Location of Cardiac Arrest in a City Center

Abstract

Background— Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. Methods and Results— All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. Conclusion— To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.

Mismatch between Sites of Incidence of Out-of-Hospital Cardiac Arrest and Locations of Installed Automated External Defibrillator in the Tokyo Metropolitan Area

“…These results were like the studies by Folke, et al [11] [12] and the study by Roger [13] that showed the application of defibrillation and chance of rescuing are higher in public spaces than residences when witnessed since the detection rate of ventricular fibrillation (VF) is higher.…”

“…In advanced countries, the installation AEDs has been mostly recommended for public facilities [11] [12]. In Japan as well, emphasis had been placed on increasing the number of AED installations, but there has been a shift in thinking to the need to strategically deploy and manage AEDs now that the number of total installations exceeds 500,000 units.…”

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

“…As the costs for purchase and maintenance of PADs, and the training of personnel are relatively stable, cost‐effectiveness is dependent on the frequency of PAD use for OHCA (ie, the incidence of cardiac arrest in places with PAD deployment). Folke et al 29. calculated the cost‐effectiveness over various deployment strategies.…”

“…Only a small fraction of deployed PADs have been actually used 23, 24, 25. An extreme example was reported in Denmark where PAD deployment took place based on unguided initiatives, and none of the PADs were used during the study period 29. Mismatches in cities in North America, though differing in degree, have also been reported (Table 3).…”

“…Railway stations and bus terminals have a high incidence in societies with highly developed and utilized public transportation system, whereas roads and parking areas have the highest incidence in societies dependent on road transportation (Table 3). 29, 38, 44, 45 Race tracks and casinos have a high incidence in societies where such recreations are popular, whereas casinos do not exist in some countries 39. Although early experiences indicated success of PAD deployment in airports, OHCA incidence in airports differs greatly between countries, with some having a very low incidence: A study in the UK showed a high incidence in airports, but studies in Australia, Canada, and Japan did not 39, 40, 44, 45…”