Category: News

Early defibrillation is a major determinant of survival in out-of-hospital cardiac arrest (OHCA). Shockable rhythms account for 18.7% of treated OHCA patients in emergency medical services (EMS), thanks to automated external defibrillators (AED). Shockable rhythms are strongly associated with improved survival rates compared to non-shockable rhythms in OHCA.

 

Defibrillation within 3–5 min of collapse can lead to survival rates as high as 50–70%.

 

Thus, reduced time between call to the emergency call centre (ECC) and AED using is a major issue.

 

Early recognition of OHCA and resuscitation performance with early defibrillation is the best way to increase survival chances. However, professional EMS arrive on site in about ten minutes in France.

 

The two steps to improve survival are one, to have volunteer rescuers on site quickly and two, to have them perform early defibrillation by an AED.

For the first step, notifying citizens as first responders to an OHCA event through a smartphone application with a mobile positioning system or a text message alert system increases early defibrillation and thereby improves survival.

 

The smartphone application SAUVLife© (Paris, France) currently used in France allows the ECC to solicit trained and registered lay rescuers. If you are connected and present in a one-kilometre perimeter around the victim, the application will alert and guide you to start CPR. It also warns another available lay-rescuer to a referenced AED and guides him to the victim.

 

In May 2022, a partnership between the EMS of the Angers University Hospital, the city of Angers, France and the SAUVLife© application was allowed to equip volunteer citizen rescuers with their own portable AED. These “super lay-rescuers” can be municipal staff, medical students or volunteers who agreed to always keep the defibrillator with them, day, and night. The geographical distribution of the portable AED in the 6 geographical districts of Angers resulted in homogeneous coverage of the city and rapid action regardless of the location of the OHCA.

 

With this innovative method, which is a first in France, aiming to increase AED usage before arrival of professional rescuers and to improve OHCA survival. This experiment should also allow to recruit more standard lay-rescuers and if successful, be extended to other areas.

 

References;

Deployment of “super lay-rescuers” equipped with AED to improve OHCA survival: An innovative partnership between emergency medical service, city hall and a mobile application in France – Resuscitation (resuscitationjournal.com)

Deployment of “super lay-rescuers” equipped with AED to improve OHCA survival: An innovative partnership between emergency medical service, city hall and a mobile application in France – PubMed (nih.gov)

Out-of-hospital cardiac arrest is a global public health issue experienced by approximately 3.8 million people annually. Only 8% to 12% of these people survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival but ensuring timely access to defibrillators has been a significant challenge.

To date, the development of public-access defibrillation programs, involving the deployment of automated external defibrillators into the public space, has been the main strategy to address this challenge. Public-access defibrillator programs have been associated with improved outcomes for out-of-hospital cardiac arrest; however, the devices are used in <3% of episodes of out-of-hospital cardiac arrest. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives:

(1) identify known barriers to public-access defibrillator use and early defibrillation,

(2) discuss established and novel strategies to address those barriers, and

(3) identify high-priority knowledge gaps for future research to address.

The writing group undertook systematic searches of the literature to inform this statement. Innovative strategies were identified that relate to enhanced public outreach, behaviour change approaches, optimisation of static public-access defibrillator deployment and housing, evolved automated external defibrillator technology and functionality, improved integration of public-access defibrillation with existing emergency dispatch protocols, and exploration of novel automated external defibrillator delivery vectors.

This study provides evidence- and consensus-based policy suggestions to enhance public-access defibrillation and guidance for future research in this area.

References;

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation | Circulation (ahajournals.org)

Optimizing Outcomes After Out-of-Hospital Cardiac Arrest With Innovative Approaches to Public-Access Defibrillation: A Scientific Statement From the International Liaison Committee on Resuscitation – PubMed (nih.gov)

 

March is AED Maintenance Month!

Maintaining your defibrillator is as important as having one

With the survival rate of sudden cardiac arrest being below 10%, the emphasis to have Automatic External Defibrillators (AEDs) in all places where we live, work, and play is becoming increasingly important. It is equally important to remember that having a maintenance plan in place will ensure all AEDs are ready to help save a life when and if needed. When a defibrillator is deployed during an emergency, it is crucial the AED is ready to be used. The outcome for the patient could be even more devastating if the AED was available but not functioning properly.

 

Proper maintenance of the AED is essential to ensure that it works correctly when needed. Here are some tips on how to maintain an AED:

 

Read the user manual: To maintain properly functioning AED, read the manual thoroughly. This will help you understand the device’s functions and how to use it correctly. It will also get you familiar with the manufacturer name when needing to reorder the disposables such as batteries & pads.

 

Regularly check the battery and electrode pads: Check the AEDs battery and electrode pads regularly. Replace them immediately if they are expired, damaged, or low on charge.

 

Perform self-tests: AEDs have a self-test feature that checks the device’s internal components and battery charge. Follow the manufacturer’s instructions for performing regular self-tests.

 

Keep the AED clean: Wipe the AED with a clean, dry cloth to remove dirt, dust, or debris. Avoid using harsh chemicals or solvents that can damage the device.

 

Store the AED correctly: Store the AED in a dry, cool place. Avoid exposing the device to extreme temperatures or moisture as may inhibit the AED’s performance.

 

Keep the AED accessible: Place the AED in an easily accessible location that is visible and known to everyone. Ensure that it is not ever blocked by any obstructions, so it is clearly available when an emergency arises.

 

Train your staff: Ensure that your staff is trained in AED use and maintenance. Regular training can help them respond quickly and confidently in an emergency. Ensure it is part of the onboarding process when a new team member comes on board. You should also appoint someone to carry out monthly checks and have these checks logged.

 

Below is a checklist when doing an AED Maintenance check:

• Is the Active Status Indicator light on your AED flashing green?
• Are the AED pads plugged in and ready for use?
• Does the AED appear to be undamaged and ready for use?
• Is the AED free of chirping and warning notifications?
• Are the AED pads within their usable date?
• Is the AED battery within its usable date?

If the answer to any of these questions is no, call Customer Service/AED manufacturer to determine what the issue might be with the AED.

 

By following these tips, you can maintain your AED in good condition and ensure that it is always ready to use when needed.

 

References;

Maintaining your defib is as Important as having one – Eiremed.ie

Guide to Defibrillator Maintenance and upkeep | St John Ambulance (sja.org.uk)

How To Maintain Your AED | AED Defibrillator Maintenance (defibtech.com)

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA

It has been hypothesised that the minority student-athletes have a lower survival rate from sudden cardiac arrest (SCA) than non-minority student-athletes. The below study examined the relationship between high school indicators of socioeconomic status (SES) and survival in student-athletes with exercise-related Sudden Cardiac Arrest.

 

Methods

High school student-athletes in the USA with exercise-related SCA on school campuses were prospectively identified from 1 July 2014 to 30 June 2018 by the National Center for Catastrophic Sports Injury Research. High school indicators of SES included the following: median household and family income, proportion of students on free/reduced lunch and percent minority students. Resuscitation details included witnessed arrest, presence of an athletic trainer, bystander cardiopulmonary resuscitation and use of an on-site automated external defibrillator (AED). The primary outcome was survival to hospital discharge. Differences in survival were analysed using risk ratios (RR) and univariate general log-binomial regression models.

Conclusion

The study concluded that minority student-athletes with exercise-related SCA on high school campuses have lower survival rates than white non-Hispanic athletes, but this difference is not fully explained by SES markers of the school.

 

See link to full study below;

 

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA – PMC (nih.gov)

 

 

What we can learn from Damar Hamlin’s cardiac arrest

 

The shocking collapse of Buffalo Bills safety Damar Hamlin on Monday 02 Jan has renewed concerns about the dangers of American football.

Hamlin’s cardiac arrest highlights the need to make automatic external defibrillators (AEDs) readily accessible in all sports facilities, especially where youth sports are played. The scary moment occurred after Hamlin, 24, apparently slammed his chest into the shoulder of Cincinnati Bengals wide receiver Tee Higgins. Hamlin stood up briefly after the tackle before collapsing on the field. His heart had stopped.

Medical staff members rushed to perform chest compressions and used an AED to shock his heart. According to a statement from the Bills, Hamlin’s heartbeat was restored on the field. An ambulance took him to the hospital, where he remains in critical condition.

Details are still emerging about Hamlin’s medical circumstances. The most likely explanation is that he suffered from commotio cordis, a very rare but serious condition after blunt trauma to the chest. If the impact is strong enough and occurs at a specific moment between heartbeats, it can send the heart into an erratic, disorganized rhythm called ventricular fibrillation. Without immediate treatment, ventricular fibrillation is fatal. Once the heart stops pumping blood, oxygen no longer reaches vital organs.

CPR can buy time by manually compressing the heart to pump blood, but what’s needed is to shock the heart back into a normal rhythm. In Hamlin’s case, the medical team arrived on the field within several seconds of his collapse. He received CPR right away, and luckily an AED was available, along with trained personnel, to deliver the shock. While we don’t yet know his prognosis, the rapid intervention gave him the best chance of survival and recovery.

 

See link to full article below;

 

https://www.washingtonpost.com/opinions/2023/01/03/damar-hamlin-buffalo-bills-cardiac-arrest-defibrillators/

 

Does modifying electrode placement of the 12 lead ECG matter in healthy subjects?

 

Limb electrodes for the 12 lead ECG are routinely placed on the torso during exercise stress testing or when limbs are clinically inaccessible. However, it is unclear whether such electrode modification produces ECG changes in healthy male or female subjects that are clinically important according to the 2009 AHA, ACCF, HRS guidelines. This study measured whether ECG modification produced clinically important or false positive ECG changes.

 

Click below for full study:

 

Does modifying electrode placement of the 12 lead ECG matter in healthy subjects? – PubMed (nih.gov)

Does modifying electrode placement of the 12 lead ECG matter in healthy subjects? – International Journal of Cardiology