Background: Little is known regarding circumstances, outcomes and quality of cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) performed by operational lifeboat crews. Our aim is to evaluate circumstances, outcomes and quality of CPR performed by the Royal Dutch Lifeboat Institution (KNRM) in out-of-hospital cardiac arrest (OHCA). Methods:The internal KNRM database has been used to identify and analyse all OHCA cases between July 2011 and December 2017. A limited set of AED data was available to study the quality of CPR.Results: In 37 patients the lifeboat crew members have performed CPR, of which 29 (78.4%) occurred under hostile conditions. The median response time to arrive at the location was 15 min. In 11 (29.7%) patients return of spontaneous circulation was achieved at any moment during CPR and 3 (8.1%) patients were still alive after one month. The lifeboat AED was used in 12 patients. Their recordings show a high median compression frequency (120, IQR 111-131) and prolonged median interruption periods (pre-analysis pause 11s (IQR 10-13), post-analysis pause 4s (IQR 3-8), pre-shock pause 24s (IQR 19-26), post-shock pause 6s (IQR 6-11), ventilation pause 6s (IQR 4-8) and other pauses 9s (IQR 4-17)).Conclusions: Compared to most out-of-hospital resuscitations, resuscitations by lifeboat crews have a low incidence, occur under difficult circumstances and in a younger population. AED's on lifeboats have not contributed to any of the survivals. Analysis of AED information can be used to study the quality of CPR and provide input for improving future training of lifeboat crews.

Study purpose: Previous work has shown that out-of-hospital cardiac arrests (OHCA) occur more frequently in deprived areas of England. Public access defibrillation (PAD) is a key element of the early stages of the chain of survival. However, placement of automatic external defibrillators (AED) has been questioned and are not necessarily located where they would be most required for use. This study aimed to highlight discrepancies in the characteristics of areas where AEDs are located and not located in England.Materials and methods: Details of 32,844 ambulance service registered AEDs were obtained. The address of each AED location was converted to a lower super output area (LSOA), the proxy unit of neighbourhood. Neighbourhood characteristics of each LSOA were obtained from the Office for National Statistics and Government websites. Comparisons were made between LSOAs with or without an AED using chi-square and t-test.Results: AEDs were in LSOAs that were more likely to have a significantly (p < 0.01) lower residential (33.2 vs. 49.8 per hectare) but higher working (20.5 vs. 12.8) population density, have a larger white population (87.7% vs. 85.5%), be in areas with a greater proportion of groups from higher socioeconomic classifications (33.6% vs. 29.5%), and be less deprived (higher index of multiple deprivation [IMD]; Rank: 17698 vs. 15459; Decile: 5.9 vs. 5.2).Conclusions: Whilst almost 80% of all OHCAs occur in residential areas, public access AEDs are located less frequently in these areas; evidence suggests they are not clinically/cost effective in these areas. However, they are also disproportionately placed in more affluent, less deprived, areas with lower proportions of population from non-white ethnic groups. Future PAD programmes should give preference to areas where OHCA are more likely to occur and more deprived areas of the country.

IMPORTANCE Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. OBJECTIVETo develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. EVIDENCE REVIEW Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. FINDINGS Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training.Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. CONCLUSIONS AND RELEVANCEThis consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.

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