Public access defibrillation remains out of reach for most victims of out-of-hospital sudden cardiac arrest

Abstract

IntroductionPublic access defibrillation (PAD) prior to ambulance arrival is a key determinant of survival from out-of-hospital (OOH) cardiac arrest. Implementation of PAD has been underway in the UK for the past 12 years, and its importance in strengthening the chain of survival has been recognised in the government's recent ‘Cardiovascular Disease Outcomes Strategy’. The extent of use of PAD in OOH cardiac arrests in the UK is unknown. We surveyed all OOH cardiac arrests in Hampshire over a 12-month period to ascertain the availability and effective use of PAD.MethodsA retrospective review of all patients with OOH cardiac arrest attended by South Central Ambulance Service (SCAS) in Hampshire during a 1-year period (1 September 2011 to 31 August 2012) was undertaken. Emergency calls were reviewed to establish the known presence of a PAD. Additionally, a review of all known PAD locations in Hampshire was undertaken, together with a survey of public areas where a PAD may be expected to be located.ResultsThe current population of Hampshire is estimated to be 1.76 million. During the study period, 673 known PADs were located in 278 Hampshire locations. Of all calls confirmed as cardiac arrest (n=1035), the caller reported access to an automated external defibrillator (AED) on 44 occasions (4.25%), successfully retrieving and using the AED before arrival of the ambulance on only 18 occasions (1.74%).ConclusionsDespite several campaigns to raise public awareness and make PADs more available, many public areas have no recorded AED available, and in those where an AED was available it was only used in a minority of cases by members of the public before arrival of the ambulance. Overall, a PAD was only deployed successfully in 1.74% OOH cardiac arrests. This weak link in the chain of survival contributes to the poor survival rate from OOH cardiac arrest and needs strengthening.

Inaccurate treatment decisions of automated external defibrillators used by emergency medical services personnel: Incidence, cause and impact on outcome

“…[19][20][21][22][23][24] Only via critical analysis of prospectively registered data, results may improve and costs may represent good value for (public) money. Second, device malfunctions occasionally occur and should be detected in a timely fashion by post-market surveillance.…”

Can tablets be used as a simulator for automated external defibrillation during cardiopulmonary resuscitation courses?

“…(2,3) Public access defibrillation (PAD) programmes have been established to empower bystanders to deliver early defibrillation, but have so far produced ambivalent results. (3)(4)(5) Although the evidence to support the benefits of public access automated external defibrillators (AEDs) is strong, (3,(5)(6)(7) unfortunately these lifesaving devices are often used only in a minority of SCA cases, even in areas where they are readily available. (4,7) Education of the public is one of the crucial factors to increase awareness, willingness and knowledge to use AEDs.…”

Public Access Defibrillation Programs: Improving Outcomes Worldwide

“…Studies show that PAD programs in railways, casinos, and airports in the United States, Europe, and Japan have improved survival in patients with OHCA 3, 4, 5, 6, 7. Despite this, a study showed that PAD was deployed successfully in less than 2% of OHCA, suggesting that there are still areas that can improve their access and deployment of PAD 8. All of the studies of PAD programs have been in the United States, Europe, and Japan.…”