DECLARATION OF CONFLICT OF INTEREST

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Magdalen Chase
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1 DECLARATION OF CONFLICT OF INTEREST Data collection supported by unconditional grant of Physio- Control

2 Place and use of the Automated External Defibrillator in the community R.W. Koster Academic Medical Center Dept. of cardiology Amsterdam

3 Some known facts Survival from OHCA 5-15% BLS and defibrillation are two key interventions Time to start BLS and to defibrillation is of key importance

4 AED implementation Weisfeldt et al Hospital survival

5 AED implementation Weisfeldt et al Hospital survival

6 AED implementation: where?

7 Arrest 7: North Holland+ AMC Study period Jan 1, April 1, 2009

Survival by AED use in 2843 patients (all rhythms) Treatment with Onsite AED Dispatched AED No AED # of patients in group N=128 N=478 N=2227 Call to arrival of ambulance (median, min) 9.0 9.2 8.

8 Survival by AED use in 2843 patients (all rhythms) Treatment with Onsite AED Dispatched AED No AED # of patients in group N=128 N=478 N=2227 Call to arrival of ambulance (median, min) Call to first shock (median, min) Observed survival % Expected survival without AED use, mean % Patients AED at home, from all AED (n, %) 11/128 (9) 345/478 (71) n/a Patients AED at home, from all home (n, %) 11/1962 (<<1%) 345/1962 (18%) 1606/1962 (82%)

attention needed for use in residential areas 29% by AED,

9 AED: public and residential use Public use of AED is highly effective Patients at home hardly treated early by AED More attention needed for use in residential areas 29% by AED, many early from on-site AED 18% by AED, most late by dispatched AED

10 Weisfeldt NEJM 2011 Public vs. Home AED use 1

11 Weisfeldt NEJM 2011 Public vs. Home AED use 2 Time to shock ± 7.6 ± 7??

12 In public: AEDs only in public? Younger, more healthy, more witnessed arrest, more bystander CPR, more VF In the home: Older, more comorbidity, less witnessed, less bystander CPR, later arrival of rescuers, less VF BUT.. There are 3-4 times as many at home!

13 AEDs in my own residential area inhabitants 40 AED s 1 AED / 3400 inhabitants Available? Public access No public access 24/ /5 8 14

14 Volendam

15 AED project Volendam

16 Experience in Volendam inhabitants 18 AEDs (1 AED/1200 inhabitants) > 400 trained volunteers Period september september x 112 alarm for cardiac arrest 5 x AED on site before ambulance arrival 3 x from GP: shocks 2 x from AED project: no shocks Why no success: no communication!

17 Modern communication: SMS message Go to Oranjelaan 10 and start CPR. Go to Rossinistraat 2, fetch the AED (Access # 2074). Then go to Oranjelaan 10.

18 Arrest 16: volunteer rescuers with SMS messages Start study 1 juli 2009

19 AEDs in residential areas

20 Rescuer activation by SMS

21 Simulation example: alarm system AED-Alert 1/5 AED in the community 500 m.

22 Simulation example: alarm system AED-Alert 2/5 AED in the community 300 m. A A

23 Simulation example: alarm system AED-Alert 3/5 AED in the community A Receives no sms.

24 Simulation example: alarm system AED-Alert 4/5 AED in the community A Receives no sms SMS: Go to Oranjelaan 10 and start CPR.

25 Simulation example: alarm system AED-Alert 5/5 AED in the community A Go to Oranjelaan 10 and start CPR. Go to Rossinistraat 2, fetch the AED (Access # 2074). Then go to Oranjelaan 10 Receives no sms.

26 Time 112 call to shock Results last 5 months ( ) 266 resuscitations First rhythm from (n) 1st rhythm VF n (%) Median time call to 1st shock in min:sec # of schocks within 6 min. (%) Ambulance (141) 40 (28%) 12:14 1 (2.5%) First Responders (75) 36 (48%) 07:31 10 (28%) On site (19) 9 (47%) 03:28 5 (56%) SMS responder(31) 14 (45%) 06:41 3 (21%) Shock <6 minutes in 19 (19%) of 99 patients with VF

27 Future of project Principle proven Improve system More AEDs More volunteers Smarter mobile phones (GPS, directions, etc.) Continue scientific evaluation Optimum of AED density? Optimum of volunteer density? Survival benefit

28 How many AEDs are needed? 23 AEDs+230 rescuers minimal? 50 AEDs+500 rescuers optimal?

29 conclusion AEDs are implemented well for ¼ of all victims of cardiac arrest: need more of the same Early arrival finds more patients in VF: rhythm of life AEDs are safe and effective, save many lives ¾ of victims are at home and rarely managed with an AED Community rescuers may offer solution, work in progress

31 AED: public and residential use AED programs need to be intensified Now focus on public use of AEDs More attention for use in residential areas home at work elsewhere

32 Why an SMS- volunteer system?? On site AED First Responders Ambulance

33 First responders Police fire fighters

34 On-site: Dirk van den Broek

AED strategies in the community

AED strategies in the community R.W. Koster Dept. of cardiology Academic Medical Center Amsterdam Conflicts of interest Arrest studies supported by Netherlands Heart Foundation Netherlands Ministry of