Cheating time in the race to assist victims of sudden cardiac arrest

Cheating time in the race to assist victims of sudden cardiac arrest

If international best practice for ambulance response times is eight minutes, and a person who has suffered a sudden cardiac arrest’s chances of survival decrease by 10 per cent for every minute without treatment, it’s no wonder emergency medical services (EMS) are constantly looking to close the gap.

A Google search of “drone delivery of AED”, for example – an AED being an automated external defibrillator – brings up more than two million links.  This is not a new idea; it is being taken seriously by emergency services around the world, looking for ways to decrease the time it takes to provide treatment to a victim of out-of-hospital cardiac arrest (OHCA).

One example of a proof-of-concept study in the US published in Resuscitation in late 2020 demonstrated surprisingly few issues with a bystander receiving a drone-delivered AED, and following application instructions given by a medical professional over the phone.

(If you’re interested, this article provided plenty of links to similar studies from other parts of the planet.  Get through those, and there are always the aforementioned Google search results to fall back on.)

AED delivery-by-drone is just one way technology is being applied to the problem of the so-called time trap – those minutes between an OHCA, and the arrival of medical personnel.  Before a drone can be dispatched, however, someone nearby has to step in, call emergency services, be willing and able to apply CPR – and once it arrives, use the AED.

The fact remains that without these willing bystanders, survivability of OHCA will remain low.  Of the many studies we have seen, estimations of OHCA survivability range from 10 per cent at their most optimistic, to as low as below one per cent.

The low survivability of OHCA is a global problem.  As an organisation dedicated to addressing this problem, we take a global approach – but we are first and foremost, an Australian-grown and based operation.  From those origins stems a parochial sense of pride at the pioneering work of other Australian institutions to find ways to tackle problems contributing to OHCA’s high death rate around the world.

One such study no doubt influenced today’s push to prove that drone-delivered AEDs can make a difference.  Published in 2004, a report by researchers who analysed data from the Victorian Ambulance Cardiac Arrest Registry found that:

“Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival…(M)ore widespread availability of AEDs may further improve outcomes of OHCA in public places.”

Studies like this one, that advocate for the role of public defibrillation in efforts to improve OHCA survivability, provide the scientific evidence proving the positive impact early defibrillation has for OHCA patients.

A focus on delivery technology, however, misses the main point: will there be someone there who is willing to use it?  A study of OHCA data collected from hospitals across the United States, for example, showed 41 per cent of events occurred near an AED that was not used.

As this clinical paper led by Monash University – also in Victoria, Australia – surmised, “increasing the ability and willingness of bystanders to provide immediate bystander CPR and early defibrillation offers the greatest opportunities for improving survival rates from OHCA.”

In the future, there’s no doubt that ambition could be aided by drone deliveries.  For now though, the focus should be on helping more people in our communities feel confident and skilled enough to step in.

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