Automated external defibrillators and the link to first responder systems

Mobile applications enhance out-of-hospital cardiac arrest outcomes: a systematic review and meta-analysis

INTRODUCTION

Mobile applications, as innovative tools for promoting bystander cardiopulmonary resuscitation (CPR), have demonstrated potential to improve outcomes for patients experiencing out-of-hospital cardiac arrest (OHCA). This meta-analysis sought to systematically review the technical features of existing mobile applications and evaluate their impact on OHCA patient outcomes under various emergency response strategies. The findings aimed to guide the development and optimization of prehospital public emergency response systems.

METHODS

A systematic search was conducted in databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Scientific Journals Database (VIP), SinoMed, PubMed, Embase, Web of Science, and the Cochrane Library, from inception to August 2023. The included studies involved notifying citizens via text messages or smartphone applications to act as first responders or volunteers in OHCA cases. Using a random effects model and subgroup analysis, we synthesized the results to identify sources of heterogeneity and assess outcomes.

RESULTS

Thirteen mobile applications were included, with an average activation rate of 35.3% among patients and a volunteer arrival rate of 53.3%. Compared to traditional emergency medical services, mobile applications significantly improved survival to discharge or 30-day survival rates (RR = 1.34, 95% CI: 1.24-1.44; P < 0.05), return of spontaneous circulation (ROSC) rates upon hospital admission (RR = 1.23, 95% CI: 1.09-1.40; P < 0.05), bystander CPR rates (RR = 1.25, 95% CI: 1.13-1.37; P < 0.05), and bystander defibrillation rates (RR = 1.23, 95% CI: 1.00-1.51; P = 0.05). Subgroup analyses revealed consistent results for bystander CPR rates and survival outcomes, while variations in defibrillation rates and ROSC at admission were observed, indicating potential influences of application design and operational parameters.

CONCLUSIONS

This study highlighted the significant potential of mobile applications in enhancing bystander interventions and improving patient outcomes. Addressing challenges such as improving access to automated external defibrillators and raising public awareness remained essential to maximizing their overall effectiveness. PROSPERO REGISTRATION NUMBER: CRD42023477676.

Cardiac arrest: Pre-hospital strategies to facilitate successful resuscitation and improve recovery rates

The estimated annual incidence of out-of-hospital cardiac arrest (OHCA) is approximately 120 cases per 100000 inhabitants in western countries. Although the rates of bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillator are increasing, the likelihood of survival to hospital discharge is no more than 8%. To date, various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients. The aim of this review is to discuss strategies that facilitate resuscitation, increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the pre-hospital setting.

Improving preparedness for time critical prehospital care: a descriptive study of the first responder system in Central Norway

BACKGROUND

First responders exist in several countries and have been a prehospital emergency medical resource in Norwegian municipalities since 2010. However, the Norwegian system has not yet been studied. The aim of this study was to describe the first responder system in Central Norway and how it is used as a supplement to emergency medical services (EMS).

METHODS

We described incidents with dispatch of first responders in the catchment area of the Emergency Medical Communication Center of Sør-Trøndelag in Central Norway, using retrospective data recorded in the Norwegian Emergency Medical Information System between 2019 and 2023.

RESULTS

First responders were dispatched to 460 incidents during the period. Of these, 441/460 (96%) incidents were assessed as "acute", and 135/460 (29%) were assessed as possible cardiac arrests. Four large rural municipalities accounted for 234/460 (51%) of the incidents. One in four patients, 112/449 (25%), died within 30 days. EMS had a median response time of 29 min in our sample.

CONCLUSION

First responders are almost exclusively dispatched to high-severity incidents, with suspected cardiac arrest being the most common dispatch criteria. Our findings suggest that the first responder system contributes to rapid response in cases of acute illness and injury, especially in rural areas.

Challenges & barriers for real-time integration of drones in emergency cardiac care: Lessons from the United States, Sweden, & Canada

Importance

Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality in the US and Europe (∼600,000 incident events annually) and around the world (∼3.8 million). With every minute that passes without cardiopulmonary resuscitation or defibrillation, the probability of survival decreases by 10%. Preliminary studies suggest that uncrewed aircraft systems, also known as drones, can deliver automated external defibrillators (AEDs) to OHCA victims faster than ground transport and potentially save lives.

Objective

To date, the United States (US), Sweden, and Canada have made significant contributions to the knowledge base regarding AED-equipped drones. The purpose of this Special Communication is to explore the challenges and facilitators impacting the progress of AED-equipped drone integration into emergency medicine research and applications in the US, Sweden, and Canada. We also explore opportunities to propel this innovative and important research forward.

Evidence review

In this narrative review, we summarize the AED-drone research to date from the US, Sweden, and Canada, including the first drone-assisted delivery of an AED to an OHCA. Further, we compare the research environment, emergency medical systems, and aviation regulatory environment in each country as they apply to OHCA, AEDs, and drones. Finally, we provide recommendations for advancing research and implementation of AED-drone technology into emergency care.

Findings

The rates that drone technologies have been integrated into both research and real-life emergency care in each country varies considerably. Based on current research, there is significant potential in incorporating AED-equipped drones into the chain of survival for OHCA emergency response. Comparing the different environments and systems in each country revealed ways that each can serve as a facilitator or barrier to future AED-drone research.

Conclusions and relevance

The US, Sweden, and Canada each offers different challenges and opportunities in this field of research. Together, the international community can learn from one another to optimize integration of AED-equipped drones into emergency systems of care.

Evaluation of functional and electrical features of automatic external defibrillators in extreme altitude and temperature environments

Aims

Human exposure to high-altitude and/or low-temperature areas is increasing and cardiac arrest in these circumstances represents an increasing proportion of all treated cardiac arrests. However, little is known about the performance of automated external defibrillators (AED) in these circumstances. The objective of this study is to assess the functional and electrical features of 6 commercially available AEDs in extreme environments.

Methods

Accuracy of shockable rhythm detection, the time required for self-test, rhythm analysis, and capacitor charging, together with total energy, peak voltage, peak current, and phasic duration of defibrillation waveform measured after placing the AEDs in simulated high-altitude, simulated low-temperature, and natural composite high-altitude and low-temperature environment for 30 min, were compared to those measured in the standard environment.

Results

All of the shockable rhythms were correctly detected and all of the defibrillation shocks were successfully delivered by the AEDs. However, the time required for self-test, rhythm detection, and capacitor charging was shortened by 1.2% (3 AEDs, maximum 12.4%) in the simulated high-altitude environment, was prolonged by 3.6% (4 AEDs, maximum 40.8%) in the simulated low-temperature environment, and was prolonged by 4.1% (5 AEDs, maximum 52.1%) in the natural environment. Additionally, the total delivered energy was decreased by 2.5% (2 AEDs, maximum 6.8%) in the natural environment.

Conclusion

All of the investigated AEDs functioned properly in simulated and natural environments, but a large variation in the functional and electrical feature change was observed. When performing cardiopulmonary resuscitation in extreme environments, the impact of environmental factors may need consideration.