JOURNAL ARTICLE

Improper bystander-performed basic life support in cardiac arrests managed with public automated external defibrillators

Taiki Nishi, Yutaka Takei, Takahisa Kamikura, Keisuke Ohta, Masaaki Hashimoto, Hideo Inaba
American Journal of Emergency Medicine 2015, 33 (1): 43-9
25455048

AIM: The aim of the study was to determine the quality of basic life support (BLS) in out-of-hospital cardiac arrests (OHCAs) receiving bystander cardiopulmonary resuscitation (CPR) and public automated external defibrillator (AED) application.

METHODS: From January 2006 to December 2012, data were prospectively collected from OHCA) and impending cardiac arrests treated with and without public AED before emergency medical technician (EMT) arrival. Basic life support actions and outcomes were compared between cases with and without public AED application. Interruptions of CPR were compared between 2 groups of AED users: health care provider (HCP) and non-HCP.

RESULTS: Public AEDs were applied in 10 and 273 cases of impending cardiac arrest and non-EMT-witnessed OHCAs, respectively (4.3% of 6407 non-EMT-witnessed OHCAs). Defibrillation was delivered to 33 (13.3%) cases. Public AED application significantly improved the rate of 1-year neurologically favorable survival in bystander CPR-performed cases with shockable initial rhythm but not in those with nonshockable rhythm. Emergency calls were significantly delayed compared with other OHCAs without public AED application (median: 3 and 2 minutes, respectively; P < .0001). Analysis of AED records obtained from 136 (54.6%) of the 249 cases with AED application revealed significantly lower rate of compressions delivered per minute and significantly greater proportion of CPR pause in the non-HCP group. Time interval between power on and the first electrocardiographic analysis widely varied in both groups and was significantly prolonged in the non-HCP group (P = .0137).

CONCLUSIONS: Improper BLS responses were common in OHCAs treated with public AEDs. Periodic training for proper BLS is necessary for both HCPs and non-HCPs.

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