Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review

Abstract

Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543.

Human factors influencing out‐of‐hospital cardiac arrest survival

“…Importantly, the work of Smith et al . in a systematic review of available studies found many of the same barriers and facilitators to early access to defibrillation as this original research . Another study found a direct link between confidence and duration of training leading to increased likelihood of a willingness to use an AED when required .…”

“…Around 25 000 Australians experience an out‐of‐hospital cardiac arrest (OHCA) every year representing a major public health problem . Extensive research has been conducted into OHCA in North America, Europe, Asia and Australia . Evidence to date shows that the early use of a defibrillator for cardiac arrest with a shockable rhythm represents the victim's best chance of survival .…”

Delivery of Automated External Defibrillators (AED) by Drones: Implications for Emergency Cardiac Care

“…OHCA victims in rural and mountainous areas remain disadvantaged in emergency cardiac care [10–12]. Barriers to public access defibrillation (PAD) include but are not limited to: knowledge and awareness; acquisition and maintenance; willingness to use; availability and accessibility; training issues; and registration and regulation [13]. PAD is both difficult to implement and impractical because of the rarity of cardiac arrest in the larger community.…”

“…We also need to examine the interplay between human and drone interaction, especially in the context of OHCA. Prior work demonstrates that bystanders’ willingness to use PADs is an ongoing barrier [13]. Prior work about bystander CPR may inform bystanders’ readiness to interact with an AED drone.…”

Underutilisation of public access defibrillation is related to retrieval distance and time-dependent availability

“…Bystander automated external defibrillator (AED) use doubles overall survival2 and may also be of benefit through the delivery of voice prompts and the encouragement to perform CPR, irrespective of shock delivery 3…”