AED in public area

Automated External Defibrillators in Public Areas :

The Evidence And Opinion

20 th ASEAN Federat ion of Card iology Congress 2014, June 12th -15th, Kuala Lumpur, MY

Nalinas Khunkhlai MD FRCPT(Emergency Med)Scientific chairman

Thai Resuscitation Council

Department of Emergency Medicine

and Narenthorn EMS Center,

DMS, MOPH

THAILAND


Conflict of Interest statement :

None


Cardiac arrest : By location

OHCA IHCA

Residential

~65%Public


Survival rate?


Cardiac arrest statistics : US

US OHCA survival Adult (%) Children (%) Overall (%)

Bystander witness + VFSurvival to discharge 28.4 57.1 28.4

- From survey , 79% Public knows what to do.

- 98% recognised for shock the heart back to normal.

- 60% familiar with CPR

- 60 % were treat by EMS ~40% bystander CPR with AED

- For EMS treat group : 23% VF

Circulation 2013 : 127; 000-000


Cardiac arrest statistics : Asia

- Largest database came from Japan, Korea, Singapore and Taiwan.

- Bystander CPR rate varies among countries.

- Available OHCA data . For IHCA - very limited.

PAROS Investigators group.

OHCA AsiaBystander CPR

(%)AED (%)

Overall survival + CPC 1-2 (%)

Korea 42.4 0.3 3

Japan 40.2 0.7 2.8

Singapore 24.3 1.1 1.7

Malaysia 22.6 NA NA

Taiwan 19.8 NA 3

Thailand 15.8 0.3 1.7

UAE 10.5 0.8 3

Overall 38.3 0.6 2.8

Asian OHCA survival Adult (%) Children (%) Overall (%)

Bystander witness + VFSurvival to discharge Unknown



Lesson learned from PAD program.


VictimRescuer AED

Out of hospital part

From chain of survival.


AED is good

Only when the

Rescuer can find them

!!!!

Lesson No.1= can’t find


Resuscitation 84 (2013) 910-914

Philadephia : Located the AEDs.

- Philadephia : 1420 buildings Door-to-Door survey

- 12% of buildings report AEDs in place.

- Confirm by visualization and photo for 53%. ….

Others : employees refused access.

(Average 67% of buildings allow public access.)

- In the building with AED : need to contact at least 2 employees

(range 1-8) before take the AED for use.

- Average time to get AED 4 minutes (range 1-55)


AEDs were placed in the place which

mostly restrict access.

Resuscitation 84 (2013) 910-914


Copenhagen 1994-2011 : OHCA in public places

- AEDs registered with Danish

AED Network,Denmark.

- Mark decrease accessibility

in evening and Night time.

and weekdays.

Malta Hansen et al. Circulation. 2013; 128:2224-2231

Lesson No.2 = can’t get


Malta Hansen et al. Circulation. 2013; 128:2224-2231

Copenhagen 1994-2011 : OHCA in public places

- AEDs hardly access during non-weekday-daytime.


Lesson No.3 = can’t plan

What data is need before the planing?

point of risk for OHCA

vs

Place for AED


PAD in Toronto :

GIS modelling to match cardiac arrest location

with possible AED sites

A.A. Siddiz et al Resuscitation 84 (2013) 904-9

- 15,786 OHCA non traumatic cases in Great Toronto.

- 1,754 (12%) arrest in public locations.

- 1,310 cases in Toronto Only.

- 44.4% Bystander Witness

- 38.1% Bystander CPR

- 5.3% Bystander AED

- 32.1% Shockable rhythm

- 12.2% Survival to hospital discharge




Best coverage calculation at 100 AEDs with 40% cases area coverage



At Ratio 1 AED for 40 m.

- Increasing coverage from 15% to 20 % needs 70 AEDs

At Ratio 1 AED for 100 m.

- Increasing coverage from 15% to 20 % needs 15 AEDs



Lesson No.4= can I?

Previous MI

Should I have AED at home?


Home use of AED for Sudden cardiac arrest

Home Automated External Defibrillators Trial : HAT Investigators NEJM 2008; 358: 1793-804

- 7000 anterior MI , who were not candidates for ICD

- Control group = Call EMS + perform CPR

- AED group = Use AED + then call EMS + perform CPR

Primary outcome = death (any cause)

Control 6.5% vs AED 6.4%

HR AED 0.97

(95%CI 0.81 to 1.77 , p 0.77)

Home AED did not improve overall survival ,

compared to conventional resuscitation methods.


Factors to make maximum benefit

from having AEDs

VictimRescuer AED

Register

maintain

easy access

quality control

in touch with local

emergency centre

High

‘possible victim’

traffic

High risk activity

(sports)

local officer as

response FR

volunteer rescuers

High density

Willing & knowledge


AED placement ? : the magic numbers

- High Incidence sites ?( ≥ 1 arrest per 30 sites in 1 year)

- Low Incidence sites ?( ≤ 1 arrest per 100 sites in 1 year)

- Places of high flow of possible victims ( ex. Airport / prison /

shopping malls )

- Places of high risk activities ; physical (sports center) or

mentally (casino).

Becker L. et al. Circulation 1998; 97:2106-9CB Lo. Hong Kong Med J (9) 2003; 114-8

Should analyse your area incidences

Strategic plan

before deploy.


Current situation of PAD program in Asia


Situation of PAD program in Asia

- Japan

- Korea

- Taiwan

- Singapore


NEJM 2010; 362:994-1004

- All-Japan Utstein Registry ; 2005 to 2007

- 312,319 adults OHCA

- Presumed cardiac + Bystander witness + Initial VF = 12,631 (4%)

- Of 12,631 OHCAs, 3.7% AED by Layperson.


Temporal trend of

Public OHCA : Japan

1113

19

0

5

10

15

20

25

2005 2006 2007

OHCA : Bystander CPR+ witness + VF

Survival to hospital discharge with CPC1-2 (%)

2429

34

0

9

18

27

36

45

2005 2006 2007

OHCA : Receive AED shock


NEJM 2010; 362:994-1004


24

29

34

0

9

18

27

36

45

2005 2006 2007

OHCA : Receive AED shock


Time from collapse to 1st shock (min)

3.73.2

2.2

NEJM 2010; 362:994-1004

PAD Japan


Murakami et al. J Am Heart Assoc. 2014; 3: e000533

OHCA outcomes after PAD era in Osaka

- Osaka, Japan. From 2005 through 2011.

- 9453 bystander witnessed OHCA.

- 9.5% occurred in public place

- Mean time from collapse to shock = 5 min

Trends in proportion of Public AED use by laypersons,

bystander witnessed OHCA

AEDs use from 2005 to 2011

2005 2011

Railway 0 41.2

Sports

facility0 56.5

Proportion of good CPC (%)

Sports

facilitySchool Railway

Public

building

51.6 41.9 28 23.3


PAD in Korea

Hyun Soo Chung Resuscitation 84 (2013) e95-e96

Using Digital Signage stand

with AED inside

Seoul , August 2011

Benefit :

- 1. cost : get money from

advertising.

- 2. user-friendly , easy to learn

- 3. more approachable to

small-scale communities

Ads


Marcus EH Ong et al. Resuscitation 2008; 76,388-396

Singapore : PADS Phase I

Geographic information systems for planning

Public Access Defibrillation?

Distribution of OHCA were different

compare day time to night time.


Singapore : Public Education / AED registry


Taipei : Geospatial analysis of OHCA / 7-11 coverage

- Green dot = OHCA

- Purple dot = 7-11 location

- Orange dot = Fire station

Chung-Yuan Huang, Tzai-Hung Wen. Computational and Mathermatical methods in Medicine.

May 2014


Taipei : Geospatial analysis of OHCA / 7-11 coverage

Chung-Yuan Huang, Tzai-Hung Wen. Computational and Mathermatical methods in Medicine.

May 2014

Comparison of coverable OHCA rates for different

AED service range when 7-11 is limit to 100 stores


VictimRescuer AED

Conclusion

PAD program returns the good survival

chance

Only with initial area assessment

continuous monitoring

and re-evaluation.


Thank you

Health & Medicine

AED in public area