BackgroundPublic access defibrillators (PADs) represent unique life-saving medical devices as they may be used by untrained lay rescuers. Collecting representative clinical data on these devices can be challenging. Here, we present results from a retrospective observational cohort study, describing real-world PAD utilisation over a 5-year period.MethodsData were collected between October 2012 and October 2017. Responders voluntarily submitted electronic data downloaded from HeartSine PADs, and patient demographics and other details using a case report form in exchange for a replacement battery and electrode pack.ResultsData were collected for 977 patients (692 males, 70.8%; 255 females, 26.1%; 30 unknown, 3.1%). The mean age (SD) was 59 (18) years (range <1 year to 101 years). PAD usage occurred most commonly in homes (n=328, 33.6%), followed by public places (n=307, 31.4%) and medical facilities (n=128, 13.1%). Location was unknown in 40 (4.09%) events. Shocks were delivered to 354 patients. First shock success was 312 of 350 patients where it could be determined (89.1%, 95% CI 85.4% to 92.2%). Patients with reported response times ≤5 min were more likely to survive to hospital admission (89/296 (30.1%) vs 40/250 (16.0%), p<0.001). Response time was unknown for 431 events.ConclusionThis is the first study to report global PAD usage in voluntarily submitted, unselected real-world cases and demonstrates the real-world effectiveness of PADs, as confirmed by first shock success.
Introduction: Refractory VF, which is defined as fibrillation that persists after three or more shocks, has been reported to occur in 20% of VF presenting cardiac arrest patients. This analysis was conducted to assess the frequency of shock resistant VF, during OHCA treated with a public access defibrillator (PAD). Methods: Heartsine Samaritan PAD post-market data collected between October 2012 to January 2021 were analyzed; electrocardiography (ECG) is recorded by the PAD and is assessed for shockability immediately after detecting patient impedance and then following each 2-minute period of CPR. Shock success (SS) was determined for each shock. SS was defined as one in which the initial shockable arrhythmia was terminated for at least five seconds. A consecutive shock was defined as a shock delivered after the first analysis mode following a previous shock. Results: Data was analyzed for 1082 patients who received at least one shock during OHCA. First shock success (FSS) was 88.2% (862/977 assessable shocks). At least three consecutive shocks were delivered in 207/1082 (19.1%) patients. Three patients (3/207, 1.4%) had two unsuccessful shocks followed by termination of VF on the third shock. A further thirteen (13/204, 6.4%) patients had VF which was resistant to defibrillation (i.e., three or more consecutive failed shocks with no observed successful shock). In the remaining 191 patients at least one of the three consecutive shocks was successful, or shock success could not be determined. Conclusion: The prevalence of shock resistant VF for OHCA treated with a PAD is much lower (6.4%) than published data. This low prevalence is in part due to the high FSS observed resulting in reduction in the number of possible shock resistant cases.
Introduction: AEDs often utilize specific modes for treating pediatric patients, enabling reduced energy defibrillation and pediatric specific guidance on performing CPR. If a pediatric mode is not available, current guidelines recommend use of adult mode. It is not fully understood if delivery of adult mode shocks or CPR results in cardiac damage in children. The aim of this pilot study was to observe the effects of delivering either adult shocks or CPR during sinus rhythm in pediatric weight swine. Methods: Six anesthetized swine (10-12 kg) were studied. Four received three adult unsynchronized shocks (150-150-200 Joules) (HeartSine, UK) without induction of VF to isolate the effect of shocks alone. Two received three, two-minute episodes of CPR. A Philips MRx (Philips, USA) recorded CPR depth. ST-segment deviation was recorded before shocks and at 10-seconds and 60-seconds post-shock. Animals then entered a 4-hour monitoring period were blood samples and echocardiographic images were taken at +2 hours and +4 hours. Results: No shock (0/12) or episode of CPR (0/6) delivered during sinus rhythm resulted in conversion to an arrest rhythm. CPR was delivered at depths between 21 and 39 mm. There was no significant change in ST-segment deviation, cardiac troponin I, creatine phosphokinase or left ventricular ejection fraction from baseline values for either group (Table 1). Additionally, there were no significant differences between the two groups for any endpoint. Conclusions: Neither adult energy shocks nor CPR delivered to pediatric weight pigs resulted in significant adverse effects by any metric analyzed. This suggests that application of adult shock energies and CPR without experimental confounders (e.g. ischemia, metabolic disturbance) does not result in significant myocardial damage in this model of pediatric resuscitation. Future studies should investigate the effect of guideline depth CPR in this model. Note: this is a pilot study with a limited sample size.
Introduction: Previous analysis of emergency medical services manual defibrillator recordings suggests that the proportion of patients with initial shockable rhythms during out-of-hospital cardiac arrest is decreasing over time. This analysis aims to determine if this decline also occurs in public access defibrillator data. Methods: Worldwide post-market data from HeartSine SAM PAD public access defibrillators was collected between 2012 and 2022. Presence of an initial shockable rhythm (ventricular fibrillation or ventricular tachycardia) was determined by the device algorithm decision and clinical overread. The proportion of patients who presented an initial shockable rhythm each year was calculated. Data was analysed using Minitab. Summary statistics were calculated for patient age and gender, and a logistic regression model was used to examine the proportion of initial shockable rhythm over time. Results: A total of 5404 patient events were collected. Seventy-four percent were male, and mean (SD) age was 61.2 (18.2) years. Proportion of initial shockable rhythm as a response to year was assessed, and occurrence of shockable rhythms decreased by approximately 6% per year [OR: 0.94, 95%CI (0.91, 0.96), p<0.001]. Conclusion: In line with findings from emergency service resuscitation attempts, the proportion of initial shockable rhythms in patients treated with a public access defibrillator declined over a ten-year period.
Introduction: As outlined by the Chain of Survival, effective cardiopulmonary resuscitation (CPR) and rapid defibrillation are vital to improve survival from sudden cardiac arrest (SCA). Placement of public access defibrillators (PADs) is becoming more common in public spaces, and they are more frequently used by untrained lay-users. The objective of this analysis was to assess the effect of CPR prior to defibrillation, and the success of PAD usage in terms of first shock success and survival to hospital admission. Methods: This dataset was composed of voluntarily submitted demographic information and electronic PAD files collected from October 2012 - June 2018. Summary statistics were calculated, and proportions were determined with 95% confidence intervals (CI) where appropriate. The association between CPR prior to defibrillation and survival was investigated by fitting a logistical model with survival as the dependent variable and CPR as covariate. Results: A total of 2812 PAD events were analyzed. Mean (SD) patient age was 61 (19) years and males comprised 72.5% (1922 of 2650 events where gender was known) of the events reported. The most common locations of SCA were the home (1039, 36.9%), public (719, 25.6%) and medical facility (328, 11.7%). Median (IQR) time to PAD delivery was 5 (3, 11) minutes. Ventricular fibrillation or tachycardia was present in 1010 (35.9%) patients, and 979 received a shock, with 87.2% (95%CI [85.0%, 89.3%]) achieving first shock success. Of the 849 shockable patients for whom survival was known, 565 (66.5%, (95%CI [63.3%, 69.7%]) survived to hospital admission. Survival outcome was known for 2150 patients, and 681 (31.7%, 95%CI [29.7%, 33.69%]) survived to hospital admission. A total of 1649 (58.6%) SCAs were witnessed and 1293 (78.4%) patients received bystander CPR prior to defibrillation. Bystander CPR prior to defibrillation was significantly associated with survival to hospital admission (OR = 2.17, 95%CI [1.69, 2.81], p<0.001). Conclusion: These results suggest that CPR application prior to application of a PAD significantly increases a patient’s chances of surviving to hospital admission. This study did not assess CPR quality, but it is intuitive that good quality CPR would align with higher survival outcomes.
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