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Locational effect on automated external defibrillator use and association of age with on-site return of spontaneous circulation

  • Tsung-Hsi Wang
    Affiliations
    Taipei Economic and Cultural Representative Office in the United States

    School of Medicine, National Yang-Ming University, Taiwan, ROC

    Graduate Institute for cancer biology and drug delivery, Taipei Medical University, Taipei, Taiwan, ROC
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  • Hui-An Lin
    Affiliations
    Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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  • Wei-Fong Kao
    Affiliations
    Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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  • Chun-Chieh Chao
    Correspondence
    Corresponding author at: 252, Wu-Xing Street, Taipei 105, Taiwan, ROC.
    Affiliations
    Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC

    Graduate Institute of Clinical Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
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Published:October 20, 2018DOI:https://doi.org/10.1016/j.ajem.2018.10.043

      Abstract

      Background

      Emergency medical services (EMSs) are used by approximately 383,000 patients with out-of-hospital sudden cardiac arrest (SCA) in the United States. Hence, it is crucial to implement automated external defibrillator (AED) programs to prepare responders for an SCA emergency. Taiwanese pass legislature to enforce AED installation in 8 mandatory areas since 2013. Our study investigated the efficacy of the policy regarding AED installation.

      Materials and methods

      We collected data of patients who had sudden cardiac arrest (SCA) in pre-hospital settings, and received resuscitative efforts, including cardiopulmonary resuscitation or defibrillation with AEDs. The data were from July 11, 2013 to July 31, 2015. In total, 209 adult patients were documented by on-site caregivers of different facilities, and a report was mailed to the central health and welfare unit.

      Results

      Schools, large-scale gathering places, and special institutions used AEDs the most, accounting for 33 (15.3%) cases. From non-mandatory AED areas, long-term care facilities had the maximum cases of AED use (32 cases; 14.9%). With commuting stations as a reference, long-distance transport had the lowest odds ratio (OR) of 0.481 (95% confidence interval [CI], 0.24–0.962). The OR for schools, large-scale gathering places, and special institutions was 4.474 (95% CI: 2.497–8.015). Regarding failure of return of spontaneous circulation (ROSC), the OR for the ≥80-year age group was higher than that for the 20–39-year age group.

      Conclusions

      The policy regarding the legislation to install AEDs in mandatory areas improved AED accessibility. Elderly patients aged ≥80 years have a higher rate of ROSC failure.
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