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Automated External Defibrillator

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Rudolph W Koster – 1st expert on this subject based on the ideXlab platform

  • impact of onsite or dispatched Automated External Defibrillator use on survival after out of hospital cardiac arrest
    Circulation, 2011
    Co-Authors: Jocelyn Berdowski, Marieke T Blom, Abdennasser Bardai, Jan G P Tijssen, Rudolph W Koster

    Abstract:

    Background—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. Methods and Results—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–…

  • survival and health care costs until hospital discharge of patients treated with onsite dispatched or without Automated External Defibrillator
    Resuscitation, 2010
    Co-Authors: Jocelyn Berdowski, Jan G P Tijssen, Mathijs J Kuiper, Marcel G W Dijkgraaf, Rudolph W Koster

    Abstract:

    Abstract Background This study aimed to determine whether Automated External Defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac cause. Clinical, survival and cost data were collected from July 2005 until March 2008. Cost data were based on hospital transport, duration of admission in hospital wards, diagnostics and interventions. We divided the study population in three groups based on AED use: (1) onsite AED, (2) dispatched AED, (3) no AED. The endpoint was survival to discharge. P Results Of the 2126 included patients, 136 were treated with an onsite AED, 365 with a dispatched AED and 1625 without AED. Overall (95% confidence interval [CI]) survival rate was 43% (35–51%), 16% (13–20%) and 14% (12–16%), respectively*. Per 100 survivors, the mean duration admitted at intensive care unit [ICU] were 267 (166–374), 495 (344–658), and 537 (450–609) days, respectively*; total duration of hospital admission was 2188 (1800–2594), 3132 (2573–3797), and 2765 (2519–3050) days, respectively*. Mean costs per survivor for hospital stay were €9233 (€7351–€11,280), €14,194 (€11,656–€17,254), and €13,693 (€12,226–€15,166), respectively*; total health care costs were €29,575 (€24,695–€34,183), €34,533 (€29,832–€39,487) and €31,772 (€29,217–€34,385), respectively. For both survivors and non-survivors, total costs per patient were €14,727 (€11,957–€18,324), €7703 (€6141–€9366) and €6580 (€5875–€7238), respectively*. Conclusions Onsite AED use was associated with higher survival rates. Surviving patients of the onsite AED group had lower total costs, mainly due to the shorter ICU stay.

  • delaying a shock after takeover from the Automated External Defibrillator by paramedics is associated with decreased survival
    Resuscitation, 2010
    Co-Authors: Jocelyn Berdowski, Anouk P Van Alem, Ron J. Schulten, Jan G P Tijssen, Rudolph W Koster

    Abstract:

    Abstract Introduction The purpose of this study was to investigate whether the takeover by Advanced Life Support [ALS] trained ambulance paramedics from rescuers using an Automated External Defibrillator [AED] delays shocks and if this delay is associated with decreased survival after out-of-hospital cardiac arrest [OHCA]. Methods We analyzed continuous ECG recordings of LIFEPAK AEDs and associated manual Defibrillator recordings of OHCA of presumed cardiac cause, prospectively collected from July 2005 to July 2009. The primary outcome measure was survival to discharge. Among 693 patients treated with AEDs, 110 had a shockable initial rhythm and a shockable rhythm during ALS takeover. We measured the time interval between the expected shock if the AED would remain attached to the patient and the first observed shock given by the manual Defibrillator [shock timing]. Results Survival was 62% (13/21) if the shock was given early ( P =0.02) if the shock was 20–150s delayed and 21% (7/34; OR=0.16, 95% CI=0.05–0.54; P =0.003) if the shock was delayed >150s. The OR for trend was 0.41, 95% CI=0.25–0.71; P =0.001. The association between shock timing and survival was significant for patients with more than 150s shock delay (OR=0.19; 95% CI=0.04–0.71; P =0.02) or for trend in shock timing (0.42, 95% CI=0.20–0.84; P =0.02) after multivariable adjustment for prognostic factors age and slope of ventricular fibrillation. Conclusions ALS takeover delays the next shock delivery in almost two-third of cases. This delay is associated with decreased survival.

Peter J Kudenchuk – 2nd expert on this subject based on the ideXlab platform

  • training seniors in the operation of an Automated External Defibrillator a randomized trial comparing two training methods
    Annals of Emergency Medicine, 2001
    Co-Authors: Hendrika Meischke, Mickey S Eisenberg, Sheri Schaeffer, Peter J Kudenchuk

    Abstract:

    Abstract Study Objective: This study evaluated the differences in efficacy of 2 methods for training seniors in the use of an Automated External Defibrillator (AED). We tested the hypothesis that each training method (face-to-face instruction compared with video-based instruction) would result in similar AED performance on a manikin. Methods: Two hundred ten seniors from various senior centers were randomized to receive face-to-face or video-based instruction on AED skills. Seniors were assessed individually and tested on the speed and quality of AED performance. We retested 177 of these initial trainees 3 months after initial training. Similar performance measures were assessed. Results: Although there were statistically significant differences between the 2 training methods in terms of average time to shock at both evaluations, the results in general demonstrate that there were no clinically meaningful distinctions (time differences of Conclusion: We believe that seniors can be trained equally well in AED performance with video-based self-instruction or face-to-face instruction. How to maintain acceptable AED performance skills over time remains a challenge. [Meischke HW, Rea T, Eisenberg MS, Schaeffer SM, Kudenchuk P. Training seniors in the operation of an Automated External Defibrillator: A randomized trial comparing two training methods. Ann Emerg Med. September 2001;38:216-222.]

  • training seniors in the operation of an Automated External Defibrillator a randomized trial comparing two training methods
    Annals of Emergency Medicine, 2001
    Co-Authors: Hendrika Meischke, Mickey S Eisenberg, Sheri Schaeffer, Peter J Kudenchuk

    Abstract:

    STUDY OBJECTIVE: This study evaluated the differences in efficacy of 2 methods for training seniors in the use of an Automated External Defibrillator (AED). We tested the hypothesis that each training method (face-to-face instruction compared with video-based instruction) would result in similar AED performance on a manikin. METHODS: Two hundred ten seniors from various senior centers were randomized to receive face-to-face or video-based instruction on AED skills. Seniors were assessed individually and tested on the speed and quality of AED performance. We retested 177 of these initial trainees 3 months after initial training. Similar performance measures were assessed. RESULTS: Although there were statistically significant differences between the 2 training methods in terms of average time to shock at both evaluations, the results in general demonstrate that there were no clinically meaningful distinctions (time differences of <20 seconds) between the AED performance of seniors trained with a video and seniors trained in a face-to-face setting at the initial training or at the retention assessment. At the initial evaluation, overall performance was satisfactory, with greater than 98% trained with either method delivering a shock. However, at the 3-month follow-up, almost one fourth of trainees were not able to deliver a shock, and almost half were not able to correctly place the pads on the manikin. CONCLUSION: We believe that seniors can be trained equally well in AED performance with video-based self-instruction or face-to-face instruction. How to maintain acceptable AED performance skills over time remains a challenge.

Lance B. Becker – 3rd expert on this subject based on the ideXlab platform

  • Automated External Defibrillator availability and cpr training among state police agencies in the united states
    Annals of Emergency Medicine, 2012
    Co-Authors: Lior M Hirsch, Lance B. Becker, Sarah K Wallace, Marion Leary, Kathryn Dipuppo L Tucker, Benjamin S Abella

    Abstract:

    Study objective Access to Automated External Defibrillators and cardiopulmonary resuscitation (CPR) training are key determinants of cardiac arrest survival. State police officers represent an important class of cardiac arrest first responders responsible for the large network of highways in the United States. We seek to determine accessibility of Automated External Defibrillators and CPR training among state police agencies. Methods Contact was attempted with all 50 state police agencies by telephone and electronic mail. Officers at each agency were guided to complete a 15-question Internet-based survey. Descriptive statistics of the responses were performed. Results Attempts were made to contact all 50 states, and 46 surveys were completed (92% response rate). Most surveys were filled out by police leadership or individuals responsible for medical programs. The median agency size was 725 (interquartile range 482 to 1,485) state police officers, with 695 (interquartile range 450 to 1,100) patrol vehicles (“squad cars”). Thirty-three percent of responding agencies (15/46) reported equipping police vehicles with Automated External Defibrillators. Of these, 53% (8/15) equipped less than half of their fleet with the devices. Regarding emergency medical training, 78% (35/45) of state police agencies reported training their officers in Automated External Defibrillator usage, and 98% (44/45) reported training them in CPR. Conclusion One third of state police agencies surveyed equipped their vehicles with Automated External Defibrillators, and among those that did, most equipped only a minority of their fleet. Most state police agencies reported training their officers in Automated External Defibrillator usage and CPR. Increasing Automated External Defibrillator deployment among state police represents an important opportunity to improve first responder preparedness for cardiac arrest care.

  • Human factors impact successful lay person Automated External Defibrillator use during simulated cardiac arrest.
    Critical Care Medicine, 2004
    Co-Authors: Sergio Callejas, Anne Barry, Ellen Demertsidis, Dawn Jorgenson, Lance B. Becker

    Abstract:

    Objective: With the dissemination of Automated External Defibrillators in the community, there is increasing lay person use, along with less formal Automated External Defibrillator training and retraining. Therefore, the ease of use factors related to the human-device interface may be vital for successful use. We sought to determine whether human factor differences would result in differences in parameters of successful or safe use by lay persons in the setting of simulated cardiac arrest. Methods: We measured parameters of successful and safe use with two Automated External Defibrillator devices among two groups of volunteers, those trained with a brief video tape and those without any training (completely naive). Both devices (the Philips FR2 or the HS1) are used in public access Defibrillator settings. Volunteers entered a mock cardiac arrest scenario after randomization to either the naive (untrained) group or to a video-trained group. Results: Both the FR2 and HS1 were found to be completely safe when used by video-trained and by naive groups of participants, with no adverse events observed (total, n = 256). For both devices, video-trained participants demonstrated high rates of successful defibrillation in the simulated testing (86% for FR2 and 89% for HS1). With the FR2, video-trained participants were significantly more successful compared with naive, untrained participants (86% vs. 48% successful use; p

  • human factors impact successful lay person Automated External Defibrillator use during simulated cardiac arrest
    Critical Care Medicine, 2004
    Co-Authors: Sergio Callejas, Anne Barry, Ellen Demertsidis, Dawn Jorgenson, Lance B. Becker

    Abstract:

    OBJECTIVE: With the dissemination of Automated External Defibrillators in the community, there is increasing lay person use, along with less formal Automated External Defibrillator training and retraining. Therefore, the “ease of use” factors related to the human-device interface may be vital for successful use. We sought to determine whether human factor differences would result in differences in parameters of successful or safe use by lay persons in the setting of simulated cardiac arrest. METHODS: We measured parameters of successful and safe use with two Automated External Defibrillator devices among two groups of volunteers, those trained with a brief video tape and those without any training (completely naive). Both devices (the Philips FR2 or the HS1) are used in public access Defibrillator settings. Volunteers entered a mock cardiac arrest scenario after randomization to either the naive (untrained) group or to a video-trained group. RESULTS: Both the FR2 and HS1 were found to be completely safe when used by video-trained and by naive groups of participants, with no adverse events observed (total, n = 256). For both devices, video-trained participants demonstrated high rates of successful defibrillation in the simulated testing (86% for FR2 and 89% for HS1). With the FR2, video-trained participants were significantly more successful compared with naive, untrained participants (86% vs. 48% successful use; p < .001). However, for the HS1, there was no significant difference in success rates for the video-trained vs. naive, untrained groups (89% vs. 87%; p = .79). CONCLUSIONS: Both devices are safe with either video-trained or naive users. The successful use of each device is high when participants view the training videotape designed for the device. An important difference in successful use was observed for naive users where the HS1 showed improved successful use compared with the FR2. Because defibrillation in the community may increasingly be attempted by lay persons whose training is remote or who have not been trained at all, the "naive" scenario may be increasingly relevant to Automated External Defibrillator use. Collectively, these data support the notion that human factors associated with ease of use may play a critical factor in survival rates achieved by specific devices.