Remote synchronous usability testing of public access defibrillators during social distancing in a pandemic.

Public access automated external defibrillators (AEDs) represent emergency medical devices that may be used by untrained lay-persons in a life-critical event. As such their usability must be confirmed through simulation testing. In 2020 the novel coronavirus caused a global pandemic. In order to reduce the spread of the virus, many restrictions such as social distancing and travel bans were enforced. Usability testing of AEDs is typically conducted in-person, but due to these restrictions, other usability solutions must be investigated. Two studies were conducted, each with 18 participants: (1) an in-person usability study of an AED conducted in an office space, and (2) a synchronous remote usability study of the same AED conducted using video conferencing software. Key metrics associated with AED use, such as time to turn on, time to place pads and time to deliver a shock, were assessed in both studies. There was no difference in time taken to turn the AED on in the in-person study compared to the remote study, but the time to place electrode pads and to deliver a shock were significantly lower in the in-person study than in the remote study. Overall, the results of this study indicate that remote user testing of public access defibrillators may be appropriate in formative usability studies for determining understanding of the user interface.

National experience with long-term use of the wearable cardioverter defibrillator in patients with cardiomyopathy.

PURPOSE: The wearable cardioverter defibrillator (WCD) is generally used for short periods of sudden cardiac death (SCD) risk; circumstances may occasionally result in prolonged use (over 1 year). The aim of this study was to determine the benefits and risks of prolonged use in patients with systolic heart failure (HF). METHODS: ZOLL's post-market US database included adult patients (≥18 years) with ischemic and/or non-ischemic cardiomyopathy (ICM, NICM) and at least 1 year of use. Cox-regression was used to identify factors associated with survival with WCD use, and reasons for stopping use were entered as time-dependent factors. RESULTS: Among 220 patients, age (mean ± SD) 55.4 ± 14.8 years, WCD use 451.4 ± 289.9 days, and 67.3 % were male and their left ventricle ejection fraction (EF) averaged 20.9 ± 7.2 %. Eighty-nine (40.5 %) were continuing WCD use at the last follow-up. Thirty-six (16.4 %) and 56 (25.5 %) patients discontinued WCD use because of EF recovery and implantable cardioverter (ICD) implantation, respectively. Nine patients (4.1 %) received appropriate shock therapy for 13 episodes of sustained ventricular tachyarrhythmia with 12 (92.3 %) successful shocks. One patient died of refractory ventricular fibrillation. One patient died from sinus bradycardia transitioning to asystole. Eight patients (3.6 %) had nine episodes of non-fatal inappropriate shocks. CONCLUSIONS: Long-term use of the WCD is safe and effective. Recovery of EF was seen in significant number of patients even after 1 year of WCD use.

Comparative performance assessment of commercially available automatic external defibrillators: A simulation and real-life measurement study of hands-off time.

PURPOSE: Early and good quality cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) improve cardiac arrest patients' survival. However, AED peri- and post-shock/analysis pauses may reduce CPR effectiveness. METHODS: The time performance of 12 different commercially available AEDs was tested in a manikin based scenario; then the AEDs recordings from the same tested models following the clinical use both in Pavia and Ticino were analyzed to evaluate the post-shock and post-analysis time. RESULTS: None of the AEDs was able to complete the analysis and to charge the capacitors in less than 10s and the mean post-shock pause was 6.7±2.4s. For non-shockable rhythms, the mean analysis time was 10.3±2s and the mean post-analysis time was 6.2±2.2s. We analyzed 154 AED records [104 by Emergency Medical Service (EMS) rescuers; 50 by lay rescuers]. EMS rescuers were faster in resuming CPR than lay rescuers [5.3s (95%CI 5-5.7) vs 8.6s (95%CI 7.3-10). CONCLUSIONS: AEDs showed different performances that may reduce CPR quality mostly for those rescuers following AED instructions. Both technological improvements and better lay rescuers training might be needed.

Effective date of requirement for premarket approval for automated external defibrillator systems. Final rule.

The Food and Drug Administration (FDA or the Agency) is issuing a final order to require the filing of premarket approval applications (PMA) for automated external defibrillator (AED) systems, which consist of an AED and those AED accessories necessary for the AED to detect and interpret an electrocardiogram and deliver an electrical shock (e.g., pad electrodes, batteries, adapters, and hardware keys for pediatric use).

Protection from outpatient sudden cardiac death following ICD removal using a wearable cardioverter defibrillator.

BACKGROUND: An implantable cardioverter defibrillator (ICD) is effective in preventing sudden cardiac death (SCD). Once an ICD is removed and reimplantation is not feasible, a wearable cardioverter defibrillator (WCD) may be an alternative option. We determined the effectiveness of WCD for SCD prevention in patients who were discharged after ICD removal. METHODS: A retrospective study was conducted on all WCD (LifeVest, ZOLL, Pittsburgh, PA, USA) patients who underwent ICD removal due to cardiac device infections (CDIs) at two referral centers between January 1, 2005 and December 31, 2009. Clinical characteristics, device information, and WCD data were analyzed. Sudden cardiac arrest was defined as all sustained ventricular tachycardia (VT) and ventricular fibrillation occurring within a single 24-hour period. RESULTS: Ninety-seven patients (mean age 62.8 ± 13.3, male 80.4%) were included in the study. The median duration of antibiotic use was 14.7 days (interquartile range [IQR] 10-30). The median daily WCD use was 20 hours/day and the median length of use was 21 days (IQR 5-47). A total of three patients were shocked by WCD. Two patients had four episodes of sustained VT, successfully terminated by the WCD. A third patient experienced two inappropriate treatments due to oversensitivity of the signal artifact. Three patients experienced sudden death outside the hospital while not wearing the device. Five patients died while hospitalized. CONCLUSION: WCD can prevent SCD, until ICD reimplantation is feasible in patients who underwent device removals for CDI. However, patient compliance is essential for the effective use of this device.

Defibrillation in the dental practice.

A large number of cardiac arrests occur outside hospital each year in the UK and as rapid defibrillation plays an integral role in survival rates, it can be seen as all healthcare premises' responsibility to have immediate access to an automated external defibrillator (AED). This article looks at the importance of the AED and the dental practice in emergency resuscitation, and national guidelines.

La desfibrilación temprana fuera del ámbito sanitario: marco legal / No disponible

En el tratamiento de la parada cardiaca, la desfibrilación temprana integrada en una cadena de socorro efectiva es la llave para la supervivencia. Por ello las organizaciones científicas internacionales han elaborado un conjunto de recomendaciones dirigidas a potenciar, con suficientes garantías de seguridad, la difusión de la desfibrilación semiautomática en la comunidad. Este artículo tiene como objetivo plasmar el resultado de una minuciosa revisión de la literatura científica sobre el desarrollo de la desfibrilación temprana, dando a conocer la señalización internacional de la presencia de un desfibrilador externo semiautomático, así como la evolución legal que regula la utilización de los desfibriladores semiautomáticos fuera del ámbito sanitario mediante el establecimiento de los requisitos mínimos de seguridad y calidad en su uso en todo el territorio, dando eficaz y amplia cobertura a las exigencias de utilización de estos aparatos en las situaciones de emergencia que requiere la desfibrilación temprana, favoreciendo su disponibilidad en el mayor número de lugares donde se concentre una gran afluencia de personas y fijando los contenidos esenciales de la formación de quienes estén habilitados para usarlos(AU)

In the treatment of the cardiac stop, the early desfibrilación integrated to an effective chain of help, is the key for the survival. for it the scientific international organizations have elaborated a set of recommendations directed to promoting, with sufficient guarantees of safety, the diffusion of the semiautomatic desfibrilación in the community. This article has as aim form the result of a meticulous review of the scientific literature on the development of the early defibrillation, announcing the international signposting of the presence of an external semiautomatic defibrillator, as well as the royal decree that regulates the utilization of the semiautomatic desfibriladores out of the sanitary area by means of the establishment of the minimal requirements of safety and quality in his use in the whole territory, giving effective and wide coverage to requirements of utilization of these devices in the emergency situations that the early defibrillation needs, favouring his availability in the major number of places where people great abundance centers and fixing the essential contents of the formation of those who are enabled to use them(AU)

Manejo del desfibrilador / Use os a defibrillator

El Desfibrilador Externo Manual (DEM) es un aparato electrónico portátil que se encuentra en todas las plantas de hospitalización, centros de atención primaria, etc. Se utiliza para revertir arritmias cardiacas graves mediante la desfibrilación. Debemos pensar que dicho protocolo no es sólo un procedimiento médico; por tanto, enfermería debe conocer las indicaciones, la técnica de desfibrilación y el adecuado empleo del mismo, ya que la pronta actuación aumenta la probabilidad de supervivencia del paciente. El objetivo del artículo es realizar una guía práctica que ayude a dominar esta técnica(AU)

A manual external defibrillator is a portable electronic device found on every hospital floor or primary health care center, etc. This device is used to reverse severe cardiac arrhythmias by means of defibrillation. We must consider this protocol to not only be a doctor’s procedure; therefore, nurses ought to know its indications, defibrillation technique and an adequate use of a defibrillator since rapid use of one, if necessary, increases a patient’s survival chances. The objective of this article is to serve as a practical guide which helps professionals dominate this technique(AU)