Increasing first responder CPR during resuscitation of out-of-hospital cardiac arrest using automated external defibrillators

OBJECTIVE: Evidence supports that increasing the balance of "hands-on" CPR may improve survival in ventricular fibrillation out-of-hospital cardiac arrest (OHCA). We assessed whether training and/or AED reconfiguration was associated with an increase in the proportion of time during which CPR was performed between first and second stacks of shocks. METHODS: The investigation was a cohort study of 291 persons who suffered ventricular fibrillation OHCA and were treated with at least two stacks of AED shocks by emergency medical services (EMS) first-tier responders. In January 2003, first-tier providers were retrained regarding the importance of CPR. In addition, a subset of AEDs was reconfigured to remove continuous fibrillation detection and its associated voice prompts as to be comparable with other AED models. The amount of time spent on CPR was assessed through review of AED electronic and audio recordings to compare the pre-intervention (n = 241) and post-intervention periods (n = 50). RESULTS: The proportion of time spent performing hands-on CPR between first and second stacks of shocks was 0.40 in the pre-intervention period compared to 0.51 in the post-intervention period (p = 0.001). The difference was greatest for AEDs where EMS was retrained and the AED reconfigured (0.33 versus 0.50, p = 0.01). No difference in survival was detected between the pre- and post-intervention periods (24.9% versus 28.0%, p = 0.65). CONCLUSIONS: An intervention consisting of retraining and AED reconfiguration was associated with an increase in the proportion of time spent performing CPR between first and second stacks of shocks by first-tier EMS. Whether this increase improves patient outcomes requires additional study.     

High acceptance of a home AED programme by survivors of sudden cardiac arrest and their families

PURPOSE: The feasibility and acceptance of providing sudden cardiac arrest survivors with life supporting first aid training and automated external defibrillators (AEDs) at their homes is unknown. Preliminary experiences are reported here. METHODS: Trained medical students provided life supporting first aid courses including AED training to cardiac arrest survivors. Patients were asked to invite relatives and friends to such training sessions at their home. Laerdal Little Anne and Heartstart AED Trainer were used. An AED was placed at the patients' disposal. A refresher course took place 1 year later. Questionnaires were used to evaluate the project. RESULTS: Since 1999, 88 families have been trained and provided with an AED. Immediately after the training 90% (66% "agree", 24% "maybe yes") believed they would perform first aid correctly, 1 year later 98% did so (68% "agree", 29% "maybe yes") (p=0.03). Families considered feeling much safer having an AED at home. The handling of an AED was regarded to be easy and AEDs would even be used on strangers. Only on one occasion an AED was used in a real emergency situation. CONCLUSION: Providing patients and relatives with life support first aid and AED training at their homes is feasible and has raised no major objections by the family members. All have considered handling of an AED much simpler than providing basic life support and therefore none think that it would be a major problem to use it in case of an emergency. This still has to be proven.     

Adverse events associated with lay emergency response programs: the public access defibrillation trial experience

The adverse event (AE) profile of lay volunteer CPR and public access defibrillation (PAD) programs is unknown. We undertook to investigate the frequency, severity, and type of AE's occurring in widespread PAD implementation. DESIGN: A randomized-controlled clinical trial. SETTING: One thousand two hundred and sixty public and residential facilities in the US and Canada. PARTICIPANTS: On-site, volunteer, lay personnel trained in CPR only compared to CPR plus automated external defibrillators (AEDs). INTERVENTION: Persons experiencing possible cardiac arrest receiving lay volunteer first response with CPR+AED compared with CPR alone. MAIN OUTCOME MEASURE: An AE is defined as an event of significance that caused, or had the potential to cause, harm to a patient or volunteer, or a criminal act. AE data were collected prospectively. RESULTS: Twenty thousand three hundred and ninety six lay volunteers were trained in either CPR or CPR+AED. One thousand seven hundred and sixteen AEDs were placed in units randomized to the AED arm. There were 26,389 exposure months. Only 36 AE's were reported. There were two patient-related AEs: both patients experienced rib fractures. There were seven volunteer-related AE's: one had a muscle pull, four experienced significant emotional distress and two reported pressure by their employee to participate. There were 27 AED-related AEs: 17 episodes of theft involving 20 devices, three involved AEDs that were placed in locations inaccessible to the volunteer, four AEDs had mechanical problems not affecting patient safety, and three devices were improperly maintained by the facility. There were no inappropriate shocks and no failures to shock when indicated (95% upper bound for probability of inappropriate shock or failure to shock = 0.0012). CONCLUSIONS: AED use following widespread training of lay-persons in CPR and AED is generally safe for the volunteer and the patient. Lay volunteers may report significant, usually transient, emotional stress following response to a potential cardiac arrest. Within the context of this prospective, randomized multi-center study, AEDs have an exceptionally high safety profile when used by trained lay responders.     

Use of gabapentin for postherpetic neuralgia: results of two randomized, placebo-controlled studies

BACKGROUND: Postherpetic neuralgia (PHN), which affects up to 70% of elderly persons with herpes zoster, can have debilitating effects, including physical and social disability and significant psychological distress. A variety of agents have been used, either singly or in combination, to control PHN, including topical and oral analgesics, antidepressants, and antiepileptic drugs (AEDs). However, PHN often proves refractory to these therapies. OBJECTIVE: This article reviews available data on the use of the newer AED gabapentin for the control of PHN. METHODS: A MEDLINE search was undertaken to identify all randomized, placebo-controlled trials on the use of gabapentin in PHN. The search terms were gabapentin and postherpetic neuralgia. RESULTS: The literature search identified 2 published studies of the efficacy of gabapentin in a total of 563 patients with PHN that had persisted for at least 3 months after the healing of herpes zoster rash. The studies employed multiple outcome measures, including visual analog and Likert scales for pain intensity, and quality-of-life and functional measures that included the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and the Profile of Mood States. At maximum target dosages of 1800 to 3600 mg/d, gabapentin produced significant reductions in mean daily pain scores compared with placebo on both visual analog(P < 0.001) and Likert scales (P < 0.01). Improvements were also seen on the SF-36 subscales for physical functioning, bodily pain, vitality, and mental health(P < 0.01). CONCLUSION: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic PHN.     

CPR education in Japan--past, present and future

the last 7 years, more than 300,000 automated external defibrillators(AEDs) installed nationwide in Japan, and at least one AED has placed in 38,634 schools. Therefore, only 0.7% of bystanders used the AEDs(By-AED) in all OHCA cases with th 48 % of ROSC. In recent years, elementary and junior high school student has interested in AED results in each school has at least one AED. Therefore, introduction of CPR education starting from elementary school was extremely important. CPR education is not yet ubiquitous, and the promotion of AEDs and CPR education on a nationwide scale remains an urgent issue. Therefore, to solve this problem, we investigated the status of CPR education in schools teachers. We conducted surveys targeting for school teachers in Tokyo. Question; "What age do you think suitable for CPR training ?" Most of teachers answered"Suitable age for start CPR education from the upper grades of elementary school to a junior high school". Reason is, physically, continuous high quality chest compression could performed age of junior high. However, 'Importance of life' could teach from lower grade of elementary school because of child have a good long time memory. In this reason, CPR education is extremely important. Also teachers need 'more time', 'curriculum for CPR education and 'good CPR instruction tool for teaching'. The solution to teacher's request, we prepared follows. A 90 minutes hands only CPR curriculum should be introduced to elementary school CPR for basic CPR education. CPR +AED education should be started in lower grade of elementary school with AED trainer. In conclusion, school CPR programs are extremely important for awareness both in skill and knowledge of CPR among the entire school. Future research is warranted to improve the resuscitation rate by school CPR program.     

AED use in businesses, public facilities and homes by minimally trained first responders

BACKGROUND: Automated external defibrillators (AEDs) have become increasingly available outside of the Emergency Medical Systems (EMS) community to treat sudden cardiac arrest (SCA). We sought to study the use of AEDs in the home, businesses and other public settings by minimally trained first responders. The frequency of AED use, type of training offered to first responders, and outcomes of AED use were investigated. In addition, minimally trained responders were asked if they had encountered any safety problems associated with the AED. METHODS: We conducted a telephone survey of businesses and public facilities (2683) and homes (145) owning at least one AED for at least 12 months. Use was defined as an AED taken to a medical emergency thought to be a SCA, regardless of whether the AED was applied to the patient or identified a shockable rhythm. RESULTS: Of owners that participated in the survey, 13% (209/1581) of businesses and 5% (4/73) of homes had responded with the AED to a suspected cardiac arrest. Ninety-five percent of the businesses/public facilities offered training that specifically covered AED use. The rate of use for the AEDs was highest in residential buildings, public places, malls and recreational facilities with an overall usage rate of 11.6% per year. In-depth interviews were conducted with lay responders who had used the AED in a suspected cardiac arrest. In the four cases where the AED was used solely by a lay responder, all four patients survived to hospital admission and two were known to be discharged from the hospital. There were no reports of injury or harm. CONCLUSIONS: This survey demonstrates that AEDs purchased by businesses and homes were frequently taken to suspected cardiac arrests. Lay responders were able to successfully use the AEDs in emergency situations. Further, there were no reports of harm or injury to the operators, bystanders or patients from lay responder use of the AEDs.     

Is there any room for shortening hands-off time further when using an AED?

Background

Automated external defibrillators (AEDs) play a very important role in out-of-hospital cardiopulmonary resuscitation (CPR). The mandatory hands-off time imposed by current AEDs is not short enough to bring about the full benefits of rapid defibrillation with an AED into light. The aim of this study is to examine whether a change in the process of charging the capacity and removing explanations from the prompts of the AEDs shortens hands-off time.

Methods

The operating steps and the voice prompts of the current AEDs were reviewed and the time intervals between the steps and the voice prompts were measured. We modified an AED to fully precharge the capacitor and to contain more concise voice prompts.

Results

We had 42 expert rescuers and 50 lay-person rescuers perform 2-rescuer CPR with the modified AED and the old AED, respectively. Using the modified AED significantly reduced hands-off times by 9.95 s (95% CI: 9.67–10.23) in 2-rescuer CPR and by 10.68 s (95% CI: 9.75–11.61) in 1-rescuer CPR (p < 0.001).

Conclusion

Full precharging of the capacitor and exclusion of explanations from the voice prompts of AEDs can shorten the hands-off time in both 1 and 2-rescuer CPR.     

Public defibrillation: increased survival from a structured response system

The Public Access Defibrillation (PAD) trial was a prospective, randomized, controlled study designed to compare the number of persons surviving to hospital discharge after experiencing an out-of-hospital cardiac arrest (OOH-CA) among "community units" randomized to receive cardiopulmonary resuscitation (CPR) only or CPR plus an automated external defibrillator (AED). In 24 centers across the United States and Canada, 993 community units, composed of 1260 individual facilities, trained more than 19,000 layperson responders in CPR-only or CPR+AED. Survival to hospital discharge in the CPR+AED arm was double that of the CPR-only arm (30 vs 15, P = .03; RR = 2.0, 95% CI [1.07-3.77]). Intense focus on facility infrastructure, including responder recruitment and training, communication, evaluation, and oversight, was necessary for implementing the emergency response systems for the trial. Use of an AED within this structured response system can increase the number of survivors to hospital discharge after OOH-CA. Trained nonmedical responders can use AEDs safely and effectively.     

Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest

Background

Because out-of-hospital cardiac arrests (OHCAs) due to a major trauma rarely present with shockable rhythms, the potential benefits of using automated external defibrillators (AEDs) at the scene of traumatic OHCAs have not been examined.

Methods

We conducted an observational, retrospective cohort study using an Utstein-style analysis in Tainan city, Taiwan. The enrollees were adult patients with traumatic OHCAs accessed by emergency medical technicians (EMTs) from January 1, 2004 to December 31, 2010. The exposure was the use or non-use of AEDs at the scene, as determined by the clinical judgment of the EMTs. The primary outcome evaluated was a sustained (≥2 h) return of spontaneous circulation (ROSC), and the secondary outcomes were prehospital ROSC, overall ROSC, survival to hospital admission, survival at one month and favorable neurologic status at one month.

Results

A total of 424 patients (313 males) were enrolled, of whom 280 had AEDs applied, and 144 did not. Only 25 (5.9%) patients had received bystander cardiopulmonary resuscitation (CPR), and merely 21 (7.5%) patients in the AED group presented with shockable rhythms. Compared to the non-AED group, the primary and secondary outcomes of the AED group were not significantly different, except for a significantly lower prehospital ROSC rate (1.1% vs 4.9%, p < 0.05). Multivariate analysis showed no significant interactions between the use of AEDs and other key variables. Use of the AED was not associated with sustained ROSC (OR 1.33; 95% CI 0.75–2.38, p = 0.33).

Conclusions

In a community with a low prevalence of shockable rhythms and administration of bystander CPR in patients with traumatic OHCA, we found no significant differences in the sustained ROSC between the AED and the non-AED groups. Considering scene safety and the possible interruption of CPR, we do not encourage the routine use of AEDs at the scene of traumatic OHCAs.     

Attitudes of Law Enforcement Officers Regarding Automated External Defibrillators

OBJECTIVE: To assess the knowledge and attitudes of law enforcement officers regarding treating out-of-hospital cardiac arrest (OHCA) and using automated external defibrillators (AEDs). METHODS: This was a survey conducted among officers serving Marion County, Indiana. RESULTS: Of 1,130 surveys distributed, 929 (82.2%) were returned. Among these officers, 603 (66.4%) were certified in cardiopulmonary resuscitation (CPR) and 103 (11.3%) had received AED training. Most officers had limited knowledge regarding OHCA. A 100-point knowledge score (mean +/- SD: 31.9 +/- 14.3) was higher in officers who had performed CPR while on duty [35.0, 95% confidence interval (95% CI) = 32.9 to 37.2, p = 0.005] and who were AED-trained (40.8, 95% CI = 38.0 to 43.6, p < 0.001). Of the respondents, 367 (40.1%) believed that AED usage by local law enforcement was needed, and 323 (35.6%) stated that they would feel comfortable using an AED if trained. A 100-point attitude score (mean +/- SD: 32.1 +/- 21.0) was higher in officers who had CPR certification (38.2, 95% CI = 35.6 to 40.8), who had performed CPR while on duty (40.6, 95% CI = 37.7 to 43.5), who were AED-trained (39.5, 95% CI = 35.6 to 43.4), and who had improved OHCA knowledge (+3.8 per 10 points knowledge score, 95% CI = 3.0 to 4.7), p < 0.001, all significant factors. CONCLUSIONS: Limited knowledge and negative attitudes of law enforcement officers regarding their involvement in treating OHCA and using AEDs are commonly present. These factors could result in barriers that negatively impact law enforcement AED programs.     

Comparison of three instructional methods for teaching cardiopulmonary resuscitation and use of an automatic external defibrillator to high school students

OBJECTIVE: To evaluate new instructional methods for teaching high school students cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, actions and skills. METHODS: We conducted a cluster-controlled trial of 3 instructional interventions among Seattle area high school students, with random allocation based on classrooms, during 2003-04. We examined two new instructional methods: interactive-computer training and interactive-computer training plus instructor-led (hands-on) practice, and compared them with traditional classroom instruction that included video, teacher demonstration and instructor-led (hands-on) practice, and with a control group. We assessed CPR and AED knowledge, performance of key AED and CPR actions, and essential CPR ventilation and compressions skills 2 days and 2 months after training. All outcomes were transformed to a scale of 0-100%. RESULTS: For all outcome measures mean scores were higher in the instructional groups than in the control group. Two days after training all instructional groups had mean CPR and AED knowledge scores above 75%, with use of the computer program scores were above 80%. Mean scores for key AED actions were above 80% for all groups with training, with hands-on practice enhancing students' positive outcomes for AED pad placement. Students who received hands-on practice more successfully performed CPR actions than those in the computer program only group. In the 2 hands-on practice groups the scores for 3 of the outcomes ranged from 57 to 74%; they were 32 to 54% in the computer only group. For the outcome of continuing CPR until the AED was available scores were high, 89 to 100% in all 3 training groups. Mean CPR skill scores were low in all groups. The highest mean score for successful ventilations was 15% and for compressions, 29%. The pattern of results was similar after 2 months. CONCLUSIONS: We found evidence that interactive computer based self instruction alone was sufficient to teach CPR and AED knowledge and AED actions to high school students. All forms of instruction were highly effective in teaching AED use. In contrast to AED skills, CPR remains a set of difficult psychomotor skills that is challenging to teach to high school students as well as other members of the lay public.     

Cardiopulmonary resuscitation alone vs. cardiopulmonary resuscitation plus automated external defibrillator use by non-healthcare professionals: a meta-analysis on 1583 cases of out-of-hospital cardiac arrest

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) accounts for 250.000-350.000 sudden cardiac deaths per year in the United States. The availability of automated external defibrillators (AEDs) promoted the implementation of public access defibrillation programs based on out-of-hospital early defibrillation by non-healthcare professionals. AIM OF THE STUDY: To perform a systematic review and a meta-analysis of the pooled effect of studies comparing the outcome of pts receiving cardiopulmonary resuscitation plus AED therapy (CPR+AED) vs. cardiopulmonary resuscitation (CPR) alone, both delivered by non-healthcare professionals, for the treatment of OHCA. METHODS: We performed a search of the relevant literature exploring major scientific databases, carrying out a hand search of key journals, analysing conference proceedings and abstracts and discussing the topic with other researchers. Two analyses were planned to assess the outcomes of interest (survival to hospital admission and survival to hospital discharge). RESULTS: Three studies were selected for the meta-analysis. The first meta-analysis evidenced a RR of 1.22 (95% C.I.: 1.04-1.43) of surviving to hospital admission for people treated with CPR+AED as compared to CPR-only. The second meta-analysis showed a RR of 1.39 (95% C.I.: 1.06-1.83) of surviving to hospital discharge for people treated with CPR+AED as compared to CPR-only. CONCLUSIONS: The results of our meta-analysis demonstrate that programs based on CPR plus early defibrillation with AEDs by trained non-healthcare professionals offer a survival advantage over CPR-only in OHCA. The conclusions of our meta-analysis add to previous evidence in favour of developing public-health strategies based on AED use by trained layrescuers.     

The effect of time on CPR and automated external defibrillator skills in the Public Access Defibrillation Trial

BACKGROUND: The time to skill deterioration between primary training/retraining and further retraining in cardiopulmonary resuscitation (CPR) and automated external defibrillation (AED) for lay-persons is unclear. The Public Access Defibrillation (PAD) trial was a multi-center randomized controlled trial evaluating survival after CPR-only versus CPR+AED delivered by onsite non-medical volunteer responders in out-of-hospital cardiac arrest. AIMS: This sub-study evaluated the relationship of time between primary training/retraining and further retraining on volunteer performance during pretest AED and CPR skill evaluation. METHODS: Volunteers at 1260 facilities in 24 North American regions underwent training/retraining according to facility randomization, which included an initial session and a refresher session at approximately 6 months. Before the next retraining, a CPR and AED skill test was completed for 2729 volunteers. Primary outcome for the study was assessment of global competence of CPR or AED performance (adequate versus not adequate) using chi(2)-test for trends by time interval (3, 6, 9, and 12 months). Confirmatory (GEE) logistic regression analysis, adjusted for site and potential confounders was done. RESULTS: The proportion of volunteers judged to be competent did not diminish by interval (3, 6, 9, and 12 months) for either CPR or AED skills. After adjusting for site and potential confounders, longer intervals to further retraining was associated with a slightly lower likelihood of performing adequate CPR but not with AED scores. CONCLUSIONS: After primary training/retraining, the CPR skills of targeted lay responders deteriorate nominally but 80% remain competent up to 1 year. AED skills do not deteriorate significantly and 90% of volunteers remain competent up to 1 year.     

Detection of ventricular fibrillation in the presence of cardiopulmonary resuscitation artefacts

Providing cardiopulmonary resuscitation (CPR) to a patient in cardiac arrest introduces artefacts into the electrocardiogram (ECG), corrupting the diagnosis of the underlying heart rhythm. CPR must therefore be discontinued for reliable shock advice analysis by an automated external defibrillator (AED). Detection of ventricular fibrillation (VF) during CPR would enable CPR to continue during AED rhythm analysis, thereby increasing the likelihood of resuscitation success. This study presents a new adaptive filtering method to clean the ECG. The approach consists of a filter that adapts its characteristics to the spectral content of the signal exclusively using the surface ECG that commercial AEDs capture through standard patches. A set of 200 VF and 25 CPR artefact samples collected from real out-of-hospital interventions were used to test the method. The performance of a shock advice algorithm was evaluated before and after artefact removal. CPR artefacts were added to the ECG signals and four degrees of corruption were tested. Mean sensitivities of 97.83%, 98.27%, 98.32% and 98.02% were achieved, producing sensitivity increases of 28.44%, 49.75%, 59.10% and 64.25%, respectively, sufficient for ECG analysis during CPR. Although satisfactory and encouraging sensitivity values have been obtained, further clinical and experimental investigation is required in order to integrate this type of artefact suppressing algorithm in current AEDs.     

Optimizing antiepileptic drug therapy in the elderly

OBJECTIVE: To review and evaluate the medical literature concerning antiepileptic drug (AED) therapy in elderly patients. DATA SOURCES: A MEDLINE search (1982-December 2004) was conducted. Bibliographies of the articles identified were also reviewed, and an Internet search engine was used to identify additional pertinent references. STUDY SELECTION AND DATA EXTRACTION: Clinical studies and reviews were evaluated, and relevant information was included. DATA SYNTHESIS: The elderly have the highest incidence of seizures among all age groups. Complex partial seizures are the most common, followed by primary generalized tonic-clonic seizures. An accurate diagnosis may prove difficult because of a low suspicion of epilepsy in the elderly and other diseases that may mimic seizures. Most AEDs are approved for treatment of elderly patients who have partial and tonic-clonic seizures. However, a number of age-related variables should be addressed when selecting an appropriate AED. Age-dependent differences in pharmacokinetics and pharmacodynamics of AEDs must be taken into account. Drug-drug interactions must be considered since elderly people often take multiple medications. The ultimate factor that often determines AED selection is tolerability. CONCLUSIONS: Numerous factors must be considered in treating elderly patients for seizures, but maximizing the ability of patients to tolerate drug therapy is often the basis for AED selection. Special consideration should be made along several lines, including elderly patients' cognitive functioning and their tendency to respond to lower AED concentrations.     

How Well are Cardiopulmonary Resuscitation and Automated External Defibrillator Skills Retained over Time? Results from the Public Access Defibrillation (PAD) Trial

Background: The current standard for cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) retraining for laypersons is a four‐hour course every two years. Others have documented substantial skill deterioration during this time period. Objectives: To evaluate 1) the retention of core CPR and AED skills among volunteer laypersons and 2) the time required to retrain laypersons to proficiency as a function of time since initial training. Methods: This was an observational follow‐up study evaluating CPR and AED skill retention and testing/retraining time up through 17 months after initial training. The study took place at 1,260 facilities recruited by 24 North American clinical research centers, and included 6,182 volunteer laypersons participating in the Public Access Defibrillation (PAD) Trial. Training to proficiency in either CPR only (N= 2,426) or CPR+AED (N= 3,756) was followed by testing/retraining provided three to 17 months later. Retraining was done in brief, one‐on‐one, individualized, interactive sessions. The outcome studied was instructors' global assessments of performance of CPR and AED skill adequacy, i.e., whether CPR actions would likely result in perfusion (yes/no) and whether AED actions would result in a shock through the heart (yes/no). Results: For global CPR performance, 79%, 73%, and 71% of volunteers tested for the first time since initial training three to five, six to 11, and 12 to 17 months after initial training, respectively, were judged by their instructors as having adequate performance (p < 0.001, chi‐square for linear trend). For global AED performance, 91%, 86%, and 84% of volunteers, respectively, were judged as having adequate performance (p < 0.001). The mean (± standard deviation) times required to test and retrain volunteers to proficiency were 5.7 (± 4.0) minutes for CPR skills and 7.7 (± 4.6) minutes for CPR+AED skills. Conclusions: Among PAD Trial volunteer laypersons participating in a simulated resuscitation, the proportions of volunteers judged by instructors to have adequate CPR and AED skills demonstrated small declines associated with longer intervals between initial training and subsequent testing. However, based on instructors' judgment, large majorities of volunteers still retained both CPR and AED core skills through 17 months after initial training. Furthermore, individual testing and retraining for CPR and AED skills were usually accomplished in less than 10 minutes per volunteer. Additional research is essential to identify training and evaluation techniques that predict adequate CPR and AED skill performance of laypersons when applied to an actual cardiac arrest.     

Automated External Defibrillator Program Does Not Impair Cardiopulmonary Resuscitation Initiation in the Public Access Defibrillation Trial

Objectives: To evaluate whether automated external defibrillator (AED) training and AED availability affected the response of volunteer rescuers and performance of cardiopulmonary resuscitation (CPR) in presumed out‐of‐hospital cardiac arrest (OOH‐CA) during the multicenter Public Access Defibrillation Trial. Methods: The Public Access Defibrillation Trial recruited 1,260 facilities in 24 North American regional sites to participate in a trial addressing survival from OOH‐CA when AED training and availability were added to a volunteer‐based emergency response team. Volunteers at each facility were trained to perform either CPR alone (CPR) or CPR in conjunction with AED use (CPR+AED) according to randomized assignments. This study reports the frequency of response and initiation of CPR actions (chest compressions and/or ventilations) by volunteers in the CPR and CPR+AED study groups. Results: A total of 314 presumed OOH‐CA episodes occurred in CPR facilities, and 308 occurred in CPR+AED facilities. The volunteers were matched well for age, gender, and other features. Overall, ventilations (23.1% vs. 13.1%), chest compressions (24.4% vs. 12.1%), and both actions (19.8% vs. 10.5%; all p < 0.05) were more commonly performed in OOH‐CA cases in the CPR+AED group. However, when only OOH‐CA cases with volunteers responding were analyzed, the rates of CPR actions were similar. In the subgroup of CPR+AED cases with a responding volunteer, the AED was turned on for only 47% of cases. Volunteers initiated a CPR action more commonly when the AED was turned on (60.7% vs. 39.3%; p = 0.003). Conclusions: In the Public Access Defibrillation Trial, rates of CPR actions for presumed OOH‐CA victims were low but similar for CPR and CPR+AED responding volunteer rescuers. Factors associated with volunteer response, CPR action initiation, and AED activation warrant further investigation.