BACKGROUND:To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators(AEDs)more accurately and quickly.METHODS:From June 1,2018,to November 30,2019...BACKGROUND:To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators(AEDs)more accurately and quickly.METHODS:From June 1,2018,to November 30,2019,a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople(18–65 years old)without prior AED training.A self-instruction card was designed to illuminate key AED operation procedures.Subjects were randomly divided into the card(n=83)and control(n=82)groups with age stratification.They were then individually evaluated in the same simulated scenario to use AED with(card group)or without the self-instruction card(control group)at baseline,posttraining,and at the 3-month follow-up.RESULTS:At baseline,the card group reached a significantly higher proportion of successful defibrillation(31.1%vs.15.9%,P=0.03),fully baring the chest(88.9%vs.63.4%,P<0.001),correct electrode placement(32.5%vs.17.1%,P=0.03),and resuming cardiopulmonary resuscitation(CPR)(72.3%vs.9.8%,P<0.001).At post-training and follow-up,there were no significant differences in key behaviors,except for resuming CPR.Time to shock and time to resume CPR were shorter in the card group,while time to power-on AED was not different in each phase of tests.In the 55–65 years group,the card group achieved more skill improvements over the control group compared to the other age groups.CONCLUSION:The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects.This could be a practical,cost-effective way to improve the AED skills of potential rescue providers among different age groups,including seniors.展开更多
Purpose:To assess the effectiveness of automated external defibrillator(AED)and manual external defibrillator(MED)training for third-year nurse students.Methods:We conducted post-demonstration and post-practice evalua...Purpose:To assess the effectiveness of automated external defibrillator(AED)and manual external defibrillator(MED)training for third-year nurse students.Methods:We conducted post-demonstration and post-practice evaluation for MED defibrillation,and pre-training,post-demonstration,and post-practice evaluation for AED defibrillation.Results:Following MED training,time and confidence to defibrillate were improved significantly post-practice(p<0.001,p<0.001,respectively).In post-demonstration and postpractice evaluation,most students placed electrodes correctly(84.21%vs.80.70%),cleared before defibrillation(75.44%vs.89.47%),and performed cardiopulmonary resuscitation immediately after defibrillation(81.81%vs.94.44%);the evaluations were not statistically different(p=0.806,p=0.094,p=0.198,respectively).For AED training,time and confidence to defibrillate post-demonstration and post-practice were significantly improved(p<0.001 vs.p<0.001;p<0.001 vs.p<0.001,respectively)compared to that of pre-training;there was no obvious difference between the post-demonstration and postpractice evaluation(p=0.235,=0.346,respectively).Post-AED demonstration,most students could place electrodes correctly(85.96%),clear(91.23%),and perform CPR immediately after defibrillation(85.96%),which remained at a high level post-practice(94.74%,85.96%,82.46%,respectively);there was no significant difference between the two evaluations(p=0.203,p=0.557,p=0.776,respectively).Conclusion:Combining MED and AED defibrillation training is effective and feasible for third-year nurse students.Minimal training is effective for AED,while MED requires additional practice.展开更多
Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique"...Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.展开更多
Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate...Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed;CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms;the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%;7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.展开更多
The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external de...The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external defibrillator(AED)can greatly improve the survival rate of patients with sudden cardiac death.Because the large probability of sudden cardiac death occurs outside the hospital,it is very important for the general public to master first aid skills.This paper will mine all kinds of data from multi-dimensional and multi-angle,analyze the mastery of public first aid skills in China,and provide practical suggestions and ideas for popularizing first aid skills in the future.展开更多
BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selecti...BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional requirement.METHODS: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and advanced.RESULTS: Lifeline? AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defi brillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline? PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians respectively.CONCLUSION: Lifeline? AUTO AED, Samaritan PAD def ibrillator, Lifeline? PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products.展开更多
AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 pa...AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.CONCLUSION In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.展开更多
基金National Natural Science Foundation of China(No.72074144)Sanming Project of Medicine in Shenzhen(No.SZSM201911005)+1 种基金Innovative Research Team of High-level Local Universities in Shanghai(No.SHSMU-ZDCX20212801)Laerdal Foundation(No.2022-0133).
文摘BACKGROUND:To evaluate whether a simplified self-instruction card can help potential rescue providers use automated external defibrillators(AEDs)more accurately and quickly.METHODS:From June 1,2018,to November 30,2019,a prospective longitudinal randomized controlled simulation study was conducted among 165 laypeople(18–65 years old)without prior AED training.A self-instruction card was designed to illuminate key AED operation procedures.Subjects were randomly divided into the card(n=83)and control(n=82)groups with age stratification.They were then individually evaluated in the same simulated scenario to use AED with(card group)or without the self-instruction card(control group)at baseline,posttraining,and at the 3-month follow-up.RESULTS:At baseline,the card group reached a significantly higher proportion of successful defibrillation(31.1%vs.15.9%,P=0.03),fully baring the chest(88.9%vs.63.4%,P<0.001),correct electrode placement(32.5%vs.17.1%,P=0.03),and resuming cardiopulmonary resuscitation(CPR)(72.3%vs.9.8%,P<0.001).At post-training and follow-up,there were no significant differences in key behaviors,except for resuming CPR.Time to shock and time to resume CPR were shorter in the card group,while time to power-on AED was not different in each phase of tests.In the 55–65 years group,the card group achieved more skill improvements over the control group compared to the other age groups.CONCLUSION:The self-instruction card could serve as a direction for first-time AED users and as a reminder for trained subjects.This could be a practical,cost-effective way to improve the AED skills of potential rescue providers among different age groups,including seniors.
基金The study was supported by the Innovation Program of Shanghai Municipal Education Commission(Grant No.12ZS080).
文摘Purpose:To assess the effectiveness of automated external defibrillator(AED)and manual external defibrillator(MED)training for third-year nurse students.Methods:We conducted post-demonstration and post-practice evaluation for MED defibrillation,and pre-training,post-demonstration,and post-practice evaluation for AED defibrillation.Results:Following MED training,time and confidence to defibrillate were improved significantly post-practice(p<0.001,p<0.001,respectively).In post-demonstration and postpractice evaluation,most students placed electrodes correctly(84.21%vs.80.70%),cleared before defibrillation(75.44%vs.89.47%),and performed cardiopulmonary resuscitation immediately after defibrillation(81.81%vs.94.44%);the evaluations were not statistically different(p=0.806,p=0.094,p=0.198,respectively).For AED training,time and confidence to defibrillate post-demonstration and post-practice were significantly improved(p<0.001 vs.p<0.001;p<0.001 vs.p<0.001,respectively)compared to that of pre-training;there was no obvious difference between the post-demonstration and postpractice evaluation(p=0.235,=0.346,respectively).Post-AED demonstration,most students could place electrodes correctly(85.96%),clear(91.23%),and perform CPR immediately after defibrillation(85.96%),which remained at a high level post-practice(94.74%,85.96%,82.46%,respectively);there was no significant difference between the two evaluations(p=0.203,p=0.557,p=0.776,respectively).Conclusion:Combining MED and AED defibrillation training is effective and feasible for third-year nurse students.Minimal training is effective for AED,while MED requires additional practice.
文摘Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator(ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction(not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a nonprospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries(GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.
文摘Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed;CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms;the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%;7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.
文摘The number of sudden cardiac death(SCD)has increased year by year,which has become one of the main causes of death in China.Timely cardiopulmonary resuscitation(CPR)and timely and accurate use of automatic external defibrillator(AED)can greatly improve the survival rate of patients with sudden cardiac death.Because the large probability of sudden cardiac death occurs outside the hospital,it is very important for the general public to master first aid skills.This paper will mine all kinds of data from multi-dimensional and multi-angle,analyze the mastery of public first aid skills in China,and provide practical suggestions and ideas for popularizing first aid skills in the future.
文摘BACKGROUND: To popularize the wide-spread use of automated external defi brillator(AED) to save life in sudden cardiac arrest, we compared the strength and weakness of different types of AEDs to enable a sound selection based on regional requirement.METHODS: This was a retrospective descriptive study. Different types of AEDs were compared according to the information of AEDs from manuals and brochures provided by the manufacturers. Fifteen types of AEDs were divided into 3 groups, basic, intermediate and advanced.RESULTS: Lifeline? AUTO AED had the best performance in price, portability and user-friendly among AEDs of basic level. It required less time for shock charging. Samaritan PAD defi brillator was superior in price, portability, durability and characteristic among AEDs of intermediate level. It had the longest warranty and highest protection against water and dust. Lifeline? PRO AED had the best performance in most of the criteria among AEDs of advanced level and offered CPR video and manual mode for laypersons and clinicians respectively.CONCLUSION: Lifeline? AUTO AED, Samaritan PAD def ibrillator, Lifeline? PRO AED are superior in AEDs of basic, intermediate and advanced levels, respectively. A feasible AED may be chosen by users according to the regional requirement and the current information about the best available products.
文摘AIM To describe our experience with shock testing for the evaluation of patients with Riata? leads.METHODS Among 51 patients with normal baseline electrical parameters, 20 died during follow-up. Of the remaining 31 patients, 15 underwent the test: In 10 cases a defibrillation testing with ventricular fibrillation(VF) induction and in 5 cases a R-wave-synchronized shock(> 20 J, without inducing VF). The test was performed under sedation with Midazolam. RESULTS Twelve patients(80%) had a normal behavior during shock testing: In 8 cases induced VF was correctly detected and treated; in 4 cases of R-wave-synchronized shock electrical parameters remained stable and normal. Three patients(20%) failed the test. One patient with externalized conductors showed a sudden drop of high-voltage impedance(< 10 Ohm) after a 25 J R-wave-synchronized shock. Two other patients with externalized conductors, undergoing defibrillation testing, showed a short-circuit during shock delivery and the implantable cardioverter defibrillator was unable to interrupt VF.CONCLUSION In Riata? leads the delivery of a low current during routine measurement of high-voltage impedance may not reveal a small short circuit, that can only be evident by attempting to deliver a true shock, either for spontaneous arrhythmias or in the context of a shock testing.
