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Automated External Defibrillators (automate + external_defibrillator)

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Medical Sciences	100%

Selected Abstracts

Safety aspects for public access defibrillation using automated external defibrillators near high-voltage power lines

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2004
C. J. Schlimp
Background:, Automated external defibrillators (AEDs) must combine easy operability and high-quality diagnosis even under unfavorable conditions. This study determined the influence of electromagnetic interference caused by high-voltage power lines with 16.7-Hz alternating current on the quality of AEDs' rhythm analysis. Methods:, Two AEDs frequently used in Austria were tested near high-voltage power lines (15 kV or 110 kV, alternating current with 16.7 Hz). The defibrillation electrodes were attached either to a proband with true sinus rhythm or to a resuscitation dummy with generated sinus rhythm, ventricular fibrillation, ventricular tachycardia or asystole. Results:, Electromagnetic interference was much more prominent in a human's than in a dummy's electrocardiogram and depended on the position of the electrodes and cables in relation to the power line. Near high-voltage power lines the AEDs showed a significant operational fault. One AED interpreted the interference as a motion artifact, even when underlying rhythms were clearly detectable. The other AED interpreted 16.7-Hz oscillation as ventricular fibrillation with consequent shock advice when no underlying rhythm was detected. Conclusion:, The tested AEDs neither filter nor recognize a technical interference of 16.7 Hz caused by 15-kV power lines above railway tracks or 110-kV overland power lines, as run by railway companies in Austria, Germany, Norway, Sweden and Switzerland. These failures in AEDs' algorithms for rhythm analysis may cause substantial harm to patients undergoing public access defibrillation. The proper function of AEDs needs to be reconsidered to guarantee patients' safety near high-voltage power lines. [source]

Can Untrained Laypersons Use a Defibrillator with Dispatcher Assistance?

ACADEMIC EMERGENCY MEDICINE, Issue 7 2007
Heini Harve MD
Objectives:Automated external defibrillators (AEDs) provide an opportunity to improve survival in out-of-hospital cardiac arrest by enabling laypersons not trained in rhythm recognition to deliver lifesaving therapy. This study was performed to examine whether untrained laypersons could safely and effectively use these AEDs with telephone-guided instructions and if this action would compromise the performance of cardiopulmonary resuscitation (CPR) during a simulated ventricular fibrillation out-of-hospital cardiac arrest. Methods:Fifty-four conscripts without previous medical education were recruited from the Western Command in Finland. For this study, the participants were divided at random to form teams of two persons. The teams were randomized to dispatcher-assisted CPR with or without AED operation during a simulated ventricular fibrillation out-of-hospital cardiac arrest. The time interval from collapse to first shock, hands-off time, and the quality of CPR were compared between the two groups. Results:The quality of CPR was poor in both groups. The use of an AED did not increase the hands-off time or the time interval to the first compression. Sixty-four percent of the teams in the AED group managed to give the first defibrillatory shock within 5 minutes. Conclusions:The quality of dispatcher-assisted CPR is poor. Dispatcher assistance in defibrillation by a layperson not trained to use an AED seems feasible and does not compromise the performance of CPR. [source]

The Effectiveness and Cost Effectiveness of Public-Access Defibrillation

CLINICAL CARDIOLOGY, Issue 7 2010
Roger A. Winkle MD
Many sudden cardiac deaths are due to ventricular fibrillation (VF). The use of defibrillators in hospitals or by outpatient emergency medical services (EMS) personnel can save many cardiac-arrest victims. Automated external defibrillators (AEDs) permit defibrillation by trained first responders and laypersons. AEDs are available at most public venues, and vast sums of money are spent installing and maintaining these devices. AEDs have been evaluated in a variety of public and private settings. AEDs accurately identify malignant ventricular tachyarrhythmias and frequently result in successful defibrillation. Prompt application of an AED shows a greater number of patients in VF compared with initial rhythms documented by later-arriving EMS personnel. Survival is greatest when the AED is placed within 3 to 5 minutes of a witnessed collapse. Community-based studies show increased cardiac-arrest survival when first responders are equipped with AEDs rather than waiting for paramedics to defibrillate. Wide dissemination of AEDs throughout a community increases survival from cardiac arrest when the AED is used; however, the AEDs are utilized in a very small percentage of all out-of-hospital cardiac arrests. AEDs save very few lives in residential units such as private homes or apartment complexes. AEDs are cost effective at sites where there is a high density of both potential victims and resuscitators. Placement at golf courses, health clubs, and similar venues is not cost effective; however, the visible devices are good for public awareness of the problem of sudden cardiac death and provide reassurance to patrons. Copyright © 2010 Wiley Periodicals, Inc. [source]

Topics of Special Interest in an Emergency Medicine Course for Dental Practice Teams

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2004
S. Weber
Considering increasing life expectancy and population comorbitity, not only dentists but also nursing staff should gain knowledge and skills in treatment of patients in acute life-threatening situations. In cooperation with the State Dental Council, a 1-day course in the management of medical emergencies based on the ERC ALS guidelines was held for primary care dental practice teams. Following a short lecture series (2 hours), a systematic skills-training session (6 hours) was performed in small groups, addressing the following subjects: BLS, airway management and ventilation, intravenous techniques, manual and automated external defibrillation, ALS and resuscitation routine in a typical dental practice setting. For all skills-training sessions, life-like manikins and models were utilized and the emergency scenarios were simulated by the use of a universal patient simulator (SimMan®, MPL/Laerdal). At the end of the course, an evaluation questionnaire was completed by all candidates to find out in which emergency situations the dental practice teams now felt well trained or incompetent. In the first course with 32 participants, 13 were dentists and 19 were dental nurses. In the evaluation results, 53% of both, dentists and nurses, stated to be competent in cardiac arrest situations. 95% of the nurses, but only 69% of the dentists, thought that an automated external defibrillator should be available in the dental practice. 26% of the dentists felt unable to treat patients with anaphylactic reactions adequately, whereas 37% of the nurses felt incompetent in respiratory emergencies. [source]

Prospective Clinical Trial, DEFI 2005: Does an AED Algorithm with More CPR Impact Out-of-Hospital Cardiac Arrest Prognosis?

ACADEMIC EMERGENCY MEDICINE, Issue 2008
Herve Degrange
Background:, Level 1 evidence is lacking for the Guidelines 2005 recommended changes in CPR and automated external defibrillator (AED) protocols. Objectives:, We conducted a block-randomized controlled trial to evaluate if changes to CPR during AED use could improve return of spontaneous circulation (ROSC) and hospital admission rates. Methods:, From September 2005 to March 2007, 200 biphasic LIFEPAKs, 500 AEDs, used by firefighters, were randomized every 2 months by fire station (clinicaltrials.gov NCT00139542). The 100 CONTROL AEDs conformed to Guidelines 2000. The 100 STUDY AEDs added pre-shock CPR and removed stacked shocks and post-shock pulse checks. In both groups, firefighters received weekly CPR training. ECG and impedance signals recorded by AEDs were reviewed to quantify CPR delivery. Median [interquartile range], *p < 0.05. Results:, Informed consent was obtained for 840 defibrillated patients (420 CONTROL vs. 420 STUDY). There were no differences in patient characteristics (age, sex, location, etiology, witnessed, bystander CPR, chest compression (CC) rate) and time from call to AED power on. The STUDY AEDs prompted for more CPR during AED use (81% [80, 83] vs. 62% [55, 67]*), resulting in more hands-on time (62% [54, 69] vs 49% [39, 57]*), more patients receiving only one shock (40 vs 33%*), and shorter pauses in CC before (9s [7, 13] vs 19s [16, 21]*) and after (11s [8, 14] vs 32s [26, 38]*) the shock. There was no difference in the rates of ROSC (48% [44, 53] vs 50% [45, 55], p = 0.63) and hospital admission (44% [40, 49] vs 45% [40, 49], p = 0.94) for the STUDY vs CONTROL groups. Conclusions:, Increasing CPR, shortening CC pauses and delivering fewer shocks resulted in no observed difference in ROSC or survival to hospital admission. The overall rate of hospitalization was higher than the historical expectation (34% hospital admission before study), possibly due to the increased emphasis on training and importance of CPR in both groups. [source]

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

ACADEMIC EMERGENCY MEDICINE, Issue 4 2003
Craig B. Key MD
Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A before-and-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n= 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p = 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p < 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p < 0.0001). Among the 9-1-1 D/Cs with FRs only (n= 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents. [source]

Safety aspects for public access defibrillation using automated external defibrillators near high-voltage power lines

Implantable cardioverter defibrillators for prevention of sudden cardiac Death

CLINICAL CARDIOLOGY, Issue 1 2007
Rishi Sukhija M.D.
Abstract Despite the multiple advances in the field of cardiovascular medicine, the incidence of sudden cardiac death (SCD) continues to rise. Of all SCDs, <25% occur in individuals deemed at high risk by current risk-stratification algorithms; hence, these risk-stratification algorithms are not satisfactory. Until better markers are identified to risk stratify patients, we will see an increasing use of implantable cardioverter defibrillators (ICDs). However, even with the increase in defibrillator use, the impact on overall incidence of SCD may only be modest, as many individuals experience SCD as the first manifestation of cardiovascular disease. Another important challenge is widespread availability of automated external defibrillators and effective utilization of public access defibrillation programs for timely and appropriate management of out-of-hospital victims with cardiac arrest. This review discusses the current understanding on SCD, risk stratification, and management aimed at reducing SCD, particularly with the use of ICDs. Copyright © 2007 John Wiley & Sons, Ltd. [source]