Anne Møller Nielsen

Use and benefits of public access defibrillation in a nation-wide network

BACKGROUND Automated External Defibrillators (AEDs) are known to increase survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the use and benefit of public-access defibrillation (PAD) in a nation-wide network. We primarily sought to assess survival at 1 month but information about the circumstances of each OHCA is provided as well. METHODS In this 28-month study, we assessed the use of 807 AEDs in Denmark. When an AED was deployed information about the circumstances of OHCA, the bystander, the AED and the victims condition was obtained. RESULTS An AED was connected to an OHCA victim prior to the arrival of Emergency Medical Services (EMS) in 48 instances. Ten percent of bystanders were off-duty healthcare professionals. Shockable arrests (N=31, 70%) were significantly more likely to be witnessed (94% vs. 54%) to occur at sports facilities (74% vs. 31%), in relation to exercise (42% vs. 0%), and with improved 30-day survival (69% vs. 15%, p=0.001). Among those presenting with a shockable rhythm, 20 (65%) had Return of Spontaneous Circulation upon arrival of EMS and 8 (26%) were conscious, which emphasizes the diagnostic value of ECG downloads from AEDs. Survival could be determined in 42 of 44 patients with OHCA of cardiac origin, and was 52% (n=22, 95% CI [38-67]) and the Cerebral Performance Category was 1 (Good Cerebral Performance) in all survivors. CONCLUSION With a 30-day neurologically intact survival of 69% for patients with shockable rhythms, this study provides further evidence of the lifesaving potential of PAD.

Can mass education and a television campaign change the attitudes towards cardiopulmonary resuscitation in a rural community

BackgroundSurvival after out-of-hospital cardiac arrest (OHCA) is improved when bystanders provide Basic Life Support (BLS). However, bystander BLS does not occur frequently. The aim of this study was to assess the effects on attitudes regarding different aspects of resuscitation of a one-year targeted media campaign and widespread education in a rural Danish community. Specifically, we investigated if the proportion willing to provide BLS and deploy an automated external defibrillator (AED) increased.MethodsBLS and AED courses were offered and the local television station had broadcasts about resuscitation in this study community. A telephone enquiry assessed the attitudes towards different aspects of resuscitation among randomly selected citizens before (2008) and after the project (2009).ResultsFor responses from 2008 (n = 824) to 2009 (n = 815), there was a significant increase in the proportions who had participated in a BLS course within the past 5 years, from 34% to 49% (p = 0.0001), the number willing to use an AED on a stranger (p < 0.0001), confident at providing chest compressions (p = 0.03), and confident at providing mouth-to-mouth ventilations (MMV) (p = 0.048). There was no significant change in the proportions willing to provide chest compressions (p = 0.15), MMV (p = 0.23) or confident at recognizing a cardiac arrest (p = 0.09). The most frequently reported reason for not being willing to provide chest compressions, MMV and use an AED was insecurity about how to perform the task.ConclusionA targeted media campaign and widespread education can significantly increase the willingness to use an AED, and the confidence in providing chest compressions and MMV. The willingness to provide chest compressions and MMV may be less influenced by a targeted campaign.

Engaging a whole community in resuscitation

BACKGROUND Survival after out-of-hospital cardiac arrest (OHCA) is influenced by each link in the chain of survival. On the Danish island of Bornholm (population 42,000, area 588 km2) none survived an OHCA in 2001-2003. Therefore, we designed a multifaceted community-based approach aiming at strengthening each link in the chain of survival. The purpose of this study was to evaluate the effect of implementation of the intervention on bystander basic life support (BLS) rates and survival to hospital discharge after OHCA. METHODS Laypersons completed 24-min DVD-based-self-instruction BLS courses in schools and workplaces or 4-h BLS/automated external defibrillator (AED) courses. The local television station had broadcasts about resuscitation. The ambulance personnel were trained and the staff at the island hospital completed BLS courses or more advanced courses. RESULTS During 2 years 9226 people (22% of the population) completed the short course and 2453 (6% of the population) completed the 4-h course. The number of AEDs increased from 3 to 147. The bystander BLS rate for OHCAs with a presumed cardiac aetiology (N=96, incidence 114/100,000 person-years) was 47% [95% CI 30-50] and for witnessed OHCAs (N=35) it increased significantly from 22% (2004) to 74% [95% CI 58-86]. The AEDs were deployed in 9 cases. Survival to discharge for all-rhythms OHCA was 5.4% [95% CI 2-12], and for witnessed ventricular fibrillation (N=17) 18% [95% CI 5-42]. CONCLUSION Strengthening all links in the chain of survival was associated with significant increases in bystander BLS rates and survival after OHCA on a rural island.

Distributing personal resuscitation manikins in an untrained population: how well are basic life support skills acquired?

Background Self-instruction with a DVD and a simple personal manikin is an effective alternative to traditional basic life support (BLS) courses. Objective To evaluate the effect of distributing DVD training kits to untrained laypersons. BLS skills were compared according to 2005 guidelines for resuscitation after 3.5 months with those obtained in untrained laypersons who completed the same course with instructor facilitation. Methods BLS skills of 55 untrained laypersons were assessed using the Laerdal ResusciAnne and PC Skill Reporting System in a 3 min test and a total score (12–48 points) was calculated. The participants received a DVD training kit without instructions. The test was repeated after 3.5 months. Data were compared with data from a previous published study where participants completed the same course in groups with instructor facilitation. Results There was no statistically significant difference in the total score after 3.5 months. The ‘DVD—self-instructor’ group obtained 33 (29–37) points and the ‘DVD—with instructor’ group obtained 34 (32–37) points, p=0.16. The ‘DVD—with instructor’ group performed significantly better in checking responsiveness and had a significantly shorter ‘total hands-off time’ (s) (85 (76–94) vs 96 (82–120), p=0.002) and delay until first compression or ventilation group (29 s (17–40) vs 33 s (22–48), p=0.04). Conclusions Since no significant difference in total BLS score was found after 3.5 months between untrained laypersons who either completed a DVD-based BLS course in groups with instructor facilitation or received the same DVD training kit without instruction, the latter seems more efficient.

Data management in automated external defibrillators: a call for a standardised solution

Background: The ECG data stored in automated external defibrillators (AEDs) may be valuable for establishing a final diagnosis and deciding further diagnostics and treatment. Different data management systems are used and this may create significant problems for data storage and access for physicians treating victims in whom an AED has been used.

Persisting effect of community approaches to resuscitation

BACKGROUND On the Danish island of Bornholm an intervention was carried out during 2008-2010 aiming at increasing out-of-hospital cardiac arrest (OHCA) survival. The intervention included mass media focus on resuscitation and widespread educational activities. The aim of this study was to compare the bystander BLS rate and survival after OHCA on Bornholm in a 3-year follow-up period after the intervention took place. METHODS Data on OHCA on Bornholm were collected from September 28th, 2010 to September 27th, 2013 and compared to data from the intervention period, September 28th, 2008 to September 27th, 2010. RESULTS The bystander BLS rate for non-EMS witnessed OHCAs with presumed cardiac aetiology was significantly higher in the follow-up period (70% [95% CI 61-77] vs. 47% [95% CI 37-57], p=0.001). AEDs were deployed in 22 (18%) cases in the follow-up period and a shock was provided in 13 cases. There was no significant change in all-rhythm 30-day survival for non-EMS witnessed OHCAs with presumed cardiac aetiology (6.7% [95% CI 3-13] in the follow-up period; vs. 4.6% [95% CI 1-12], p=0.76). CONCLUSION In a 3-year follow-up period after an intervention engaging laypersons in resuscitation through mass education in BLS combined with a media focus on resuscitation, we observed a persistent significant increase in the bystander BLS rate for all OHCAs with presumed cardiac aetiology. There was no significant difference in 30-day survival.

Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting

BackgroundAmbulance personnel play an essential role in the ‘Chain of Survival’. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island.MethodsThe Basic Life Support (BLS) and Automated External Defibrillator (AED) skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given.ResultsOn 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2) was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm). The mean compression rate was 123 per min (SD 15/min). The mean tidal volume was 746 ml (SD 221 ml). Only the mean tidal volume deviated significantly from the recommended (p = 0.01).During the rhythm analysis, 65% did not perform any visual or verbal safety check.ConclusionThe EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.

Engaging a whole community in resuscitation – ‘Bornholm to the rescue’

O cardiac arrest (OHCA) is a major public health problem with survival rates generally below 10%. On the Danish Island of Bornholm (588 km, population 42,000), 22% of witnessed OHCA patients received bystander basic life support (BLS) in 2004, and none survived an OHCA in 2001–2003. Therefore, we designed a multifaceted community-based approach aiming at strengthening each link in the chain of survival. The local television station had broadcasts about resuscitation. Short 24-min DVD-based BLS courses (MiniAnne) and 4-h BLS/automated external defibrillator (AED) courses were offered to laypersons. A telephone enquiry assessed attitudes regarding resuscitation. The ambulance personnel were trained, and staff at the hospital completed resuscitation courses. Untrained laypersons who completed the MiniAnne course in groups had a significantly improved BLS performance after 3/2 to 4 months and especially the number of chest compressions and the ‘hands-on’ time improved. Untrained laypersons, among who the training kit was distributed, had obtained equal improvements at 3/2 months. The telephone enquiry revealed that the proportion willing to use an AED increased significantly, whereas the willingness to provide chest compressions and mouth-to-mouth ventilations remained unchanged. The number of AEDs increased from 3 to 147, and they were used in 9% of all OHCA. The data on cardiac rhythm stored in the AEDs provided decisive diagnostic and therapeutic information in several cases. The ambulance personnel obtained 70% of the maximal achievable points in a resuscitation assessment. There was a tendency toward hyperventilation, and chest compressions were performed at a too high rate. In the 2-year project period from September 2008 to September 2010, there was 96 OHCA with a presumed cardiac etiology. Bystander BLS was provided in 47% of all OHCA, and for the witnessed OHCA, the bystander BLS rate was 74%. The overall survival to hospital discharge was 5.4%, and for the witnessed OHCA with an initial shockable rhythm, the survival rate was 18%. The multifaceted approach was associated with significant increases in bystander BLS rates and survival after OHCA on a rural island.