Incorporation of Drone Technology Into the Chain of Survival for OHCA: Estimation of Time Needed for Bystander Treatment of OHCA and CPR Performance.

BACKGROUND: Drone-delivered automated external defibrillators (AEDs) hold promises in the treatment of out-of-hospital cardiac arrest. Our objective was to estimate the time needed to perform resuscitation with a drone-delivered AED and to measure cardiopulmonary resuscitation (CPR) quality. METHODS: Mock out-of-hospital cardiac arrest simulations that included a 9-1-1 call, CPR, and drone-delivered AED were conducted. Each simulation was timed and video-recorded. CPR performance metrics were recorded by a Laerdal Resusci Anne Quality Feedback System. Multivariable regression modeling examined factors associated with time from 9-1-1 call to AED shock and CPR quality metrics (compression rate, depth, recoil, and chest compression fraction). Comparisons were made among those with recent CPR training (≤2 years) versus no recent (>2 years) or prior CPR training. RESULTS: We recruited 51 research participants between September 2019 and March 2020. The median age was 34 (Q1-Q3, 23-54) years, 56.9% were female, and 41.2% had recent CPR training. The median time from 9-1-1 call to initiation of CPR was 1:19 (Q1-Q3, 1:06-1:26) minutes. A median time of 1:59 (Q1-Q3, 01:50-02:20) minutes was needed to retrieve a drone-delivered AED and deliver a shock. The median CPR compression rate was 115 (Q1-Q3, 109-124) beats per minute, the correct compression depth percentage was 92% (Q1-Q3, 25-98), and the chest compression fraction was 46.7% (Q1-Q3, 39.9%-50.6%). Recent CPR training was not associated with CPR quality or time from 9-1-1 call to AED shock. Younger age (per 10-year increase; ß, 9.97 [95% CI, 4.63-15.31] s; P<0.001) and prior experience with AED (ß, -30.0 [95% CI, -50.1 to -10.0] s; P=0.004) were associated with more rapid time from 9-1-1 call to AED shock. Prior AED use (ß, 6.71 [95% CI, 1.62-11.79]; P=0.011) was associated with improved chest compression fraction percentage. CONCLUSION: Research participants were able to rapidly retrieve an AED from a drone while largely maintaining CPR quality according to American Heart Association guidelines. Chest compression fraction was lower than expected.

Enhancing the accuracy of shock advisory algorithms in automated external defibrillators during ongoing cardiopulmonary resuscitation using a cascade of CNNEDs.

Delivery of continuous cardiopulmonary resuscitation (CPR) plays an important role in the out-of-hospital cardiac arrest (OHCA) survival rate. However, to prevent CPR artifacts being superimposed on ECG morphology data, currently available automated external defibrillators (AEDs) require pauses in CPR for accurate analysis heart rhythms. In this study, we propose a novel Convolutional Neural Network-based Encoder-Decoder (CNNED) structure with a shock advisory algorithm to improve the accuracy and reliability of shock versus non-shock decision-making without CPR pause in OHCA scenarios. Our approach employs a cascade of CNNEDs in conjunction with an AED shock advisory algorithm to process the ECG data for shock decisions. Initially, a CNNED trained on an equal number of shockable and non-shockable rhythms is used to filter the CPR-contaminated data. The resulting filtered signal is then fed into a second CNNED, which is trained on imbalanced data more tilted toward the specific rhythm being analyzed. A reliable shock versus non-shock decision is made when both classifiers from the cascade structure agree, while segments with conflicting classifications are labeled as indeterminate, indicating the need for additional segments to analyze. To evaluate our approach, we generated CPR-contaminated ECG data by combining clean ECG data with 52 CPR samples. We used clean ECG data from the CUDB, AFDB, SDDB, and VFDB databases, to which 52 CPR artifact cases were added, while a separate test set provided by the AED manufacturer Defibtech LLC was used for performance evaluation. The test set comprised 20,384 non-shockable CPR-contaminated segments from 392 subjects, as well as 3744 shockable CPR-contaminated samples from 41 subjects with coarse ventricular fibrillation (VF) and 31 subjects with rapid ventricular tachycardia (rapid VT). We observed improvements in rhythm analysis using our proposed cascading CNNED structure when compared to using a single CNNED structure. Specifically, the specificity of the proposed cascade of CNNED structure increased from 99.14% to 99.35% for normal sinus rhythm and from 96.45% to 97.22% for other non-shockable rhythms. Moreover, the sensitivity for shockable rhythm detection increased from 90.90% to 95.41% for ventricular fibrillation and from 82.26% to 87.66% for rapid ventricular tachycardia. These results meet the performance thresholds set by the American Heart Association and demonstrate the reliable and accurate analysis of heart rhythms during CPR using only ECG data without the need for CPR interruptions or a reference signal.

[Whether to implant a defibrillator or not? The Possibility of Using the MADIT-ICD Benefit Score Calculator in Real Practice].

AIM: To study the predictive capabilities of the MADIT-ICD Benefit Score calculator in assessing the benefit of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death (SCD). MATERIAL AND METHODS: This study included 388 patients with NYHA II-IV functional class chronic heart failure (CHF) with a left ventricular ejection fraction (LVEF) ≤35 % who underwent ICD placement for the primary prevention of SCD. Patients were followed up for two years to record the endpoints of first-time paroxysmal sustained ventricular tachyarrhythmia (VT) or non-arrhythmic death. RESULTS: According to the results of calculation with the MADIT-ICD Benefit Score calculator, 276 (71 %) patients had a high risk of VT (score ≥7) and 150 (39 %) had a high risk of non-arrhythmic death (score ≥3). 336 (94%) patients would benefit from an ICD: 148 (38 %) with a high level of probability and 218 (56 %) with a medium level of probability. According to the incidence of endpoints, VT episodes predominated in the low-ICD benefit group (36%), while the high-ICD benefit group had a relatively high incidence of non-arrhythmic death (12%). CONCLUSION: The results obtained for a cohort of Russian patients with CHF and reduced LVEF indicated that the use of the MADIT-ICD Benefit Score in routine clinical practice does not improve the stratification of SCD risk compared to the traditional approach to selecting patients with CHF for ICD based on the LVEF value.

Effects of cardiopulmonary resuscitation training on mortality rates after out-of-hospital cardiac arrest: protocol for a systematic review and meta-analysis.

INTRODUCTION: An out-of-hospital cardiac arrest occurs at a rate of 67-170 cases per 100 000 inhabitants per year in Europe. The early recognition of the occurrence of a cardiac arrest, placing an emergency call, performing cardiopulmonary resuscitation (CPR) and performing defibrillation are the most important response measures. The objective of this systematic review and meta-analysis is to assess the effects of laypersons' CPR training with respect to CPR initiation rates, cardiovascular mortality rates, survival rate and the use of an automated external defibrillator. METHODS AND ANALYSIS: The literature search will be performed in the following databases: MEDLINE, Web of Science, the Cochrane Central Register of Controlled Studies, CINAHL, HBI, TESEO and NTX. Intervention studies and quasi-experimental studies in which CPR training interventions were performed will be included. We will exclude studies in which the participants do not meet the inclusion criteria, without a control group and in which the methodology of the intervention applied is unclear. There will be no restrictions on publication date or language of publication. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomised controlled trials (RCT), non-RCT and quasi-experimental trials. Data analysis and synthesis will be performed using RevMan V.5.4.1 software. The findings will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. ETHICS AND DISSEMINATION: Ethical approval is not required, as only secondary data will be used. The findings will be published in a journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42022365288.

Desafíos en la enseñanza escolar de los primeros auxilios: análisis de la legislación educativa (LOMLOE) y orientación curricular / Challenges in teaching first aids at schools: analysis of spanish educational legislation (LOMLOE) and curricular guidance

Fundamentos: la enseñanza de los primeros auxilios (ppaa) a escolares y jóvenes es una estrategia prioritaria en salud pública. El objetivo de este trabajo fue revisar y analizar la nueva legislación educativa en el marco curricular de ppaa, lo cual es necesario para ofrecer a los docentes y sanitarios una guía práctica que oriente la enseñanza para formar a primeros intervinientes en las diferentes etapas escolares. Métodos: un grupo de cuatro expertos con experiencia curricular en los diferentes niveles educativos, así como en el campo de los ppaa, participaron en este análisis. La metodología consistió en un enfoque de análisis de consenso sobre el contenido de los reales decretos (rd) de educación primaria (rd 157/2022), secundaria (rd 217/2022) y bachillerato (rd 243/2022) que desarrollan curricularmente la ley orgánica 3/2020 (lomloe). Resultados: en el análisis de los tres rd se encontraron diez conceptos generales: prevención de accidentes; protocolo proteger, alertar, socorrer (pas); protocolo 1-1-2; posición lateral de seguridad (pls); reanimación cardiopulmonar (rcp); desfibrilador externo automático o semiautomático (dea/desa); obstrucción de vía aérea por cuerpo extraño (ovace); ppaa; traslado de accidentados; e ictus. A lo largo de todas las etapas educativas fueron veintisiete las veces en que aparecían explícitamente contenidos vinculados con la prevención de accidentes o al aprendizaje de ppaa. Conclusiones: el currículo actual dota de contenido en materia de ppaa desde los ocho-nueve años (3º de educación primaria). Al finalizar la enseñanza secundaria obligatoria, todo el alumnado debería saber identificar la parada cardíaca, alertar a los servicios de emergencias, iniciar las maniobras de reanimación, usar el desfibrilador y saber actuar ante un atragantamiento.(AU)

Background: teaching first aid (fa) to children and young people is a priority strategy in public health. The aim of this paper was to review and analyze new educational legislation within the fa curriculum framework, which is necessary for providing teachers and healthcare professionals with a practical guide that guides teaching to train first responders in different school stages.methods: a group of four experts with curricular experience at different educational levels, as well as in the field of fa, partici-pated in this analysis. The methodology involved a consensus analysis approach on the content of the spanish royal decrees (rd) for primary education (rd 157/2022), secondary education (rd 217/2022), and baccalaureate (rd 243/2022) that develop the curriculum of the organic law 3/2020 (lomloe).results: in the analysis of the three rd, ten general concepts were identified: accident prevention; protocol protect, alert, assist (pas); 1-1-2 protocol; recovery position (pls); cardiopulmonary resuscitation (cpr); automated external or semi-automatic defibrillator (aed); foreign body airway obstruction (fbao); fa; transportation of the injured; and stroke. Throughout all educational stages, in twenty-seven instances appeared content explicitly related to accident prevention or the learning of fa.conclusions: the current curriculum provides fa content from the age of eight-nine (3rd year of primary education). By the end of compulsory education, all students should be able to identify cardiac arrest, alert emergency services, initiate resuscitation maneuvers, use the defibrillator, and know how to respond to choking incidents.(AU)

Online platform for cardiopulmonary resuscitation and automated external defibrillator training in a rural area: a community clinical trial protocol.

INTRODUCTION: Sudden death resulting from cardiorespiratory arrest carries a high mortality rate and frequently occurs out of hospital. Immediate initiation of cardiopulmonary resuscitation (CPR) by witnesses, combined with automated external defibrillator (AED) use, has proven to double survival rates. Recognising the challenges of timely emergency services in rural areas, the implementation of basic CPR training programmes can improve survival outcomes. This study aims to evaluate the effectiveness of online CPR-AED training among residents in a rural area of Tarragona, Spain. METHODS: Quasi-experimental design, comprising two phases. Phase 1 involves assessing the effectiveness of online CPR-AED training in terms of knowledge acquisition. Phase 2 focuses on evaluating participant proficiency in CPR-AED simulation manoeuvres at 1 and 6 months post training. The main variables include the score difference between pre-training and post-training test (phase 1) and the outcomes of the simulated test (pass/fail; phase 2). Continuous variables will be compared using Student's t-test or Mann-Whitney U test, depending on normality. Pearson's χ2 test will be applied for categorical variables. A multivariate analysis will be conducted to identify independent factors influencing the main variable. ETHICS AND DISSEMINATION: This study adheres to the tenets outlined in the Declaration of Helsinki and of Good Clinical Practice. It operated within the Smartwatch project, approved by the Clinical Research Ethics Committee of the Primary Care Research Institute IDIAP Jordi Gol i Gurina Foundation, code 23/081-P. Data confidentiality aligns with Spanish and European Commission laws for the protection of personal data. The study's findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER: NCT05747495.

[Public access defibrillation programs: Progetto Vita, current legal aspects and challenges for the future]. / Programmi di pubblico accesso alla defibrillazione: l'esperienza ultraventennale di Progetto Vita a Piacenza, aspetti legislativi attuali e sfide per il futuro.

Out-of-hospital cardiac arrest (OHCA) represents a significant healthcare issue that is often underestimated. OHCA predominantly affects the general population, with staggering numbers: 400 000 cases annually in Europe and 350 000 in the United States, contributing to 50% of cardiovascular-related deaths. The vast majority of OHCA cases begin with a shockable rhythm, making effective treatment possible through early defibrillation, even by non-medical personnel using automated external defibrillators (AEDs). Despite the availability of such devices, survival from OHCA remains below 10%, with no substantial improvements over the last 25 years. Public access defibrillation programs, which reduce response times with AEDs, have demonstrated a significant increase in survival chances for OHCA victims. Particularly, the "Progetto Vita" in Piacenza is an emblematic example of early defibrillation in Europe, tripling survival rates in OHCA patients treated by laypersons compared to patients treated with the traditional system. This experience contributed to the approval of Law 116, dated August 4, 2021, in Italy, aimed at promoting the distribution and use of AEDs in sports facilities, public venues, transportation, and public services. The law also emphasizes that AEDs can be used without the need for specific training, thus promoting wider usage. In this article, we will briefly examine the epidemiology of OHCA and delve into the organizational model of the "Progetto Vita", which aligns with the principles of Law 116/2021. The goal is to provide some insights into organizational aspects that could facilitate the nationwide expansion of early defibrillation programs in the near future.

Multi-phase implementation of automated external defibrillator use by nurses during in-hospital cardiac arrest and its impact on survival.

OBJECTIVE: We sought to evaluate the impact of a medical directive allowing nurses to use defibrillators in automated external defibrillator-mode (AED) on in-hospital cardiac arrest (IHCA) outcomes. METHODS: We completed a health record review of consecutive IHCA for which resuscitation was attempted using a pragmatic multi-phase before-after cohort design. We report Utstein outcomes before (Jan.2012-Aug.2013;Control) the implementation of the AED medical directive following usual practice (Sept.2013-Aug.2016;Phase 1), and following the addition of a theory-based educational video (Sept.2016-Dec.2017;Phase 2). RESULTS: There were 753 IHCA with the following characteristics (Before n = 195; Phase 1n = 372; Phase 2n = 186): mean age 66, 60.0% male, 79.3% witnessed, 29.1% noncardiac-monitored medical ward, 23.9% cardiac cause, and initial ventricular fibrillation/tachycardia (VF/VT) 27.2%. Comparing the Before, Phase 1 and 2: an AED was used 0 time (0.0%), 21 times (5.7%), 15 times (8.1%); mean times to 1st analysis were 7 min, 3 min and 1 min (p < 0.0001); mean times to 1st shock were 12 min, 10 min and 8 min (p = 0.32); return of spontaneous circulation (ROSC) was 63.6%, 59.4% and 58.1% (p = 0.77); survival was 24.6%, 21.0% and 25.8% (p = 0.37). Among IHCA in VF/VT (n = 165), time to 1st analysis and 1st shock decreased by 5 min (p = 0.01) and 6 min (p = 0.23), and ROSC and survival increased by 3.0% (p = 0.80) and 15.6% (p = 0.31). There was no survival benefit overall (1.2%; p = 0.37) or within noncardiac-monitored areas (-7.2%; p = 0.24). CONCLUSIONS: The implementation of a medical directive allowing for AED use by nurses successfully improved key outcomes for IHCA victims, particularly following the theory-based education video and among the VF/VT group.

Automated External Defibrillator Use After Out-of-Hospital Cardiac Arrest at Recreational Facilities.

This cohort study examines bystander automated external defibrillator (AED) application and survival outcomes for out-of-hospital cardiac arrest at recreational facilities in US states with and without AED legislation.