reached within 1–1.5 minutes of brisk walking or approximately 100 m.15, 16, 17 However, international recommendations regarding specific AED placement are scarce, resulting in unguided AED placement in most cases.6, 7, 18 So far, AED use from specific locations remains largely unknown. Also, data addressing the actual distances AEDs are carried to OHCA sites is limited, making it difficult to assess the coverage of AEDs placed at different locations.
The aim of this study was three-fold: 1) to assess the relative use of AEDs placed at different types of locations; 2) to assess whether AEDs are carried across different location types before they are used; and 3) to assess the AED coverage distances at different AED locations.
Section snippets
Settings and study design
This is a retrospective cohort study with prospectively collected data from AEDs used by bystanders in the Region of Southern Denmark from January 1st 2014 to December 31st 2018. The region is mixed rural-urban and covers an area of 12,191 km2. It has 39 Emergency Medical Service (EMS) stations and one emergency medical dispatch centre (EMDC). The region has 1.2 million inhabitants. During the years 2009–2014, a total of 4350 OHCAs occurred in the region, resulting in 42.4 OHCAs per 100,000
Baseline characteristics and outcomes
During the study period, the AED-centre collected 621 AEDs. As illustrated in Fig. 1, 509 OHCA-patients fulfilled the inclusion criteria. Table 1 shows the demographic and prognostic results. OHCAs in public places and in the ‘Mixed’ group were more often male and more frequently had a witnessed cardiac arrest. Shockable first AED rhythm was less frequent in OHCAs in residential areas and nursing homes. Survival after OHCA in public places and the ‘Mixed’ group was three to four times higher
Discussion
This study presents novel data addressing real life use of AEDs in patients with OHCA from a mixed rural-urban area. A relative high use was observed of AEDs placed in public places and nursing homes, whereas a low use was observed in residential areas. The majority of AEDs were placed and used in the same type of location. Thirty-nine percent of AEDs used in residential areas were retrieved from public places. AEDs placed in residential areas and at public places had a median coverage distance
Conclusion
By collecting data from AEDs that were used during OHCAs in a mixed rural-urban area, we observed high AED use from public places, nursing homes, sports facilities/recreational areas and health clinics, and low use from companies/workplaces, residential areas and institutions. The majority of AEDs were placed and used in the same type of location, except for residential OHCAs, where AEDs more frequently were retrieved from public places. By measuring en-route distances from AED location to OHCA
Conflicts of interest
Doctor Møller has received grants and personal fees from Abiomed, and personal fees from Orion Pharma and Novartis. All other authors declared no conflict of interests.
CRediT authorship contribution statement
Laura Sarkisian: Conceptualization, Methodology, Validation, Formal analysis, Investigation, Data curation, Writing - original draft, Writing - review & editing, Visualization, Project administration, Funding acquisition. Hans Mickley: Conceptualization, Methodology, Validation, Formal analysis, Writing - original draft, Writing - review & editing, Supervision, Project administration, Funding acquisition. Henrik Schakow: Conceptualization, Methodology, Investigation, Resources, Data curation,
Acknowledgements
We thank the health care professionals at the EMDC for the assistance in data acquisition and collaboration with the AED-centre. Also, we thank the AED-network for sharing data for the purpose of this study.
References (30)
- et al.
Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies
Resuscitation.
(2010) - et al.
Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million
J Am Coll Cardiol.
(2010) - et al.
Out-of-hospital cardiac arrest: Probability of bystander defibrillation relative to distance to nearest automated external defibrillator
Resuscitation.
(2018) - et al.
Overcoming Spatial and Temporal Barriers to Public Access Defibrillators Via Optimization
J Am Coll Cardiol.
(2016) - et al.
Regional variation in out-of-hospital cardiac arrest: Incidence and survival - A nationwide study of regions in Denmark
Resuscitation.
(2020) - et al.
Out-of-Hospital Cardiac Arrest at Home in Japan
Am J Cardiol.
(2019) - et al.
Expanding the first link in the chain of survival - Experiences from dispatcher referral of callers to AED locations
Resuscitation.
(2016) - et al.
Optimization of automated external defibrillator deployment outdoors: An evidence-based approach
Resuscitation.
(2016) - et al.
Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study
Resuscitation.
(2019) - et al.
Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos
N Engl J Med.
(2000)
Public use of automated external defibrillators
N Engl J Med.
Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan
N Engl J Med.
Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations
JAMA cardiology.
Identifying locations for public access defibrillators using mathematical optimization
Circulation.
Improving bystander defibrillation in out-of-hospital cardiac arrests at home
Eur Heart J Acute Cardiovasc Care.
Cited by (9)
Bystander cardiopulmonary resuscitation, automated external defibrillator use, and survival after out-of-hospital cardiac arrest
2023, American Journal of Emergency MedicineLonger retrieval distances to the automated external defibrillator reduces survival after out-of-hospital cardiac arrest
2022, ResuscitationCitation Excerpt :However, evaluating the effect of AED retrieval distance on survival can be addressed exclusively in an observational context; 2) OHCAs in nursing homes were excluded as these markedly differ regarding age, comorbidity and prognosis compared with OHCAs outside of nursing homes.25,41 Furthermore, in nursing homes, OHCA and AED location have the same address,25 which could affect the regression analysis, when evaluating survival in relation to AED retrieval distances; 3) the number of used AEDs that did not reach the AED-center is not available. However, in the event of AED deployment, the EMDC is required to inform both the AED-centre and EMS staff to ensure transportation to the AED-centre, which should limit this issue.