Effectiveness of combining manual external defibrillator and automated external defibrillator training for third-year nurse students

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.

Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

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.

Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study

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.

Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo

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.

Comprehensive Analysis,Discussion and Suggestion on the Current Situation of Cardiopulmonary Resuscitation and Automatic External Defibrillator in General Public in China

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.

Characterization of available automated external def ibrillators in the market based on the product manuals in 2014

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.

Riata silicone defibrillation lead with normal electrical measures at routine ambulatory check:The role of highvoltage shock testing

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.

医院护理人员自动体外除颤仪认知现况调查

目的 调查医院护理人员对自动体外除颤仪(automated external defibrillator, AED)的认知状况,以期为医院对护理人员的操作培训提供依据及建议。方法 采用自行设计调查问卷,通过问卷星平台对医院全体护理人员进行问卷调查。结果 共回收有效问卷247份。护理人员对AED的掌握率为25.91%,施救意愿为50.61%,通过培训后,护理人员对AED的掌握率达到76.51%,施救意愿率提高到81.38%。结论 医院护理人员对体外自动除颤仪知识掌握水平低,施救意愿仍需加强,可通过相关法律知识的普及、有计划的培训等来促进AED应用等急救知识的掌握,增强护理人员施救意愿,提高知识掌握水平,提高心搏骤停施救率。

“PAD链”研究进展及优化措施

综述公众启动除颤链(PAD链)的概念、研究概况,提出影响公众启动除颤实施的因素及优化措施,以提高我国院外心搏骤停病人的总体存活率。

急救无人机在院外心肺复苏中的应用研究进展

院外心搏骤停(OHCA)是常见致死原因,急救无人机携带自动体外除颤器(AED),可以快速到达OHCA患者身旁,交付AED,缩短心肺复苏(CPR)时间,提高生存率,改善患者预后。本文回顾近年来国内外急救无人机在院外心肺复苏中应用的研究进展,探讨急救无人机的优缺点,为未来我国急救无人机技术的广泛推广提供参考。

冠心病患者主要照护者AED知信行现状及影响因素分析

目的调查冠心病患者主要照护者对自动体外除颤仪(AED)知识、态度和行为(知信行)现状,并探讨其影响因素。方法采用多阶段整群随机抽样法,选取637名西安市冠心病患者主要照护者进行问卷调查。采用AED知信行量表评估调查对象的知信行情况,采用多元线性回归分析调查对象知信行状况的影响因素。结果西安市冠心病患者主要照护者AED知信行平均得分(33.93±9.29)分,3个维度中,知识维度得分(7.62±2.14),态度维度得分(14.09±5.24),行为维度得分(12.22±4.94)。回归分析结果显示,年龄、文化程度、居住地、家庭月收入、患者患病时长、社区宣教、对机器使用技术的恐惧、亲朋心肌梗死经历是影响冠心病患者主要照护者AED知信行的主要因素。结论冠心病患者主要照护者AED知信行水平有待提高,有关部门今后可通过理论加实践宣教切实提高冠心病患者主要照护者AED知信行水平。

杭州市自动体外除颤器智能管理系统设计与应用

目的:协助公众准确快速获取自动体外除颤器(AED)进行救援,实现对杭州市公共场所AED的便捷、科学和高效运维管理。方法:从公众、卫生健康部门、配置单位、AED厂商和急救中心等多个视角,针对AED使用、管理和运维等方面存在的问题,全面梳理业务流程和功能需求,设计和应用自动体外除颤器智能化管理系统,形成智能化解决方案。结果:2022年7月1日至2023年12月31日,全市公共场所共7 486台AED接入系统。系统具备公众查找AED,AED异常状态预警、巡检维护、记录救治信息、线上线下监管等功能,并与120调度指挥系统、互联急救系统互联互通。结论:AED智能管理系统的应用,实现了杭州市公共场所AED统一规范管理和有效运维,完善了立体化应急救援体系,确保AED处于随时可用状态,可帮助公众准确快速获取AED实施救援。

沈阳市公众自动体外除颤器认知度及实施除颤行为意向调查分析

目的调查分析沈阳市公众自动体外除颤器(AED)认知度及实施除颤行为意向的影响因素,为提升沈阳市公众AED认知度及实施除颤行为意向提供理论依据。方法采取便利抽样法,于2022年4—5月对辽宁省沈阳市公众进行问卷调查。结果完全没听过AED的占19.4%;知道名字和作用,但不会操作的占39.0%;愿意对陌生人实施AED急救复苏的占71.3%。沈阳市公众实施除颤行为意向受性别、文化程度、职业、对AED了解程度、是否参加过相关急救培训等多种因素影响。相关分析显示,基本认知、行为态度、感知行为控制维度得分与沈阳市公众实施除颤行为意向均呈正相关关系。结论沈阳市公众AED认知度较低,但实施除颤行为意向水平较高,表明大多数人对使用AED救人行为的态度积极,应提高沈阳市公众AED相关知识与技能水平,优化AED布局与投放方案,促进急救设备共享共用。

厦门市自动体外除颤器空间配置、覆盖能力及可达性分析

基于核密度、缓冲区地理空间分析方法和高斯两步移动搜索模型,结合厦门市人口分布、兴趣点以及地理信息数据,探究厦门市自动体外除颤器的空间配置、覆盖能力和可达性。结果表明:厦门市自动体外除颤器呈现出多级中心-圈层状空间分布形态,中心城区与起步发展区间的设施密度存在明显差异,空间分布不均衡;厦门市自动体外除颤器分布场所类型广,整体空间覆盖能力较好,可达性水平和人口密度之间存在负相关现象,约65.39%的统计区域为可达性盲区。建议厦门市对自动体外除颤器的配置实施因地制宜分区施策、因时制宜适度超前、以风险评估为导向的优化策略,进一步提升其覆盖能力和可达性。

心脏除颤仪自动体外除颤和起搏功能质控检测实践方法探讨

目的 研究心脏除颤仪自动体外除颤和起搏功能的质量控制检测方法,完善心脏除颤仪日常运维管理,保障临床急救能力。方法 根据心脏除颤仪自动体外除颤和起搏的原理,结合各模拟器、质控检测工具的功能情况,研定从自动体外除颤功能的“电击心律识别、自动体外放电时间、释放能量”和起搏功能的“起搏脉冲电流、起搏脉冲宽度、起搏脉率”6个维度进行质控检测。结果 制定自动体外除颤和起搏功能质控表格,研究明确一次性电极片的替代办法,同时通过实测番禺区23台心脏除颤仪,得到电击心律识别检测的合格率为100%,自动体外除颤放电时间、自动除颤释放能量(最大偏差)、起搏脉冲电流(最大偏差)、起搏脉冲宽度(最大偏差)内容均符合规程要求(P<0.05)的质控检测结果。结论 本院制定的心脏除颤仪自动体外除颤和起搏功能质控检测方法能切实检测自动体外除颤和起搏功能的精准性,确保心脏除颤仪功能正常,保障医疗安全。

基于FBM行为模型的自动体外除颤器设计研究

目的依据FBM行为模型,研究如何提高自动体外除颤器的可用性和易用性,从而增加施救者对产品的使用率及成功率,为院外心脏骤停患者赢得更大的生存机会。方法通过对用户体验行为的深入分析,挖掘并总结救助者在救助过程中的体验痛点。依据FBM行为模型,增强施救者的意愿、简化施救的目标行为、并根据动机与能力的差异给予不同提示,从动机、能力、触发机制三方面探究劝导式设计下的自动体外除颤产品设计策略。结果通过劝导策略对自动体外除颤器进行功能规划,促使非专业人士在遇到心脏骤停患者的紧急情况下,也能够正确有效地使用自动体外除颤产品。结论FBM行为模型为提高自动体外除颤产品的可用性和易用性提供了有效的方法指导,进而提高院前复苏率,改善患者预后。

基于多层次语意特征的自动体外除颤器设计

针对当前自动体外除颤器存在的操作门槛,依据产品语意理论对自动体外除颤器进行语意研究,以提高产品的自明性能,降低产品的操作难度。从信息传播的角度分析了影响自动体外除颤器的语意表达因素:语境、符码和用户语意认知,构建了形式——意义——行为的良好用户语意模型以及各影响因素制约下产品语意认知转换框架,依据产品语意认知转换框架将用户的认知和行为与产品语意进行关联映射,最后在获取了自动体外除颤器图标、指示、象征3个层面的语意特征后通过组合、变异等方法结合情境需求进行了设计创新实践。

基层军医除颤技能掌握现状及自动体外除颤仪培训的效果

目的调查基层军医的除颤技能掌握现状,并通过自动体外除颤仪(automated external defibrillator,AED)培训,增强其除颤能力和自信心。方法便利抽样选择参加第二军医大学全科医学培训的基层军医224名,对其进行AED培训,并在培训前后填答相关调查问卷。结果基层军医培训后首次除颤时间、自信心水平、电极片放置准确率、除颤前确保所有人离开患者及除颤后立即重新开始心肺复苏的实施率均优于培训前,差异有统计学意义(均P<0.01)。结论基层军医缺乏实施除颤的经历且很少接受除颤培训,除颤能力和自信心不足;考虑到AED的优势,应为基层部队更多地配置AED以保证早期除颤的实施,同时AED培训可以有效提升基层军医的除颤能力和自信心。

用于低能量除颤的除颤器设计

设计了用于低能量除颤的,可灵活调节放电脉冲宽度和准确测量实际放电能量的除颤器。该除颤器的放电波形为双相指数截尾波,通过人工设置,可释放1-3组双相指数截尾波 放电脉冲的宽度、各脉冲之间的时间间隔可人工灵活调节,最小步长为0.1 ms 可测量放电前后储能电容电压,再根据储能电容的容值准确地计算出实际放电能量。该除颤器在双相指数截尾波的基础上,通过调节放电脉冲的宽度、各脉冲之间的时间间隔及脉冲数量,优化放电波形,达到低能量除颤的目的。已在20余例低能量除颤的动物实验中应用,各项功能符合设计要求。

院前心脏骤停患者心肺复苏时由第一目击者使用自动体外除颤器的优势Meta分析

目的 评价第一目击者在医护急救人员（emergency medical service, EMS）到来之前对院前心脏骤停（out-of-hospital cardiac arrest, OHCA）患者进行心肺复苏（cardiopulmonary resuscitation, CPR）时是否使用自动体外除颤器（automated external defibrillator, AED）对复苏结局的影响。方法 计算机检索在国内外各大数据库公开发表的关于院前心脏骤停患者是否早期使用AED进行CPR的临床队列研究，并对获得文献进行严格的筛选,按照Cochrane Handbook5.1.0质量评价标准评价纳入文献质量并提取有效数据，应用RevMan5.3软件分别对三个结局指标（存活至出院、存活至入院、自主循环恢复）进行Meta分析。结果 纳入10个研究，共计9478例患者，其中由第一目击者应用AED的CPR（CPR＋AED）组3014人，第一目击者未应用AED的CPR（CPR-Only）组6464人。Meta分析结果显示：CPR＋AED相比CPR-Only而言可以提高院前心脏骤停患者的出院生存率，差异有统计学意义（RR=1.48，95%CI 1.35～1.63，P＜0.00001）。在纳入的10项研究中，5项报道了入院存活率，Meta分析结果同样表明：CPR＋AED相比CPR-Only对于提高成年心脏骤停患者的入院生存率也具有一些优势，差异有统计学意义（RR=1.24，95%CI 1.12～1.37，P＜0.0001）。3项研究报道了ROSC，而Meta分析结果表明CPR＋AED与CPR-Only改善患者自主循环恢复（restoration of spontaneous circulation,ROSC）比较差异无统计学意义（RR=1.09，95%CI 1.00～1.19，P=0.05）。结论 在提高院前心脏骤停患者的出院生存率和入院生存率方面，由第一目击者使用自动体外除颤器的CPR效果优于未使用自动体外除颤器或在医护人员到场之后才进行除颤的心肺复苏。