Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime and Weekends
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations.
Methods and Results: We identified cardiac arrests in public locations (1994-2011) in terms of location and time and viewed these in relation to the location and accessibility of all AEDs linked to the Emergency Dispatch Center as of December 31, 2011, in Copenhagen, Denmark. AED coverage of cardiac arrests was defined as cardiac arrests within 100m (109.4yd) of an AED: 1) irrespective of AED accessibility, and 2) accessible at the time of cardiac arrest. Daytime, evening and nighttime were defined as 08:00-15:59, 16:00-23:59, and 00:00-07:59, respectively. Of 1864 cardiac arrests in public locations, 61.8% (n=1152) occurred during the evening, nighttime or weekends. Of 552 registered AEDs, 9.1% (n=50) were accessible at all hours, and 96.4% (n=532) during daytime, all weekdays. Irrespective of AED accessibility, 28.8% (537/1864) of all cardiac arrests were covered by an AED. Limited AED accessibility decreased coverage of cardiac arrests by 4.1% (9/217) during daytime on weekdays, and by 53.4% (171/320) during the evening, nighttime and weekends.
Conclusions: Limited AED accessibility at the time of cardiac arrest decreased AED coverage by 53.4% during the evening, nighttime and weekends, which is when 61.8% of all cardiac arrests in public locations occurred. Thus, not only strategic placement but also uninterrupted AED accessibility warrants attention if public access defibrillation is to improve survival after out-of-hospital cardiac arrest.
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Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime and Weekends
Circulation 2013 Sep 13;[EPub Ahead of Print], CM Hansen, M Wissenberg, P Weeke, MH Ruwald, M Lamberts, F Lippert, GH Gislason, SL Nielsen, L Køber, C Torp-Pedersen, F FolkeFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Sudden cardiac arrest (SCA) remains a major challenge for contemporary cardiologists. The ability to identify an individual at risk before he/she becomes one of over 300,000 annual SCA statistics has been a major, unfulfilled goal. Because of this fact, we need to be able to respond to him/her at the time of the SCA. In 1992, I wrote, “short-term efforts should be directed toward delivering cardiopulmonary resuscitation and electrical therapy as soon as possible after the onset of an arrest” (Circulation. 1992;85(suppl1):1160-1166), and suggested CPR classes for high school students and automated external defibrillators (AEDs) become as “common as fire extinguishers.” I think that commentary is as valid today as it was over 20 years ago.
Three articles featured in PracticeUpdate Cardiology this week highlight some of the problems involved. The study by Narayanan et al (Circulation;9/18/2013 [epub ahead of print]) emphasizes the difficulty identifying people at risk. They found that only about 20% of 448 individuals with SCA had ejection fractions (EFs) that would have qualified them for an implantable cardioverter defibrillator (ICD) and, of those, only 13% received an ICD. Thus, many people at risk have reasonable EFs, making screening difficult. The study by Hansen et al (Circulation; 9/13/13 [epub ahead of print]), a Danish registry of 1864 out-of-hospital cardiac arrests (OHCA), found that over 60% of OHCAs occurred during the evening, nighttime, or weekend, and the limited AED availability decreased AED coverage by over 50% during those times. This underscores the need not only for public AED placement but for public accessibility as well. The article by Bagai and colleagues (Circulation; 9/17/13 [epub ahead of print]), analyzing 18,588 OHCAs, found that the highest OHCA incidence occurred during the daytime over the weekend and in December. Survival to hospital discharge was lowest when it occurred overnight and during the winter. Weekend and weekday survival was not different. Years ago, I suggested that the “short days of winter may be hazardous to your health” (Circulation. 1999;100[15]:1590-1592), consistent with these findings. It is clear that significant variability in the incidence and survival exists after OHCA, and some of it may be impacted by AED availability. Other factors may be operative as well. While these three important articles take us a bit further in our quest, the challenges of SCA remain.