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- Ringh, M, et al.
(författare)
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The challenges and possibilities of public access defibrillation.
- 2018
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 283:3, s. 238-256
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Tidskriftsartikel (refereegranskat)abstract
- Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.
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| 2. |
- Fredman, D., et al.
(författare)
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Expanding the first link in the chain of survival – Experiences from dispatcher referral of callers to AED locations
- 2016
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Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 107, s. 129-134
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Early use of automated external defibrillators (AED) increases survival in cases of out-of-hospital cardiac arrest (OHCA). Dispatchers play important roles in identifying OHCA, dispatching ambulances and providing callers with telephone-assisted cardiopulmonary resuscitation. Guidelines recommend that AED registries be linked to dispatch centres as tools to refer callers to nearby AED. Aim The aim of this study was to investigate to what extent dispatchers, when provided with a tool to display AED locations and accessibility, referred callers to nearby AED. Methods An application providing real-time visualization of AED locations and accessibility was implemented at four dispatch centres in Sweden. Dispatchers were instructed to refer callers to nearby AED when OHCA was suspected. Such cases were prospectively collected, and geographic information systems were used to identify those located ≤100 m from an AED. Audio recordings of emergency calls were assessed to evaluate the AED referral rate. Results Between February and August 2014, 3009 suspected OHCA calls were received. In 6.6% of those calls (200/3009), an AED was ≤100 m from the suspected OHCA. The AED was accessible and the caller was not alone on scene in 24% (47/200) of these cases. In two of those 47 cases (4.3%), the dispatcher referred the caller to the AED. Conclusion Despite a tool for dispatchers to refer callers to a nearby AED, referral was rare. Only a minority of the suspected OHCA cases occurred ≤100 m from an AED. We identified AED accessibility and callers being alone on scene as obstacles for AED referral.
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- Nordberg, P, et al.
(författare)
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The implementation of a dual dispatch system in out-of--hospital cardiac arrest is associated withimproved short and long term survival
- 2014
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Ingår i: European Heart Journal. - : SAGE Publications. - 2048-8726 .- 2048-8734. ; 3:4, s. 293-303
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To determine the impact of a dual dispatch system, using fire fighters as first responders, in out-of-hospital cardiac arrest (OHCA) on short (30 days) and long term (three years) survival, and, to investigate the potential differences regarding in-hospital factors and interventions between the patient groups, such as the use of therapeutic hypothermia and cardiac catheterization. METHODS AND RESULTS: OHCAs from 2004 (historical controls) and 2006-2009 (intervention period) were included. During the intervention period, fire fighters equipped with automated external defibrillators (AEDs) were dispatched in suspected OHCA. Logistic regression analyses of outcome data included: the intervention with dual dispatch, sex, age, location, aetiology, witnessed status, bystander-cardiopulmonary resuscitation, first rhythm and therapeutic hypothermia. In total, 2581 OHCAs were included (historical controls n=620, intervention period n=1961). Fire fighters initiated cardiopulmonary resuscitation and connected an AED before emergency medical services' arrival in 41% of the cases. The median time from dispatch to arrival of first responder or emergency medical services shortened from 7.7 in the control period to 6.7 min in the intervention period (p<0.001). The 30-day survival improved from 3.9% to 7.6% (p=0.001), adjusted odds ratio 2.8 (confidence interval 1.6-4.9). Survival to three years increased from 2.4% to 6.5% (p<0.001), adjusted odds ratio 3.8 (confidence interval 1.9-7.6). In the logistic regression analysis including in-hospital factors we found no outcome benefit of therapeutic hypothermia. CONCLUSIONS: The implementation of a dual dispatch system using fire fighters in OHCA was associated with increased 30-day and three-year survival. No major differences in the in-hospital treatment were seen between the studied patient groups.
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