Dataset Information

The AED Project: Multiorganization Collaboration to Streamline Automatic External Defibrillator Data in Out-of-Hospital Cardiac Arrests.

ABSTRACT:

Background

In patients with out-of-hospital cardiac arrest (OHCA), automated external defibrillator (AED) devices contain valuable data about the patient's initial rhythm. The retrieval process was previously without protocol, despite its critical role in the patient journey.

Methods

Through a Plan-Do-Study-Act model, the cardiology department at Royal Jubilee Hospital (Victoria, British Columbia, Canada) collaborated with provincial emergency health services (British Columbia Emergency Health Services) to cocreate a request process for data from AEDs used by first responders. British Columbia Fire Departments, which are under municipal oversight, required an alternate strategy. Educational presentations allowed for feedback and spread. Patients surviving OHCA and transfer to the regional cardiac centre were consecutively enrolled from November 2018 to April 2020. We evaluated the timeliness of AED information retrieval, and tracked the process to admission. A retrospective chart review informed specifics after admission. A survey to the Coronary Intensive Care Unit staff was used to assess clinical utility.

Results

Seventy-one consecutive patients were enrolled during the study period. Seven rhythm strips arrived with the patient, thus not affected by the initiative. From the remaining 64 cases, 80% (n = 51/64) were received within 48 hours, and 88% (n = 45/51) were received within 24 hours with a median of 1 hour. Eighteen Coronary Intensive Care Unit staff completed the survey; 81% reported AED data as "very useful" to clinical decision-making (n = 13/16). The AED rhythm strips provided insight into OHCA etiology (100%; n = 11/11), supported evidence for diagnoses (100%; n = 11/11), and reduced unnecessary testing (64%; n = 7/11).

Conclusions

Implementing an organized protocol allowed for timely access to AED data, which was directly integrated into clinical decision-making and positively affected hospital stay.

SUBMITTER: Burden L

PROVIDER: S-EPMC8209392 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceSmartphone dispatch of volunteer responders to nearby out-of-hospital cardiac arrests (OHCAs) has emerged in several emergency medical services, but no randomized clinical trials have evaluated the effect on bystander use of automated external defibrillators (AEDs).ObjectiveTo evaluate if bystander AED use could be increased by smartphone-aided dispatch of lay volunteer responders with instructions to collect nearby AEDs compared with instructions to go directly to patients with OHCAs to start cardiopulmonary resuscitation (CPR).Design, setting, and participantsThis randomized clinical trial assessed a system for smartphone dispatch of volunteer responders to individuals experiencing OHCAs that was triggered at emergency dispatch centers in response to suspected OHCAs and randomized 1:1. The study was conducted in 2 main Swedish regions: Stockholm and Västra Götaland between December 2018 and January 2020. At study start, there were 3123 AEDs in Stockholm and 3195 in Västra Götaland and 24 493 volunteer responders in Stockholm and 19 117 in Västra Götaland. All OHCAs in which the volunteer responder system was activated by dispatchers were included. Excluded were patients with no OHCAs, those with OHCAs not treated by the emergency medical services, and those with OHCAs witnessed by the emergency medical services.InterventionsVolunteer responders were alerted through the volunteer responder system smartphone application and received map-aided instructions to retrieve nearest available public AEDs on their way to the OHCAs. The control arm included volunteer responders who were instructed to go directly to the OHCAs to perform CPR.Main outcomes and measuresOverall bystander AED attachment, including those attached by volunteer responders and lay volunteers who did not use the smartphone application.ResultsVolunteer responders were activated for 947 patients with OHCAs. Of those, 461 were randomized to the intervention group (median [IQR] age of patients, 73 [61-81] years; 295 male patients [65.3%]) and 486 were randomized to the control group (median [IQR] age of patients, 73 [63-82] years; 312 male patients [65.3%]). Primary outcome of AED attachment occurred in 61 patients (13.2%) in the intervention arm vs 46 patients (9.5%) in the control arm (difference, 3.8% [95% CI, -0.3% to 7.9%]; P = .08). The majority of AEDs were attached by lay volunteers who were not using the smartphone application (37 in intervention arm, 28 in control). There were no significant differences in secondary outcomes. Among the volunteer responders using the application, crossover was 11% and compliance to instructions was 31%. Volunteer responders attached 38% (41 of 107) of all AEDs and provided 45% (16 of 36) of all defibrillations and 43% (293 of 666) of all CPR.Conclusions and relevanceIn this study, smartphone dispatch of volunteer responders to OHCAs to retrieve nearby AEDs vs instructions to directly perform CPR did not significantly increase volunteer AED use. High baseline AED attachement rate and crossover may explain why the difference was not significant.Trial registrationClinicalTrials.gov Identifier: NCT02992873.

Project description:BACKGROUND:Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ?25% of overall arrests, ?60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. METHODS:From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ?2. Survival to hospital discharge was the secondary outcome measure. RESULTS:Among 49?555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. CONCLUSIONS:Bystander automated external defibrillator use before emergency medical services arrival in shockable observed public OHCA was associated with better survival and functional outcomes. Continued emphasis on public automated external defibrillator utilization programs may further improve outcomes of OHCA.