Quality of basic life support when using different commercially available public access defibrillators

Abstract

BackgroundBasic life support (BLS) guidelines focus on chest compressions with a minimal no-flow fraction (NFF), early defibrillation, and a short perishock pause. By using an automated external defibrillator (AED) lay persons are guided through the process of attaching electrodes and initiating defibrillation. It is unclear, however, to what extent the voice instructions given by the AED might influence the quality of initial resuscitation.MethodsUsing a patient simulator, 8 different commercially available AEDs were evaluated within two different BLS scenarios (ventricular fibrillation vs. asystole). A BLS certified instructor acted according to the current European Resuscitation Council 2010 Guidelines and followed all of the AED voice prompts. In a second set of scenarios, the rescuer anticipated the appropriate actions and started already before the AED stopped speaking. A BLS scenario without AED served as the control. All scenarios were run three times.ResultsThe time until the first chest compression was 25 ± 2 seconds without the AED and ranged from 50 ± 3 to 148 ± 13 seconds with the AED depending on the model used. The NFF was .26 ± .01 without the AED and between .37 ± .01 and .72 ± .01 when an AED was used. The perishock pause ranged from 12 ± 0 to 46 ± 0 seconds. The optimized sequence of actions reduced the NFF, which ranged now from .32 ± .01 to .41 ± .01, and the perishock pause ranging from 1 ± 1 to 19 ± 1 seconds.ConclusionsVoice prompts given by commercially available AED merely meet the requirements of current evidence in basic life support. Furthermore, there is a significant difference between devices with regard to time until the first chest compression, perishock pause, no-flow fraction and other objective measures of the quality of BLS. However, the BLS quality may be improved with optimized handling of the AED. Thus, rescuers should be trained on the respective AED devices, and manufacturers should expend more effort in improving user guidance to shorten the NFF and perishock pause.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-015-0123-1) contains supplementary material, which is available to authorized users.

Manual Versus Semiautomatic Rhythm Analysis and Defibrillation for Out-of-Hospital Cardiac Arrest

“…SAED rhythm analysis can delay the time to first compression by between 5 and 50 seconds, depending on the device manufacturer. 19,34 Similarly, interruptions in CPR during manual rhythm analysis could also be influenced by the competency, training, and protocols of EMS personnel. 13,35 EMS systems that allow paramedics to perform CPR during defibrillator charging may also help to reduce the frequency of preshock CPR interruptions.…”

Fatores associados ao conhecimento de pessoas leigas sobre suporte básico de vida

“…Devido às condições abruptas da PCR em ambiente extra-hospitalar, grande parte delas acontece em ritmo chocável 6 , tendo uma taxa de sobrevida de 20% quem recebe a desfibrilação precoce 29 . A ação pode ser decisiva em uma parada cardíaca, por isso existe a necessidade de modificar a realidade, através da disponibilização do DEA em espaços públicos, tantos nas capitais quanto nas cidades de médio e pequeno porte 7,24 .…”

“…Desse modo, enfatiza-se a importância do socorrista bem treinado, visto que das duas mil PCRs que acontecem no Brasil anualmente, cerca da metade ocorrem fora do ambiente hospitalar, sendo grande parte em ritmo chocável 6 . Entretanto, a taxa de sobrevivência após uma PCR em ambiente extra-hospitalar é muito pequena, haja vista que cerca de 10% das vítimas voltam à vida sem sequelas, apesar dos esforços por parte da equipe para otimizar o tratamento 7 .…”

Challenges in Basic Life Support and Automated External Defibrillator Training of Deaf People

“…Using the AED can be a challenge for a deaf person, as many AEDs provide only voice prompts [16]. On the other hand, the untrained deaf rescuers are capable of using AED appropriately with visual prompts after basic training [6].…”