糖心vlog

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. Bystander response is critical to improved OHCA outcomes, and bystander automated external defibrillator (AED) placement can more than double a patient鈥檚 odds of survival through early defibrillation (public access defibrillation [PAD]). However, despite its substantial potential, bystander AED application is dismally rare; only 2% of individuals who experienced OHCA in the US received bystander AED application.¹ Although these rates are higher in public settings,¹ efforts to date have failed to move the needle regarding bystander AED application. Understanding barriers to increased bystander AED use is essential to optimizing this life-saving bystander intervention.

To investigate this topic, Huang et al² conducted a prospective, nationwide survey in Taiwan to evaluate factors associated with bystander AED use. Through a professional polling agency, they contacted Taiwanese citizens by telephone and invited them to participate in an 18-item questionnaire to assess participant demographics, knowledge about AEDs, attitudes regarding AEDs, and willingness to apply AEDs. They then evaluated factors associated with awareness of the nearest AED location.

Their study included 1083 respondents with only 5% identifying as health care professionals. Most participants acknowledged the importance of the general public learning to use AEDs (89.4%) and wanted to be able to use an AED on a stranger (86.6%). However, familiarity with AEDs and expressed ability to use an AED were lacking; most participants (63.8%) were not familiar with the use of AEDs, and nearly two-thirds of participants (65.0%) had not participated in an AED training course. Although familiarity with AEDs is essential to successful AED application, another crucial consideration is AED accessibility. Few participants in the study knew where the closest AED was to their home (20.5%), public transportation (14.9%), or workplace (34.2%). However, across all 3 location categories, confidence with AED identification was associated with knowing where the nearest AED was.

Although increasing the geographic density of AEDs could improve accessibility, this approach may not be cost-effective. One option to increase AED access is through AED mobilization. An exciting approach is AED drone delivery, where AEDs are delivered via drone to individuals experiencing OHCA before the arrival of first responders or emergency medical services (EMS). Schierbeck et al³ demonstrated the feasibility of drone-delivered AEDs in their prospective study, and drone-delivered AEDs improved the time to AED application by nearly a minute. Although this solution comes with its own cost considerations, drone delivery might increase access to AEDs for individuals experiencing OHCA, particularly for residential or rural locations that do not commonly have AEDs. Another novel solution to addressing access is through crowdsourced volunteer responder programs. One example is a smartphone application in Denmark that alerts volunteer responders to nearby individuals who are experiencing cardiac arrest and guides them to nearby AEDs. For individuals who experienced cardiac arrest and had at least 1 volunteer responder, the rate of AED application doubled.⁴ The use of volunteer responders addresses the difficulties with broad AED education dissemination while also mobilizing AEDs, increasing the use of AEDs by dedicated bystanders for minimal investment.

Even if accessibility is improved, high-quality and widely accessible AED training is a key component of the solution. Although traditional AED training is either expensive or limited in availability because of requiring volunteer trainers, novel use of technology may provide an economical solution. Leary et al⁵ designed a virtual reality app that uses an inexpensive cardboard virtual reality smartphone adapter, making AED education nearly free and very easy to disseminate. They found that most virtual reality鈥搕rained responders asked for and applied the AED during a simulated cardiac arrest. The low rate of AED training and knowledge in the US, and beyond, could also be because of how we simplify messaging of bystander care. In the US, bystanders are asked to (1) call 9-1-1 and (2) push hard and fast. Although this messaging is clear and concise, AED use is notably excluded. As a resuscitation community, we should consider increasing public awareness through messaging that includes AED use, for example, 鈥渃all, push, shock鈥濃��(1) call 9-1-1, (2) push hard and fast, and (3) use an AED if available.

Improving AED use has special importance for populations that may receive bystander interventions at lower rates. Although socioeconomic status, race, and ethnicity were not included in the survey, our research in the US found that patients who experienced OHCA from majority Black, majority Latino, and low-income communities received bystander AED placement at much lower rates.⁶ There is also an important association between gender and AED application, with women, particularly of reproductive age, receiving bystander AED application half as often as men.⁷ In their study, Huang et al² did find that men more commonly knew where the nearest AED was, but the 0% to 30% relative difference based on location is unlikely to account for the large AED gender gap found in prior studies. One proposed reason for lower AED placement rates for women is the fear of undressing a woman in public and the potential legal repercussions from being seen as assaulting a woman. Thus, awareness of Good Samaritan laws could increase a bystander鈥檚 willingness to apply an AED on a female patient experiencing OHCA. Future studies may consider evaluating comfort with applying an AED on men compared with women to improve our understanding of methods to address these gender disparities.

The study by Huang et al⁷ has its limitations. Although the demographics of their participants were representative of the Taiwanese population as a whole, interest in bystander AEDs might have influenced a participant鈥檚 willingness to complete the survey. It is also not known if participant responses reflect what they might actually do in the event of an OHCA. However, these 2 factors are likely to have overestimated AED placement familiarity, further strengthening their findings.

Although bystander AED application rates are abysmally low and familiarity remains lacking, enthusiasm and acknowledgment of AED鈥檚 importance are encouragingly high. Work such as that of Huang et al⁷ pave the road for researchers to better grasp this gap between desire and ability. Paired with an ever-growing group of researchers developing novel solutions to ameliorate AED accessibility and education gaps, bystander PAD has a bright future.

Published: October 10, 2024. doi:10.1001/jamanetworkopen.2024.38286

Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Huebinger R et al. 糖心vlog Open.

Corresponding Author: Ryan Huebinger, MD, Department of Emergency Medicine, University of New Mexico, One University of New Mexico, MSC11 6025, Albuquerque, NM 87131 (rhuebinger@salud.unm.edu).

Conflict of Interest Disclosures: Dr Blewer reported receiving grant K12HD043446 from the National Institutes of Health (NIH), grant 23HERNPRH1150361 from the American Heart Association, and grants from NIH/National Heart, Lung, and Blood Institute and the Laerdal Foundation outside the submitted work. No other disclosures were reported.