The general public’s ability to operate automated external defibrillator: A controlled simulation study

doi:10.5847/wjem.j.1920-8642.2020.04.006

Abstract

Abstract:

BACKGROUND: Automated external defibrillators (AEDs) enable laypeople to provide early defibrillations to patients undergoing cardiac arrest, but scant information is available on the general public’s ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age.

METHODS: From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants’ AED skills were assessed individually pre-training, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process.

RESULTS: Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defibrillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defibrillations increased significantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defibrillations, which was significantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test.

CONCLUSIONS: The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.

Key words: Automated external defibrillator, Cardiac arrest, General public, Training, Simulation

Xue-jie Dong, Lin Zhang, Yue-lin Yu, Shu-xiao Shi, Xiao-chen Yang, Xiao-qian Zhang, Shuang Tian, Helge Myklebust, Guo-hong Li, Zhi-jie Zheng. The general public’s ability to operate automated external defibrillator: A controlled simulation study[J]. World Journal of Emergency Medicine, 2020, 11(4): 238-245.

Figures/Tables 6

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Table 1

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Figure 3.

Table 3

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Critical actions	Pre-training (n=94)	Post-training (n=94)	Three-month follow-up^a (n=82)	P-value^b (pre-training vs. post-training)	P-value^b (post-training vs. follow-up)
Successful defibrillations	14 (14.9)	66 (70.2)	41 (50.0)	<0.001	0.01
Turning on the AED	94 (100.0)	94 (100.0)	82 (100.0)	-	-
Baring the chest	59 (62.8)	94 (100.0)	75 (91.4)	<0.001	0.01
Placing the electrodes	66 (70.2)	94 (100.0)	78 (95.1)	<0.001	0.05
Correct electrode placement	17 (18.1)	72 (76.6)	44 (53.7)	<0.001	<0.01
Attaching the connector	94 (100.0)	94 (100.0)	82 (100.0)	-	-
Clear while AED analyzes the rhythm	72 (76.6)	86 (91.5)	76 (92.7)	0.005	0.79
Clear while AED delivers the shock	87 (92.6)	93 (98.9)	79 (96.3)	0.070	0.34
Pressing the shock button	94 (100.0)	94 (100.0)	82 (100.0)	-	-
Resuming CPR after shock	9 (9.6)	82 (87.2)	46 (56.1)	<0.001	<0.01

Critical actions	Pre-training				Post-training				Three-month follow-up^a
Critical actions	18-24 (n=32)	25-54 (n=34)	55-65 (n=28)	P-value^b	18-24 (n=32)	25-54 (n=34)	55-65 (n=28)	P-value^b	18-24 (n=31)	25-54 (n=28)	55-65 (n=23)	P-value^b
Successful defibrillations	8 (25.0)	4 (11.8)	2 (7.1)	0.15	23 (71.9)	24 (70.6)	19 (67.9)	0.96	17 (54.8)	18 (64.3)	6 (26.1)	0.02
Turning on the AED	32 (100.0)	34 (100.0)	28 (100.0)	-	32 (100.0)	34 (100.0)	28 (100.0)	-	31 (100.0)	28 (100.0)	23 (100.0)	-
Baring the chest	27 (84.4)	25 (73.5)	7 (25.0)	<0.01	32 (100.0)	34 (100.0)	28 (100.0)	-	30 (96.8)	26 (92.9)	19 (82.6)	0.37
Placing the electrodes	31 (96.9)	26 (76.5)	9 (32.1)	<0.01	32 (100.0)	34 (100.0)	28 (100.0)	-	31 (100.0)	27 (96.4)	20 (87.0)	0.06
Correct electrode placement	10 (31.3)	4 (11.8)	3 (10.7)	0.06	27 (84.4)	24 (70.6)	21 (75.0)	0.41	17 (54.8)	18 (64.3)	6 (26.1)	0.02
Attaching the connectors	32 (100.0)	34 (100.0)	28 (100.0)	-	32 (100.0)	34 (100.0)	28 (100.0)	-	31 (100.0)	28 (100.0)	23 (100.0)	-
Clear while AED analyzes the rhythm	27 (84.4)	27 (79.4)	18 (64.3)	0.17	27 (84.4)	33 (97.1)	26 (92.9)	0.18	28 (90.3)	28 (100.0)	20 (87.0)	0.17
Clear while AED delivers the shock	31 (96.9)	34 (100.0)	22 (78.6)	0.01	31 (96.9)	34 (100.0)	28 (100.0)	0.38	28 (90.3)	28 (100.0)	23 (100.0)	0.11
Pressing the shock button	32 (100.0)	34 (100.0)	28 (100.0)	-	32 (100.0)	34 (100.0)	28 (100.0)	-	31 (100.0)	28 (100.0)	23 (100.0)	-
Resuming CPR after shock	3 (9.4)	4 (11.8)	2 (7.1)	0.91	26 (81.3)	30 (88.2)	26 (92.9)	0.43	22 (71.0)	20 (71.4)	4 (17.4)	<0.01

Time intervals	Pre-training				Post-training				Three-month follow-up
Time intervals	18-24 (n=8)	25-54 (n=4)	55-65 (n=2)^b	P-value^c	18-24 (n=23)	25-54 (n=24)	55-65 (n=19)	P-value^c	18-24 (n=17)	25-54 (n=18)	55-65 (n=6)	P-value^c
Time for power on	79 (20-155)	28 (13-92)	18, 39	0.06	26 (11-52)	17 (10-43)	20 (12-56)	0.38	31 (22-53)	29 (17-52)	32 (9-41)	0.07
Time to start baring chest	42 (31-65)	44 (41-51)	1, 19	0.55	12 (4-17)	16 (6-25)	14 (1-22)	0.48	4 (1-11)	9 (3-24)	15 (10-31)	0.14
Time for baring the chest	12 (8-15)	8 (7-10)	4, 5	0.08	7 (6-8)	7 (6-9)	6 (6-7)	0.54	6 (6-10)	8 (6-10)	8 (7-8)	0.78
Time for placing the electrodes	24 (18-36)	23 (17-45)	14, 17	0.03	16 (13-23)	17 (11-23)	16 (13-19)	0.60	20 (18-22)	19 (14-23)	16 (13-18)	0.02
Time for inserting the plug	8 (4-11)	6 (3-8)	5, 7	0.94	4 (2-4)	3 (2-6)	3 (3-5)	0.10	4 (3-7)	3 (2-5)	6 (4-6)	0.41
Time for AED indicating a shock	113 (99-177)	105 (100-125)	81, 88	0.09	73 (62-83)	79 (66-86)	76 (72-82)	0.96	78 (73-87)	74 (63-90)	86 (72-103)	0.33
Time for response to shock instruction	3 (3-4)	5 (3-5)	4, 4	0.31	2 (1-3)	3 (2-4)	3 (2-4)	0.01	4 (2-4)	4 (2-5)	5 (3-6)	0.56
Time for shock	117 (102-181)	110 (105-128)	85, 92	0.09	76 (63-86)	82 (69-91)	79 (77-86)	0.90	80 (76-90)	78 (68-95)	93 (75-106)	0.38
Time for resuming CPR after shock	6 (1-12)	15 (12-15)	16, 16	0.23	9 (6-10)	9 (8-10)	10 (9-12)	0.01	12.5 (6-20)	9 (8-11)	9 (9-9)	0.16

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