Artikel over Effect van Onsite én Dispatched AED's van ARREST, periode 2007 to 2009
Impact of onsite or dispatched automated external defibrillator use on survival after out-of-hospital cardiac arrest.
Berdowski J, Blom MT, Bardai A, Tan HL, Tijssen JG, Koster RW.
In het artikel staat:
Time to shock was determined by calculating the time between the beginning of the emergency call and the first shock given by either the AED or the manual defibrillator. Survival to discharge was determined by review of the hospital charts, and survival was confirmed in the civic registry. Two researchers (J.B. and A.B.) classified neurological outcome on the Cerebral Performance Category scale by reviewing hospital charts of patients who survived until hospital discharge. Category 1 represents good cerebral performance; category 2, moderate cerebral disability; category 3, severe cerebral disability; category 4, coma or vegetative state; and category 5, death. Neurologically intact survival was defined as a Cerebral Performance Category of 1 or 2.18
The primary end point of this analysis was neurologically intact survival to discharge; the secondary end point was survival to discharge.
During the 39-month study period, EMS personnel attempted to resuscitate 3604 OHCA patients, 3160 of whom had a presumed cardiac cause. We excluded 327 patients (the Figure). The eventual analysis cohort consisted of 2833 arrests; 128 patients (5%) had been treated with an onsite AED, 478 (17%) were treated with a dispatched AED, and 2227 (79%) had not received AED treatment. Lay rescuers brought the onsite AED from a nearby location other than the location of the arrest in 32 of 128 cases (25%); most were from a nearby public building (9 of 32, 28%) or were publicly available AEDs (8 of 32, 25%).
Most OHCAs occurred at home (1962 of 2833, 69%). An onsite AED had been applied in 0.6% of these cases (11 of 1962). The onsite AED was used in 13.4% (117 of 871) of all OHCAs occurring in public locations, most frequently in public buildings (57 of 265, 22%) and sports or recreational places (32 of 150, 21%). The EMS response interval was not statistically significantly different between patients treated with an onsite AED and those without AED treatment. Patients treated with an onsite AED were more likely to have collapsed in public areas, to have received bystander CPR, and to have a shockable initial rhythm. Patients treated with an onsite AED received the first shock 6 minutes (median) earlier.Patients treated with an onsite AED had a significantly higher rate of neurologically intact survival than those without AED treatment (50% versus 14%, respectively; unadjusted OR, 5.63; 95% confidence interval [CI], 3.91–8.10; Tables 3 and 4). The OR for neurologically intact survival remained statistically significant after adjustment for confounding by age, public location, witness status, bystander CPR, dispatched AED area, and initial rhythm in a multivariable regression analysis (adjusted OR, 2.72; 95% CI, 1.77–4.18). Adjustment with a stratified propensity score analysis yielded a similar OR (2.60; 95% CI, 1.67–4.01). The adjusted ORs were virtually the same when the population was restricted to those arrests that occurred at a public location or to those that received bystander CPR.
De Meeste OHCA's vinden thuis plaats (69%), daar is zelden een onsite AED die ingezet wordt (0,6%). Onsite AED inzet leidt tot een Neurologisch intacte overleving van 50% t.o.v. 14% bij geen AED inzet.
Among patients with a shockable initial rhythm, those who had been treated with an onsite AED had a significantly higher rate of neurologically intact survival (64% versus 28%, respectively; unadjusted OR, 4.26; 95% CI, 2.77–6.57; Tables 3 and 4).
Dispatched AED Treatment Versus No AED Treatment
Patient characteristics were similar for patients treated with a dispatched AED and those not receiving AED treatment (Table 2). Patients treated with a dispatched AED were more likely to have received bystander CPR and received the first shock 2.5 minutes (median) earlier.
Neurologically intact survival was not statistically significantly improved among patients treated with a dispatched AED compared with those without AED treatment (17% versus 14%, respectively; unadjusted OR, 1.07; 95% CI, 0.82–1.39; Tables 3 and 4). The ORs were unchanged after adjustment for confounding and after limiting the population to those who had received bystander CPR. When the population was limited to arrests that occurred in a public location, there was a statistically significant benefit in survival (multivariable-adjusted OR, 1.88; 95% CI, 1.18–3.00; propensity score–adjusted OR, 1.52; 95% CI, 0.96–2.39). Among patients with a shockable initial rhythm, neurologically intact survival of patients treated with a dispatched AED was similar to that of patients without AED treatment (32% versus 28%, respectively; unadjusted OR, 1.06; 95% CI, 0.79–1.43; Tables 3 and 4). The ORs were similar to those for all initial rhythms. Among patients with a nonshockable initial rhythm, those who had been treated with a dispatched AED had a similar rate of neurologically intact survival (2% versus 2%; unadjusted OR, 0.87; 95% CI, 0.33–2.27; Tables 3 and 4). These ORs also were similar to those for all initial rhythms.
Er zijn 478 mensen behandeld met een dispatched AED.Er worden geen aantallen gegeven voor ingezette Dispatched AED's in de thuissituatie. Er blijkt echter dat er vaker gereanimeerd wordt als er een AED alert en dat de schok eerder gegeven wordt. Er is geen significant verschil in neurologisch intact overleven met geen AED met uitzondering van de reanimaties in de openbare ruimte.
Lives Saved by AED Treatment
We estimated that the use of onsite AEDs saved 3.6 lives per 1 million population per year, whereas AEDs dispatched by the EMS response system saved 1.2 lives per 1 million population per year (Table 5).
Er is zelden een inzet van een Onsite AED in de thuissituatie. Als dit wel gebeurt stijgt de neurologisch intacte survival gemiddeld tot 50% t.o.v 14% bij geen AED inzet.
Bij Dispatched AED inzet in de thuissituatie en openbare ruimte is er geen significant verschil (17% vs. 14%). Bij Dispatched AED's in de openbare ruimte is er wel een significant verschil gevonden
AED's redden 3x meer levens als ze onsite zijn versus dispatched, waarschijnlijk vanwege de langere inzettijd.
Op basis van deze gegevens kunnen we concluderen: Snelle inzet van een AED kan de Neurologisch intacte overleving verhogen tot 50% en leidt in de thuissituatie tot een grotere kans op vroege reanimatie en een eerdere eerste shock t.o.v geen AED inzet.
Snel inzetten van een AED (onsite) is dus bewezen zinvol, is er bij het inzetten van een AED alert nog niet significant bewezen dat er een verschil is, waarschijnlijk door de langere inzettijden vanaf melding.
De responstijd van AED providers zou dus omlaag moeten om een significant effect te sorteren in de thuissituatie. 69% van de reanimaties vindt hier plaats, en deze mensen worden maar in een klein percentage van de gevallen bereikt met een AED.
Zouden we thuissituaties dus uitsluiten, dan zullen 69+% van de mensen geen reanimatie met AED meer krijgen.
http://circ.ahajournals.org/content/124/20/2225.long