The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibril- lation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pedi- atricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.
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The use of automated external defibrillators (AEDs) has been advocated in recent years as one part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they had not been tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from the use of AEDs. Recent literature has shown that children do experience ven- tricular fibrillation, which has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become avail- able to downregulate the energy delivered by AEDs to allow their use on children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of them on children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.
Introduction: Cardiac arrhythmia is sometimes life-threatening, and automated external defibrillators are presently used in some countries. Coronary artery spasm is one of the primary causes of life-threatening arrhythmia. In general, chest symptoms are key indicators of possible coronary artery spasm; however, if chest symptoms are not present, clinicians may not suspect this disease. We encountered a patient who had recovered from ventricular fibrillation treated by using an automated external defibrillator, and silent coronary artery spasm was considered to be the cause of this life-threatening arrhythmia. In this case, I-123 metaiodobenzylguanidine scintigraphy was a useful screening tool for a silent coronary artery spasm.
very short time in order to achieve potential high survival rates. The results show a promising future for the foundation and expansion of optimised AED placements in rural areas. It is important to consider the dynamic differences of the rural areas. For example, seasonal popuation changes affect the demands of these areas, their organizational planning as well as the needs for possible medical attention. Geographic information systems play a significant role not only for optimizing location-allocation methods but also for creating a real- time active network of citizen/rescuers that could provide information about the needs and statuses of each of these areas. As a next step creating an application that will contain information of all the available defibrilators, including these allocated ones, their current functioning status and availability will give the citizens and first responders the opportunity to be informed at all times as well as become themeselves geo-citizens and provide the system on a constant basis data about the defibrillators and any medical event that needs immediate attention. There are a lot of issues from legal to technological that the research community will need to shed light upon, however, based on the existing literature positive steps and outcomes can be seen around the world.
Additional acceptable evidence is needed to resolve these contemporary inconsistencies. The theme of the evidence suggests that children have higher tho- racic impedance than would be expected on the basis of weight alone. This suggests that the present dose of 2 J/kg may need an upward adjustment in smaller patients, or, equally valid, the chance of myocardial damage from any particular dose is less than previ- ously feared. Another important factor influencing shock effectiveness is the shock wave form. In recent years, biphasic waveforms have been introduced into external defibrillators and have been shown in clinical studies to have advantages over conventional monophasic waveforms. With biphasic waveforms, a smaller shock will defibrillate effectively, yet larger energies are well tolerated, so that a single energy delivery may be applicable across a wider age or size range. 32–34
Public Access Defibrillator (PAD) use. Each was from a different manufacturer, provid- ing a cross section of device designs for testing. All were battery powered with no pro- vision for external power connections. All devices issued audio prompts to the operator and some had a text message or lights on the panel to display instructions to the operator for the next step to perform, such as a flashing light to indicate the but- ton to push to initiate a shock or lights that highlighted a graphic on the face of the device to identify the action expected by the operator. The devices tested are listed in Table 1 with the manufacturers’ names omitted. The CPR cycle times are listed to show how much time it adds to the total operating cycle from analysis to CPR and back to analysis again. The lead length is also listed to provide a reference point for considering wavelength resonance (as discussed in the results section).
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The Emergency Medical Services Learning Resources Center of the University of Iowa maintains a Cardiac Arrest Surveillance program for 419 primarily rural emergency ambulance services that include First Responder, EMT-D, and EMT-Intermediate units. The defibrillators used by these services are equipped with two channel recorders, electrocardiograms, and voice recordings associated with patient management. All out-of hospital cardiac arrests are recorded automatically and the tapes sent to the Emer- gency Medical Services Learning Resources Center. Written de- tails of the arrest and resuscitation also are provided. All tape recordings are reviewed by one person (LLH), who provides confirmation of the rhythm analysis and evaluation of the AED performance and crew response and performance.
Out-of-hospital cardiac arrest (OHCA) is a major public health problem that can strike seemingly healthy individ- uals of any age, often without warning . In Europe, the survival rate following OHCA is only ≈ 10% and costs 350,000 lives each year . It has been known for more than two decades that bystander cardiopulmonary resuscitation (CPR) before the arrival of emergency med- ical services (EMS) increases survival rates 2 – 4 times [3, 4]. While CPR can extend the window for successful de- fibrillation, it is only defibrillation that can re-establish a normal, spontaneous heart rhythm , and survival rates >50% have been documented when an automated exter- nal defibrillator (AED) is used . However, research suggests that bystanders face barriers in attempting re- suscitation, especially concerning the use of AEDs [4, 6].
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Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and in sports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah, Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimate the overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiac arrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant was consented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills of CPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ± 8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants had previous CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey, 110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participants of our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort could explain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls. 73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that 264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED. Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose of use in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of the importance of CPR and AED performance using different pathways for education through media and new legislations .
Although expert can adjust the baseline statistical predictions with additional market insights, this is not always feasible or accurate. Long term expert forecasts are notoriously difficult because of the complexity of the economic system and the biased and inconsistent nature of human judgement (Fildes and Goodwin, 2007). The Delphi method can be used to reduce bias and increase the accuracy of such forecasts (Goodwin and Wright, 2010). How- ever, using multiple experts can be very expensive and since it cannot be automated it is not scalable to global portfolios that include several different product and market combinations. Alternatively, supply chain management could rely on external market growth forecasts for different countries by analysts. Irrespective of the quality of analyst predictions, these are often not available on the detail that is required to feed to the tactical forecasts of organ- isations. Furthermore, research has shown that field knowledge is not always incorporated in the most effective way through human judgement (Petropoulos et al., 2016) and that the forecasting accuracy gain of these managerial adjustments is inconsistent (Trapero et al., 2013). As a result, our motivation for this work is to provide a statistical method, that is not limited in the same ways, to incorporate external data consistently.
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The initial rhythm in about 25% of in-hospital cardiac arrest is ventricular tachycardia or fibrillation (VT/VF). Early provision of good quality CPR and rapid defibrilla- tion have the highest impact on survival for the victims of VT/VF cardiac arrest. Early defibrillation is an inde- pendent predictor of survival in CPR events caused by VT/ VF.[4,5] Delay in provision of defibrillation for 10 min- utes renders CPR ineffective. Each minute of delay in defibrillation increases the likelihood of death by 7% to 10% in cardiac arrest. If defibrillation is provided within 3 minutes in in-hospital cardiac arrest, 38% sur- vival to discharge is reported versus 21%, if defibrillation is provided after 3 minutes. Addressing this delay, a program encouraging early defibrillation using auto- mated external defibrillators (AED) in the hospital
1. Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators: A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near- fatal ventricular arrhythmias. N Engl J Med 1997; 337: 1576–1583. 2. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implantable defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial (MADIT) Investigators. N Engl J Med 1996; 335: 1933–1940. 3. Heidenreich PA, Keeffe B, McDonald KM, Hlatky MA. Overview of randomized trials of antiarrhythmic drugs and devices for the prevention of sudden cardiac death. Am Heart J. 2002;144:422-30.
There are several limitations to this research that influenced the impact of the results. Some limitations were already discussed in previous sections, and these will only be shortly summarised subsequently. First, there were some limitations due to constraints to the size and available time for this research. Only a part of a design science research process could be performed for designing the guidelines in this research, and these constraints also cause that the designed guidelines are very high-level, and mainly pertain to the identified ‘gaps’. Demonstration, evaluation and communication of the guidelines was not performed. Also, concepts and tools related to automated IT controls could not be further studied. Secondly, there were some limitations to the literature review. The limited access to resources is one of them, which caused that a number of potential references might be missed. Next to that, the quality and impact scores of the references could possibly be higher, and the chance of outdated information is significant since many old references were found. Also, most references pertain research applied to a limited number of countries, which mostly concerns traditional developed countries such as the US and the UK. A more diverse sample could be possible. Furthermore, no evidence from the literature was used when discarding ten of the found characteristics in the discussion of the search results from the literature review. Logic reasoning was used there, which is weaker compared to evidence from
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In Japan, the placement of the automated external defibrillator (AED) has been advanced since its use by non-medical workers was approved on July 1, 2004. The total sales of AEDs in all of Japan in 2004 were 6,701 sets (H. Kondo, 2012). In 2014 the total became 636,007 sets (Japan Heart Foundation, 2016), increasing by 95 times in ten years. AEDs installed in fire departments total 15,151 sets (2.4%), in medical institutions, 104,721 sets (16.5%), and in public facilities, 516,135 sets (81.2%). By 2016, 1.37 public-access AEDs were installed per square kilometer, amounting to 4.05 AEDs per 1,000 persons (Japan Heart Foundation, 2016). According to Kitamura et al. (2010), when the number of public-access AEDs increased from less than one per square kilometer to four or more, the mean time to electroshock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million populations who survived with one- month minimal neurologic impairment increased from 2.4 to 8.9. The effect of increasing public- access AEDs is clear from increasing patients who survived with the one-month minimal neurologic impairment.
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While a number of questionnaire measuring the various dimensions of bystander cardiopulmonary resuscitation (CPR) [1–4] and AED [2–7] have been published, there are few questionnaires that combine both bystander CPR and automated external defibrillator (AED) measurement [8, 9]. We reported the development and construct vali- dation (exploratory factor analysis, EFA and confirma- tory factor analysis, CFA) of a bilingual (English and local Malay language) questionnaire that comprehensively measures four objectives: (1) the perception of AED placement strategy, (2) the perception on the importance
1. Yong qin Li, Member, IEEE, Joe Bisera, Max Harry, Weil Senior Member, “An Algorithm used for ventricular fibrillation detection without interrupting chest compression”,IEEE, and Wanchun Tang IEEE Transactions on biomedical engineering, vol.59, no.1, January 2012. In this paper it describes the detection of ventricular fibrillation and how the automated external defibrillator has been used are explained.
Background: Survival rates for in-hospital cardiac (IHCA) arrest are low. Early defibrillation is vital and inter- national guidelines, which requests defibrillation within three minutes. Can dissemination of automatic external defibrillators (AED) at hospital wards shorten time to defibrillation compared to standard care, calling for med- ical emergency team (MET)? Material & Methods: Forty-eight (48) units at Södersjukhuset, Sweden, were in- cluded in the study. They were divided into the intervention group (24 units equipped with AEDs) and the stan- dard care group (24 units with no AEDs). Intervention group staff were trained in CPR to use AEDs and stan- dard care group staff were trained in just CPR. Data were gathered from patient records, AEDs and the Swedish National Registry of Cardiopulmonary Resuscitation (NRCR). Results: 126 IHCA patients were included, 47 in the standard care group, 79 in the intervention group. AEDs in the intervention group were connected to a defi- brillator and it was ready to shock before arrival of MET in 83.5% of all cases. AEDs were ready to be used on average 96 seconds (14 - 427 s) before arrival of MET. Seven (15%) patients were defibrillated in the control group and Twenty (25%) in the intervention group. Defibrillation within three minutes occurred in 67% in the intervention group (11/17), compared with none (0/7) in the control group (p = 0.02). Conclusion: A systematic implementation of AEDs in hospital wards decrease time to defibrillation compared to a standard MET response system. Larger studies are needed to evaluate the impact on the outcome.
aEEG: continuous and simplified EEG‑montage with two channels in com‑ bination with amplitude integrated trend analysis; AED: automated external defibrillators; ALS: advanced life support; BLS: basic life support; CA: cardiac arrest; CCPR: conventional CPR; cEEG: continuous electroencephalography; CPR: cardio‑pulmonary resuscitation; DBD: donation after brain death; DCD: donation after cardiocirculatory death; DNAR: do‑not‑attempt‑resuscitation; ECPR: extracorporeal CPR; EMS: emergency medical services; ETI: endotra‑ cheal intubation; FOUR: full outline of unresponsiveness; GCS: Glasgow coma score; ICU: intensive care unit; IHCA: in‑hospital cardiac arrest; MCS: minimally conscious state; MET: medical emergency team; MTH: mild therapeutic hypo‑ thermia; NIRS: near‑infrared spectrophotometry; OHCA: out‑hospital‑cardiac arrest; PCI: percutaneous coronary intervention; PE: pulmonary embolism; PEA: pulseless electrical activity; PVS: persistent vegetative state; ROSC: return of spontaneous circulation; RRS: rapid response systems; TH: therapeutic hypothermia; TTM: targeted temperature management; UWS: unresponsive wakefulness syndrome; VF: ventricular fibrillation; WLST: withdrawal of life‑ sustaining therapy.
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Congenital long-QT syndrome with 2:1 atrioventricular block presenting in the perinatal period is rare, has a poor prognosis, and leads to high risk for lethal ventricular arrhythmic events. An implantable cardioverter-defibrillator seems to be the most effective treatment in the prevention of arrhythmic sudden cardiac death in patients with long-QT syndrome. Technical limitations and risks associated with implantable cardioverter-defibrillators in asymp- tomatic infants is considered too great to justify use for primary prophylaxis against sudden cardiac death. In this case report we describe the first successful parental use of an automated external defibrillator prescribed for primary prophylaxis against sudden cardiac death in an infant with long-QT syndrome.