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Arabloo J, Ahmadizadeh E, Rezapour A, Ehsanzadeh SJ, Alipour V, Peighambari MM, Sarabi Asiabar A, Souresrafil A. Economic evaluation of automated external defibrillator deployment in public settings for out-of-hospital cardiac arrest: a systematic review. Expert Rev Med Devices 2024:1-18. [PMID: 38736307 DOI: 10.1080/17434440.2024.2354472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a major issue in aging populations. The use of automatic external defibrillators (AEDs) in public places improves cardiac arrest survival rates. The purpose of this study is to review economic evaluation studies of the use of AED technology in public settings for cardiac arrest resuscitation. METHODS Our search covered 1990-2021 and included PubMed, Cochrane Library, Embase, Scopus, and Web of Science. We included studies that analyzed cost-effectiveness, cost-utility and cost-benefit of the AED technology. Also, we performed the quality assessment of the studies through the checklist of quality assessment standard of health economic studies (QHES). RESULTS Our inclusion criteria were met by 25 studies. AEDs are found to be cost-effective in places with a high occurrence of cardiac arrest. In addition, proper integration of drones with AEDs into existing systems has the potential to significantly improve OHCA survival rates. CONCLUSION The present study found that putting AEDs in high-cardiac arrest and crowded areas reduces average costs. Despite this, the costs associated with acquiring and maintaining AEDs prevent their widespread use. Further research is needed to evaluate feasibility and explore innovative strategies for AED maintenance and accessibility.
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Affiliation(s)
- Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Ahmadizadeh
- Department of Management sciences and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Jafar Ehsanzadeh
- Department of English Language, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Alipour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Sarabi Asiabar
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Aghdas Souresrafil
- Department of Health Services and Health Promotion, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Malloy-Walton L, Gopineti L, Thompson AJ, Vetter VL, Batlivala SP. Assessing Effective Practices and Barriers to Creating School and Community Partnerships for a Sudden Cardiac Death Prevention Program: A National Project ADAM® study. Acad Pediatr 2022; 23:808-813. [PMID: 36220618 DOI: 10.1016/j.acap.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Project ADAM (Automated Defibrillators in Adam's Memory) is a national collaborative to improve outcomes for out-of-hospital sudden cardiac arrest. Given Project ADAM's expansion, we sought to identify effective methods to partner with community leaders and understand barriers to engagement. Our aim was to establish effective practices to guide affiliates and optimize site operations and partnerships. METHODS We conducted a survey of all Project ADAM sites in 2020. Medical Directors and Program Coordinators were included for generalizability. The survey consisted of 20 questions covering the domains of communication, goals for partner organizations, partnership barriers, staff time commitments, and Project ADAM program needs. RESULTS Thirty-one members responded: 14 Medical Directors and 17 Program Coordinators. E-mail was the predominant method to initiate (58%) and maintain (87%) contact with partner organizations, though telephone (21%) and in-person visits (14%) were common for initiating contact. Presentations at school board, Emergency Medical Services, and athletic director meetings and student/family testimonials were powerful engagement tools. Barriers to partnership varied, revolving around limited school budgets, overburdened staff, and Covid-19. Limited time, difficulty coordinating schedules, and lack of dedicated resources were common challenges for Project ADAM sites. Only 36% of Medical Directors receive institutional recognition of Project ADAM effort. CONCLUSIONS Project ADAM's partnership with community stakeholders creates unique opportunities and challenges. Optimal communication methods should be identified early for each school, with regular interaction for long-term success. Institutional recognition of Project ADAM efforts may boost success. Additionally, the Covid-19 pandemic created numerous challenges and may spur operational changes.
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Affiliation(s)
- Lindsey Malloy-Walton
- Ward Family Heart Center, Children's Mercy Hospital Kansas City and Division of Pediatric Cardiology (L Malloy-Walton), University of Missouri School of Medicine, Kansas City
| | - Lalitha Gopineti
- Ward Family Heart Center, Children's Mercy Hospital Wichita and Division of Pediatric Cardiology (L Gopineti), Kansas University School of Medicine, Wichita
| | - Alison J Thompson
- Herma Heart Institute, Children's Hospital of Wisconsin (AJ Thompson), Milwaukee
| | - Victoria L Vetter
- The Cardiac Center (VL Vetter), Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Sarosh P Batlivala
- The Heart Institute, Cincinnati Children's Hospital Medical Center and Division of Pediatric Cardiology (SP Batlivala), University of Cincinnati College of Medicine, Ohio.
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Arabadjian M, Serrato S, Sherrid MV. Availability and Utilization of Automated External Defibrillators in New York State Schools. Front Pediatr 2021; 9:711124. [PMID: 34660480 PMCID: PMC8514828 DOI: 10.3389/fped.2021.711124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 01/14/2023] Open
Abstract
Background: Use of automated external defibrillators (AEDs) in out-of-hospital cardiac arrests (OHCAs) improve survival. Professional health organizations recommend that AEDs be available in crowded places, including schools but currently only 18 US states require them. Sudden cardiac arrest (SCA) research in the school-age population has largely focused on school sub-groups, leaving out the majority of US students and adults working in schools. New York State (NYS) has one of the largest student populations in the US. Our objective was to gain epidemiologic data on SCA across a variety of school levels and examine the availability and utilization of AEDs in a state that requires them. Methods: This was an observational, cross-sectional study utilizing an electronic survey. We included NYS school nurses and collected electronic surveys in January-March, 2018. We analyzed demographic data of school characteristics, SCA occurrences and AED use and availability. Results: Of 876 respondents (36.1% response rate), 71 (8.2%) reported SCAs, with 41 occurring in adults. AEDs were deployed in 59 of 71 (84.3%) events, 40 individuals had long-term survival. Most SCAs occurred in middle-schools. School size or number of AEDs/school had no bearing on short-term or long-term survival. AEDs were widely available in private schools, though this was not required by state law. Conclusions: Our data suggest a need for more comprehensive examination of SCA in US schools. Research comparing the availability and utilization of school AEDs between states that do and do not require them is needed and may have important clinical and policy implications for SCA emergency preparedness in US schools.
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Affiliation(s)
- Milla Arabadjian
- Rory Meyers College of Nursing, New York University, New York, NY, United States.,Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York, NY, United States
| | - Stephanie Serrato
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York, NY, United States
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York, NY, United States
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Rucinski C, Winbo A, Marcondes L, Earle N, Stiles M, Stiles R, Hooks D, Neas K, Hayes I, Crawford J, Martin A, Skinner JR. A Population-Based Registry of Patients With Inherited Cardiac Conditions and Resuscitated Cardiac Arrest. J Am Coll Cardiol 2020; 75:2698-2707. [DOI: 10.1016/j.jacc.2020.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/02/2020] [Accepted: 04/02/2020] [Indexed: 01/30/2023]
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Saberian S, Pendyala VS, Siebert VR, Himmel BA, R. Wigant R, Knepp MD, Orcutt JW, Mungee S, Chan DP, Baman TS. Disparities Regarding Inadequate Automated External Defibrillator Training and Potential Barriers to Successful Cardiac Resuscitation in Public School Systems. Am J Cardiol 2018; 122:1565-1569. [PMID: 30172365 DOI: 10.1016/j.amjcard.2018.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 11/25/2022]
Abstract
Installation of automated external defibrillators (AEDs) in public schools has been shown to improve outcomes for children with sudden cardiac arrest (SCA). However, the adequacy of faculty AED training and potential barriers to successful cardiac resuscitation remain unknown. A questionnaire was mailed to all public schools in the state of Illinois (n = 3796). The survey focused on the demographic variables of each school as well as the confidence of the responder regarding effectiveness of AED training. 2,192 surveys were included in this study (58% response rate). Independent variables for perceived inadequate AED training were schools that were predominantly black (odds ratio [OR] 3.93; 3.01 to 5.13) or Hispanic (OR 2.75; 2.11 to 3.58), elementary schools (OR 2.05; 1.69 to 2.50), schools with <250 students (OR 1.69; 1.19 to 2.40) and <25 faculty (OR 1.54; 1.10 to 2.15). Eighty-eight percent of responders cited at least one barrier to successful AED utilization. Location in a town setting (OR 9.34; 4.73 to 18.44) or rural setting (OR 3.18; 2.47 to 4.10) as well as upper socioeconomic status (OR 3.85; 2.04 to 7.29) were found to be predictors of schools with no barriers to AED utilization.
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Fuchs SM, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N. Advocating for Life Support Training of Children, Parents, Caregivers, School Personnel, and the Public. Pediatrics 2018; 141:peds.2018-0705. [PMID: 29793985 DOI: 10.1542/peds.2018-0705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric cardiac arrest in the out-of-hospital setting is a traumatic event for family, friends, caregivers, classmates, and school personnel. Immediate bystander cardiopulmonary resuscitation and the use of automatic external defibrillators have been shown to improve survival in adults. There is some evidence to show improved survival in children who receive immediate bystander cardiopulmonary resuscitation. Pediatricians, in their role as advocates to improve the health of all children, are uniquely positioned to strongly encourage the training of children, parents, caregivers, school personnel, and the lay public in the provision of basic life support, including pediatric basic life support, as well as the appropriate use of automated external defibrillators.
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Affiliation(s)
| | - Joseph Wright
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Terry Adirim
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Michael S.D. Agus
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - James Callahan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Toni Gross
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Natalie Lane
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Lois Lee
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Suzan Mazor
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Prashant Mahajan
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Timm
- Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois; and Division of Emergency Medicine, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois
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Kiyohara K, Sado J, Kitamura T, Ayusawa M, Nitta M, Iwami T, Nakata K, Sato Y, Kojimahara N, Yamaguchi N, Sobue T, Kitamura Y. Epidemiology of Pediatric Out-of-Hospital Cardiac Arrest at School - An Investigation of a Nationwide Registry in Japan. Circ J 2018; 82:1026-1032. [PMID: 29445066 DOI: 10.1253/circj.cj-17-1237] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in school settings is important to establish an evidence-based strategy for prevention and better prognosis.Methods and Results:The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide prospective observational study linking databases from 2 nationally representative registries, the Injury and the Accident Mutual Aid Benefit System of The Japan Sport Council and the All-Japan Utstein Registry of the Fire and Disaster Management Agency. Using these databases, we described the detailed characteristics and outcomes of pediatric OHCAs that occurred in school settings in Japan between 2009 and 2014. During the 6-year study period, 295 OHCA cases were confirmed. Overall incidence rate was 0.4 per 100,000 students per year. The majority of OHCA cases had a cardiac origin (71%), occurred during exercise (65%), were witnessed by bystanders (70%), and received bystander-initiated cardiopulmonary resuscitation (73%). In approximately one-third of cases the student was defibrillated by public-access automated external defibrillator (38%). The proportion of patients with 1-month survival and a favorable neurological outcome was 34% among all OHCAs and 43% among OHCAs of cardiac origin. CONCLUSIONS In Japan, approximately 50 pediatric cases of OHCA consistently occur yearly in school settings. The majority of students received basic life support from bystanders, and patients with OHCA of cardiac origin had a relatively good prognosis.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Public Health, Tokyo Women's Medical University
| | - Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College.,Department of Pediatrics, Osaka Medical College
| | | | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University
| | | | | | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
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Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2017; 120:77-87. [PMID: 28888810 DOI: 10.1016/j.resuscitation.2017.09.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
AIM To systematically review studies comparing bystander automated external defibrillator (AED) use to no AED use in regard to clinical outcomes in out-of-hospital cardiac arrest (OHCA), and to provide a descriptive summary of studies on the cost-effectiveness of bystander AED use. METHODS We searched Medline, Embase, the Web of Science, and the Cochrane Library for randomized trials and observational studies published before June 1, 2017. Meta-analyses were performed for patients with all rhythms, shockable rhythms, and non-shockable rhythms. RESULTS Forty-four observational studies, 3 randomized trials, and 13 cost-effectiveness studies were included. Meta-analysis of 6 observational studies without critical risk of bias showed that bystander AED use was associated with survival to hospital discharge (all rhythms OR: 1.73 [95%CI: 1.36, 2.18], shockable rhythms OR: 1.66 [95%CI: 1.54, 1.79]) and favorable neurological outcome (all rhythms OR: 2.12 [95%CI: 1.36, 3.29], shockable rhythms OR: 2.37 [95%CI: 1.58, 3.57]). There was no association between bystander AED use and neurological outcome for non-shockable rhythms (OR: 0.76 [95%CI: 0.10, 5.87]). The Public-Access Defibrillation trial found higher survival rates when volunteers were equipped with AEDs. The other trials found no survival difference, although their study settings differed. The quality of evidence was low for randomized trials and very low for observational studies. AEDs were cost-effective in settings with high cardiac arrest incidence, with most studies reporting ratios < $100,000 per quality-adjusted life years. CONCLUSIONS The evidence supports the association between bystander AED use and improved clinical outcomes, although the quality of evidence was low to very low.
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Affiliation(s)
- Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Mikael Vognsen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Mikkel S Andersen
- Department of Emergency Medicine, Odense University Hospital, 5000 Odense C, Denmark
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA.
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Sudden cardiac arrest preparedness in Michigan: Partnering with Project ADAM to develop a HEARTSafe Schools state model. PROGRESS IN PEDIATRIC CARDIOLOGY 2017. [DOI: 10.1016/j.ppedcard.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cardiopulmonary Resuscitation Training in Schools: A Comparison of Trainee Satisfaction among Different Age Groups. Keio J Med 2016; 65:49-56. [PMID: 27319976 DOI: 10.2302/kjm.2015-0009-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cardiopulmonary resuscitation (CPR) has recently been added to the school curriculum worldwide and is currently taught to students between the ages of 10 and 16 years. The effect of the age of trainees on their satisfaction with CPR training has yet been elucidated. The aim of this study was to compare the satisfaction of trainees of different ages who participated in CPR training in schools in Japan. In total, 392 primary school students (10-11 years old), 1798 junior high school students (12-13 years old), and 4162 high schools students (15-16 years old) underwent the same 3-h course of CPR training, according to the guidelines of 2000 for Emergency Cardiovascular Care and CPR. The course was evaluated by a questionnaire completed by the participants. Primary school students responded most positively to all questions, including those reflecting enjoyment and the confidence of participants to apply CPR (Jonckheere-Terpstra test: P < 0.01). Exploratory factor analysis defined three latent variables (reaction, concentration, and naïveté) based on the seven variables addressed in the questionnaire. In the causal relationships analyzed by structural equation modeling (SEM), naïveté (which is related to age) directly affected the other latent variables. The current model suggested that the students' satisfaction with CPR training was strongly related to their age. Primary school students enjoyed CPR training more and were more confident in their ability to perform CPR than junior high and high school students were. Therefore, children aged 10-11 years may be the most appropriate candidates for the introduction of CPR training in schools.
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Thomas VC, Shen JJ, Stanley R, Dahlke J, McPartlin S, Row L. Improving Defibrillation Efficiency in Area Schools. CONGENIT HEART DIS 2016; 11:359-64. [DOI: 10.1111/chd.12375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Vincent C. Thomas
- Department of Pediatrics, Division of Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center; Omaha Nebr USA
| | - Jay J. Shen
- Division of Health Sciences, University of Nevada-Las Vegas; Las Vegas Nev USA
| | | | | | | | - Lynn Row
- Clark County School District; Las Vegas Nev USA
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Smith CM, Colquhoun MC. Out-of-hospital cardiac arrest in schools: A systematic review. Resuscitation 2015; 96:296-302. [PMID: 26386373 DOI: 10.1016/j.resuscitation.2015.08.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/10/2015] [Accepted: 08/25/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) in children and adolescents is rare, with a minority of cases occurring at school. When OHCA does occur at school it is more likely to affect an adult than a student. Developing comprehensive strategies to treat cardiac arrest occurring at schools would be helped by accurate data regarding its epidemiology. METHODS A systematic review was undertaken. An electronic search strategy of MEDLINE and EMBASE databases was devised and relevant papers reporting data on school-based OHCA incidence and/or outcome in both adults and children were identified. Further articles were obtained from the bibliographies of these papers and from related articles. RESULTS Nine studies were included in the systematic review. Cardiac arrest incidence was one per 23.8-284.1 schools per year. Cardiac arrest incidence amongst students, reported in some studies, was 0.17-4.4 per 100,000 students per year. Studies also reported, although not universally, rates of witnessed OHCA (25.0-97.2%), VF (57.4-67.6%), bystander CPR (25.0-94.4%) and automated external defibrillator (AED) use (23.4-91.5%). Survival to hospital discharge or at one month was between 31.9% and 71.2%. CONCLUSION Cardiac arrest in schools is rare, and more likely to occur in adults than children. Outcomes are better than OHCA occurring at other locations, probably due to the high proportion of witnessed arrests and high rates of bystander CPR. It is likely that school-based AEDs will rarely be needed, but have the potential to make a dramatic impact on outcome.
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Affiliation(s)
| | - Michael C Colquhoun
- Resuscitation Council (UK), Tavistock House North, Tavistock Square, London WC1H 9HR, UK
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Bouland AJ, Risko N, Lawner BJ, Seaman KG, Godar CM, Levy MJ. The Price of a Helping Hand: Modeling the Outcomes and Costs of Bystander CPR. PREHOSP EMERG CARE 2015; 19:524-34. [PMID: 25665010 DOI: 10.3109/10903127.2014.995844] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Early, high-quality, minimally interrupted bystander cardio-pulmonary resuscitation (BCPR) is essential for out-of-hospital cardiac arrest survival. However, rates of bystander intervention remain low in many geographic areas. Community CPR programs have been initiated to combat these low numbers by teaching compression-only CPR to laypersons. This study examined bystander CPR and the cost-effectiveness of a countywide CPR program to improve out-of-hospital cardiac arrest survival. METHODS A 2-year retrospective review of emergency medical services (EMS) run reports for adult nontraumatic cardiac arrests was performed using existing prehospital EMS quality assurance data. The incidence and success of bystander CPR to produce prehospital return of spontaneous circulation and favorable neurologic outcomes at hospital discharge were analyzed. The outcomes were paired with cost data for the jurisdiction's community CPR program to develop a cost-effectiveness model. RESULTS During the 23-month study period, a total of 371 nontraumatic adult out-of-hospital cardiac arrests occurred, with a 33.4% incidence of bystander CPR. Incremental cost-effectiveness analysis for the community CPR program demonstrated a total cost of $22,539 per quality-adjusted life-year (QALY). A significantly increased proportion of those who received BCPR also had an automated external defibrillator (AED) applied. There was no correlation between witnessed arrest and performance of BCPR. A significantly increased proportion of those who received BCPR were found to be in a shockable rhythm when the initial ECG was performed. In the home setting, the chances of receiving BCPR were significantly smaller, whereas in the public setting a nearly equal number of people received and did not receive BCPR. Witnessed arrest, AED application, public location, and shockable rhythm on initial ECG were all significantly associated with positive ROSC and neurologic outcomes. A home arrest was significantly associated with worse neurologic outcome. CONCLUSIONS Cost-effectiveness analysis demonstrates that a community CPR outreach program is a cost-effective means for saving lives when compared to other healthcare-related interventions. Bystander CPR showed a clear trend toward improving the neurologic outcome of survivors. The findings of this study indicate a need for additional research into the economic effects of bystander CPR.
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Toresdahl BG, Rao AL, Harmon KG, Drezner JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 2014; 11:1190-4. [DOI: 10.1016/j.hrthm.2014.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/01/2022]
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Wasilko SM, Lisle DK. Automated External Defibrillators and Emergency Planning for Sudden Cardiac Arrest in Vermont High Schools: A Rural State's Perspective. Sports Health 2014; 5:548-52. [PMID: 24427431 PMCID: PMC3806176 DOI: 10.1177/1941738113484250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Sudden cardiac death (SCD) events are tragic. Secondary prevention of SCD depends on availability of automated external defibrillators (AEDs). High school athletes represent a high-risk group for SCD, and current efforts aim to place AEDs in all high schools. Hypothesis: The prevalence of AEDs and emergency planning for sudden cardiac arrest (SCA) in Vermont high schools is similar to other states. Understanding specific needs and limitations in rural states may prevent SCD in rural high schools. Study Design: Cross-sectional survey. Methods: A survey was distributed to all 74 Vermont high school athletic directors. Outcome measures included AED prevalence, AED location, individuals trained in cardiopulmonary resuscitation (CPR) and AED utilization, funding methods for AED attainment, and the establishment of an emergency action plan (EAP) for response to SCA. Results: All schools (100%, 74 of 74) completed the survey. Of those, 60 (81%) schools have at least 1 AED on school premises, with the most common location for AED placement being the main office or lobby (50%). Larger sized schools were more likely to have an AED on the premises than smaller sized schools (P = 0.00). School nurses (77%) were the most likely individuals to receive formal AED training. Forty-one schools (55%) had an EAP in place for response to SCA, and 71% of schools coordinated AED placement with local emergency medical services (EMS) responders. Conclusion: In Vermont, more than two-thirds of high schools have at least 1 AED on school premises. However, significant improvement in the establishment of EAPs for SCA and training in CPR and AED utilization is essential given the rural demography of the state of Vermont. Clinical Relevance: Rural high schools inherently have longer EMS response times. In addition to obtaining AEDs, high schools must develop a public access to defibrillation program to maximize the chance of survival following cardiac arrest, especially in rural settings.
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Affiliation(s)
- Scott M Wasilko
- Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont
| | - David K Lisle
- Division of Sports Medicine, Departments of Orthopaedics & Rehabilitation and Family Medicine, University of Vermont College of Medicine, Burlington, Vermont
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Mitani Y, Ohta K, Yodoya N, Otsuki S, Ohashi H, Sawada H, Nagashima M, Sumitomo N, Komada Y. Public access defibrillation improved the outcome after out-of-hospital cardiac arrest in school-age children: a nationwide, population-based, Utstein registry study in Japan. Europace 2013; 15:1259-66. [PMID: 23603306 PMCID: PMC3753060 DOI: 10.1093/europace/eut053] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The purpose of this study was to determine whether implementation of public access defibrillation (PAD) improves the outcome after out-of-hospital cardiac arrest (OHCA) in school-age children at national level. METHODS AND RESULTS We conducted a prospective, nationwide, population-based Japanese Utstein registry study of consecutive OHCA cases in elementary and middle school children (7-15 years of age) who had a bystander-witnessed arrest of presumed cardiac origin during 2005-09 and received pre-hospital resuscitation by emergency responders. The primary endpoint was a favourable neurological outcome 1 month after an arrest. Among 230 eligible patients enrolled, 128 had ventricular fibrillation (VF) as an initial rhythm. Among these 128 patients, 29 (23%) children received a first shock by a bystander. Among these 29 patients, the proportion of the favourable neurological outcome after OHCA was 55%. During the study period, the proportion of patients initially shocked by a bystander among eligible patients increased from 2 to 21% (P = 0.002 for trend). The proportion of patients with a favourable neurological outcome after OHCA increased from 12 to 36% overall (P = 0.006). The collapse to defibrillation time was shorter in bystander-initiated defibrillation when compared with defibrillation by emergency responders (3.3 ± 3.7 vs. 12.9 ± 5.8 min, P < 0.001), and was independently associated with a favourable neurological outcome after OHCA [P = 0.03, odds ratio (OR) per 1 min increase, 0.90 (95% confidence interval 0.82-0.99)]. A non-family member's witness was independently associated with VF as the initial rhythm [P < 0.001, OR 4.03 (2.08-7.80)]. CONCLUSION Implementation of PAD improved the outcome after OHCA in school-age children at national level in Japan.
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Affiliation(s)
- Yoshihide Mitani
- Department of Pediatrics, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan.
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Sudden cardiac arrests, automated external defibrillators, and medical emergency response plans in Tennessee high schools. Pediatr Emerg Care 2013; 29:352-6. [PMID: 23426252 DOI: 10.1097/pec.0b013e31828530c1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Schools are important public locations of sudden cardiac arrest (SCA), and the American Heart Association (AHA) recommends medical emergency response plans (MERPs), which may include an automated external defibrillator (AED) in schools. The objective of this study was to determine the incidence of SCA and the prevalence of AEDs and MERPs in Tennessee high schools. METHODS Tennessee Secondary School Athletic Association member schools were surveyed regarding SCA on campus within 5 years, AED presence, and MERP characteristics. RESULTS Of 378 schools, 257 (68%) completed the survey. There were 21 (5 student and 16 adult) SCAs on school grounds, yielding a 5-year incidence of 1 SCA per 12 high schools. An AED was present at 11 of 21 schools with SCA, and 6 SCA victims were treated with an AED shock. A linear increase in SCA frequency was noted with increasing school size (<500 students: 3.3% incidence, 500-1000: 6.5%, 1000-1500: 12.5%, ≥1500: 18.2%; P = 0.003). Of 257 schools, 71% had an MERP, 48% had an AED, and only 4% were fully compliant with AHA recommendations. Schools with a history of SCA were more likely to be compliant (19% vs. 3%, P = 0.011). CONCLUSIONS The 5-year incidence of SCA in Tennessee high schools is 1 in 12, but increases to 1 in 7 for schools with more than 1000 students. Compliance with AHA guidelines for MERPs is poor, but improved in schools with recent SCA. Future recommendations should encourage the inclusion of AED placement in schools with more than 1000 students.
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AEDs in schools: lessons learned and to be learned. Resuscitation 2013; 84:401-2. [PMID: 23357704 DOI: 10.1016/j.resuscitation.2013.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 01/21/2013] [Indexed: 11/22/2022]
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Schoenbaum M, Denchev P, Vitiello B, Kaltman JR. Economic evaluation of strategies to reduce sudden cardiac death in young athletes. Pediatrics 2012; 130:e380-9. [PMID: 22753553 PMCID: PMC4074613 DOI: 10.1542/peds.2011-3241] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is controversy about appropriate methods to reduce sudden cardiac death (SCD) in young athletes, but there is limited evidence on costs or consequences of alternative strategies. The objective of this study was to evaluate the cost-effectiveness of adding electrocardiogram (ECG) screening to the currently standard practice of preparticipation history and physical examination (H&P) to reduce SCD. METHODS Decision analysis modeling by using a societal perspective, with annual Markov cycles from age 14 until death. Three screening strategies were evaluated: (1) H&P, with cardiology referral if abnormal (current standard practice); (2) H&P, plus ECG after negative H&P, and cardiology referral if either is abnormal; and (3) ECG only, with cardiology referral if abnormal. Children identified with SCD-associated cardiac abnormalities were restricted from sports and received cardiac treatment. Main outcome measures were costs of screening and treatment, quality-adjusted life years (QALYs), and premature deaths averted. RESULTS Relative to strategy 1, incremental cost-effectiveness is $68800/QALY for strategy 2 and $37700/QALY for strategy 3. Monte Carlo simulation revealed the chance of incremental cost-effectiveness compared with strategy 1 was 30% for strategy 2 and 66% for strategy 3 (assumed willingness to pay ≤$50000/QALY). Compared with strategy 1, strategy 2 averted 131 additional SCDs at $900000 per case, and strategy 3 averted 127 SCDs at $600000 per case. CONCLUSIONS Under a societal willingness to pay threshold of $50000/QALY, adding ECGs to current preparticipation evaluations for athletes is not cost-effective, with costs driven largely by false-positive findings.
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Affiliation(s)
- Michael Schoenbaum
- National Institute of Mental Health, 6001 Executive Blvd, Room 8225 MSC 9669, Bethesda, MD 20892, USA.
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Abstract
Pediatric sudden cardiac arrest (SCA), which can cause sudden cardiac death if not treated within minutes, has a profound effect on everyone: children, parents, family members, communities, and health care providers. Preventing the tragedy of pediatric SCA, defined as the abrupt and unexpected loss of heart function, remains a concern to all. The goal of this statement is to increase the knowledge of pediatricians (including primary care providers and specialists) of the incidence of pediatric SCA, the spectrum of causes of pediatric SCA, disease-specific presentations, the role of patient and family screening, the rapidly evolving role of genetic testing, and finally, important aspects of secondary SCA prevention. This statement is not intended to address sudden infant death syndrome or sudden unexplained death syndrome, nor will specific treatment of individual cardiac conditions be discussed. This statement has been endorsed by the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society.
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Kovach J, Berger S. Automated external defibrillators and secondary prevention of sudden cardiac death among children and adolescents. Pediatr Cardiol 2012; 33:402-6. [PMID: 22302278 DOI: 10.1007/s00246-012-0158-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 08/16/2011] [Indexed: 11/30/2022]
Abstract
Sudden cardiac death is devastating at any age, but it is especially so among children and adolescents. This report discusses the outcomes for patients with out-of hospital cardiac arrest (OHCA) and describes public access defibrillation programs in general and those directed at children and adolescents. In addition, the relatively new concept of cardiopulmonary resuscitation (CPR)–automated external defibrillator (AED) programs directed at schools is discussed. Although limited data are available, some of the preliminary data suggest improved OHCA outcomes associated with CPR-AED programs implemented in schools. These early data provide hope for the future potential reduction in the incidence of sudden cardiac deaths in the school setting, not only among children and adolescents, but also among adults.
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Affiliation(s)
- Joshua Kovach
- The Herma Heart Center, Children’s Hospital of Wisconsin, The Medical College of Wisconsin, 9000 W. Wisconsin Ave, MS 713, Milwaukee, WI 53226, USA.
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Berger S. Automated external defibrillators utility, rational, and controversies. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 32 Suppl 2:S75-9. [PMID: 19602169 DOI: 10.1111/j.1540-8159.2009.02390.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Automated external defibrillators (AEDs) and their role in resuscitation has been documented in the adult population with the reported beneficial outcomes documented in multiple studies. Data for children are lacking because of the relatively small incidence of cardiac arrest in the pediatric population as well as the absence of randomized studies. There have been a few studies that have reviewed sudden cardiac arrest in the school setting as well the use and efficacy of AEDs. This article will review the data with regard to cardiac arrest in the school settings as well as the potential benefits of school CPR-AED programs. There are multiple criticisms and potential barriers of school CPR-AED programs. The specific criticisms will be addressed.
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Affiliation(s)
- Stuart Berger
- Pediatric Cardiology, The Herma Heart Center, Children's Hospital of Wisconsin, The Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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Berger S. Cardiopulmonary resuscitation – automated external defibrillation programs for children and adolescents: Is public access defibrillation directed at our youth justifiable? Paediatr Child Health 2009; 14:183-4. [DOI: 10.1093/pch/14.3.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2009] [Indexed: 11/12/2022] Open
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Drezner JA, Courson RW, Roberts WO, Mosesso VN, Link MS, Maron BJ. Inter Association Task Force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. PREHOSP EMERG CARE 2007; 11:253-71. [PMID: 17613898 DOI: 10.1080/10903120701204839] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assist high school and college athletic programs prepare for and respond to a sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA. BACKGROUND Sudden cardiac arrest is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes. RECOMMENDATIONS Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishing an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination, and integration of on-site responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.
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Abstract
BACKGROUND The purpose of the present study is to improve understanding of the epidemiology of cardiac arrest in the school setting, with a special focus on the role of school-based automated external defibrillators. METHODS AND RESULTS The investigation was a retrospective study of emergency medical service-treated, nontraumatic, out-of-hospital cardiac arrests in Seattle and King County, Washington, that occurred in schools between 1990 and 2005. Cases were identified with cardiac arrest location data from emergency medical service cardiac arrest registries. Patient characteristics, cardiac arrest characteristics, and outcome information were abstracted from the registries and incident report forms. During the study period, 97 cardiac arrests occurred in schools, accounting for 0.4% of all treated cardiac arrests and 2.6% of public location cardiac arrests. Of the 97 cases, 12 cardiac arrests were among students, 33 among faculty and staff, and 45 among adults not employed by the school (7 adults with indeterminate school association). School-based cardiac arrest occurred on average in 1 of 111 schools annually, with a greater annual incidence among colleges (1 cardiac arrest per 8 colleges) than high schools (1 per 125 high schools) or lower-level schools (1 cardiac arrest per 200 preschools through middle schools). The estimated annual incidence of cardiac arrest was 0.18 per 100,000 person-years among students and 4.51 per 100,000 person-years for school faculty and staff. CONCLUSIONS The present study characterizes school-setting cardiac arrest and provides a framework within which to consider preparation efforts and outcome expectations.
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Affiliation(s)
- Katayoun Lotfi
- Emergency Medical Services Division, Public Health Seattle and King County, 401 Fifth Ave, Suite 1200, Seattle, WA 98104, USA
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Rothmier JD, Drezner JA, Harmon KG. Automated external defibrillators in Washington State high schools. Br J Sports Med 2007; 41:301-5; discussion 305. [PMID: 17289857 PMCID: PMC2659060 DOI: 10.1136/bjsm.2006.032979] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2006] [Indexed: 11/04/2022]
Abstract
BACKGROUND The placement of automated external defibrillators (AEDs) in schools and public sporting venues is a growing national trend. OBJECTIVE To determine the prevalence and use of AEDs in Washington State high schools and to examine the existing emergency preparedness for sudden cardiac arrest (SCA). DESIGN Cross-sectional survey. SETTING High schools in Washington State. PARTICIPANTS The principal at each high school in the Washington Interscholastic Activities Association (n = 407) was invited to complete a web-based questionnaire using the National Registry for AED Use in Sports (http://www.AEDSPORTS.com). MAIN OUTCOME MEASUREMENTS The primary outcome measures studied included AED prevalence and location, funding for AEDs, AED training of school personnel, coordination of AED placement with local emergency response agencies, and prior AED use. RESULTS 118 schools completed the survey (29% response rate). 64 (54%) of the schools have at least one AED on school grounds (mean 1.6, range 1-4). The likelihood of AED placement increased with larger school size (p = 0.044). 60% of AEDs were funded by donations, 27% by the school district and 11% by the school or athletic department itself. Coaches (78%) were the most likely to receive AED training, followed by administrators (72%), school nurses (70%) and teachers (48%). Only 25% of schools coordinated the implementation of AEDs with an outside medical agency and only 6% of schools coordinated with the local emergency medical system. One school reported having used an AED previously to treat SCA in a basketball official who survived after a single shock. The estimated probability of AED use to treat SCA was 1 in 154 schools per year. CONCLUSIONS Over half of Washington State high schools have an AED on school grounds. AED use occurred in <1% of schools annually and was effective in the treatment of SCA. Funding of AED programmes was mostly through private donations, with little coordination with local emergency response teams. Significant improvement is needed in structuring emergency response plans and training targeted rescuers for an SCA in the high-school setting.
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Affiliation(s)
- Justin D Rothmier
- Department of Family Medicine, University of Washington, Seattle, WA 98105, USA
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Drezner JA, Courson RW, Roberts WO, Mosesso VN, Link MS, Maron BJ. Inter-Association Task Force Recommendations on Emergency Preparedness and Management of Sudden Cardiac Arrest in High School and College Athletic Programs: A Consensus Statement. Heart Rhythm 2007; 4:549-65. [DOI: 10.1016/j.hrthm.2007.02.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Indexed: 11/26/2022]
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Drezner JA, Courson RW, Roberts WO, Mosesso VN, Link MS, Maron BJ. Inter-association task force recommendations on emergency preparedness and management of sudden cardiac arrest in high school and college athletic programs: a consensus statement. Clin J Sport Med 2007; 17:87-103. [PMID: 17414476 DOI: 10.1097/jsm.0b013e3180415466] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assist high school and college athletic programs prepare for and respond to sudden cardiac arrest (SCA). This consensus statement summarizes our current understanding of SCA in young athletes, defines the necessary elements for emergency preparedness, and establishes uniform treatment protocols for the management of SCA. BACKGROUND SCA is the leading cause of death in young athletes. The increasing presence of and timely access to automated external defibrillators (AEDs) at sporting events provides a means of early defibrillation and the potential for effective secondary prevention of sudden cardiac death. An Inter-Association Task Force was sponsored by the National Athletic Trainers' Association to develop consensus recommendations on emergency preparedness and management of SCA in athletes. RECOMMENDATIONS Comprehensive emergency planning is needed for high school and college athletic programs to ensure an efficient and structured response to SCA. Essential elements of an emergency action plan include establishing an effective communication system, training of anticipated responders in cardiopulmonary resuscitation and AED use, access to an AED for early defibrillation, acquisition of necessary emergency equipment, coordination and integration of onsite responder and AED programs with the local emergency medical services system, and practice and review of the response plan. Prompt recognition of SCA, early activation of the emergency medical services system, the presence of a trained rescuer to initiate cardiopulmonary resuscitation, and access to early defibrillation are critical in the management of SCA. In any collapsed and unresponsive athlete, SCA should be suspected and an AED applied as soon as possible for rhythm analysis and defibrillation if indicated.
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Fleischhackl R, Foitik G, Czech G, Roessler B, Mittlboeck M, Domanovits H, Hoerauf K. Reaching the public via a multi media campaign as a first step to nationwide public access defibrillation. Resuscitation 2006; 69:269-75. [PMID: 16631300 DOI: 10.1016/j.resuscitation.2005.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Revised: 07/18/2005] [Accepted: 07/27/2005] [Indexed: 10/24/2022]
Abstract
Public access defibrillation (PAD) is a promising strategy to fight sudden cardiac death. The Austrian Red Cross provided automated external defibrillators (AEDs) and basic life support (BLS) training as an "all inclusive package" combined with on site consultation and maintenance with annual retraining as a part of a nationwide PAD programme. A multi media campaign was started to promote the package and to increase awareness about sudden cardiac death. Data about the campaign, its recognition by the public in Austria and the number of packages were recorded. Sixty-eight percent of the Austrian public above the age of 15 years were able to recall the multi media campaign. Comparing the periods before and after the campaign, the number of website hits climbed significantly from 2,931 hits/month (1,866-6,168) to 4,812 hits/month (3,432-13,434) (p=0.0276). The number of AED services implemented before the campaign increased significantly (p=0.0026) in the time after the campaign. Therefore, we conclude that a multi media campaign is useful to stimulate public discussion and it encourages companies to buy "all inclusive packages" containing AEDs, BLS training, on site consultation and maintenance. These measures represent a possible first step in introducing PAD but it seems that they have to be continued on a constant basis.
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Flores G, Abreu M, Chaisson CE, Meyers A, Sachdeva RC, Fernandez H, Francisco P, Diaz B, Diaz AM, Santos-Guerrero I. A randomized, controlled trial of the effectiveness of community-based case management in insuring uninsured Latino children. Pediatrics 2005; 116:1433-41. [PMID: 16322168 DOI: 10.1542/peds.2005-0786] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. OBJECTIVE To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. DESIGN Randomized, controlled trial conducted from May 2002 to August 2004. SETTING AND PARTICIPANTS A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. INTERVENTION Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. MAIN OUTCOME MEASURES Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. RESULTS One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had approximately 8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. CONCLUSIONS Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations.
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Affiliation(s)
- Glenn Flores
- Center for the Advancement of Underserved Children, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Abstract
This article focuses on sudden unexpected cardiac death (SCD) in children and adolescents. The authors discuss the epidemiology of SCD in children and adolescents, its incidence and etiologies, and strategies for prevention. Because most of the episodes of SCD or sudden cardiac arrest in children and adolescents occur in asymptomatic individuals unknown to have an underlying abnormality before their "event," the issues in this article primarily focus on this group of individuals.
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Affiliation(s)
- Stuart Berger
- Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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