Layperson’s performance on an unconversant type of AED device: A prospective crossover simulation experimental study

doi:10.5847/wjem.j.1920-8642.2022.024

Abstract

Abstract:

BACKGROUND: Diverse models of automated external defibrillators (AEDs) possess distinctive features. This study aimed to investigate whether laypersons trained with one type of AED could intelligently use another initial contact type of AED with varying features.
METHODS: This was a prospective crossover simulation experimental study conducted among college students. Subjects were randomly trained with either AED1 (AED1 group) or AED2 (AED2 group), and the AED operation performance was evaluated individually (Phase I test). At the 6-month follow-up AED performance test (Phase II test), half of the subjects were randomly switched to use another type of AED, which formed two switches (Switch A: AED1-1 group vs. AED2-1 group; Switch B: AED2-2 group vs. AED1-2 group).
RESULTS: A total of 224 college students participated in the study. In the phase I test, a significantly higher proportion of successful defibrillation and shorter shock delivery time to achieve successful defibrillation was observed in the AED2 group than in the AED1 group. In the phase II test, no statistical differences were observed in the proportion of successful defibrillation in Switch A (51.4% vs. 36.6%, P=0.19) and Switch B (78.0% vs. 53.7%, P=0.08). The median shock delivery time within participants achieving successful defibrillation was significantly longer in the switched group than that of the initial group in both Switch A (89 [81-107] s vs. 124 [95-135] s, P=0.006) and Switch B (68 [61.5-81.5] s vs. 95.5 [55-131] s, P<0.001).
CONCLUSION: College students were able to effectively use AEDs different from those used in the initial training after six months, although the time to shock delivery was prolonged.

Key words: Automated external defibrillator, Layperson, Cardiac arrest, Simulation

Chao-yu Lei, Heng-wei Qin, Xue-jie Dong, Jia-lin You, Lin Zhang. Layperson’s performance on an unconversant type of AED device: A prospective crossover simulation experimental study[J]. World Journal of Emergency Medicine, 2022, 13(2): 98-105.

Figures/Tables 4

Table 1

Figure 1.

Figure 2.

Figure 3.

References 21

1	You JS, Park S, Chung SP, Park JW. Performance of cellular phones with video telephony in the use of automated external defibrillators by untrained laypersons. Emerg Med J. 2008; 25(9):597-600. doi: 10.1136/emj.2008.058503 pmid: 18723715
2	Marenco JP, Wang PJ, Link MS, Homoud MK, Estes NA. Improving survival from sudden cardiac arrest: the role of the automated external defibrillator. JAMA. 2001; 285(9):1193-200. doi: 10.1001/jama.285.9.1193
3	England H, Weinberg PS, Estes NAM. The automated external defibrillator: clinical benefits and legal liability. JAMA. 2006; 295(6):687-90. pmid: 16467238
4	Takata TS, Page RL, Joglar JA. Automated external defibrillators: technical considerations and clinical promise. Ann Intern Med. 2001; 135(11):990-8. pmid: 11730400
5	Merchant RM, Topjian AA, Panchal AR, Cheng A, Aziz K, Berg KM, et al. Part 1: executive summary: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142(16_suppl_2):S337-57. doi: 10.1161/CIR.0000000000000918 pmid: 33081530
6	Kitamura T, Iwami T, Kawamura T, Ken NG, Tanaka H, Hiraide A, et al. Nationwide public-access defibrillation in Japan. N Engl J Med. 2010; 362(11):994-1004. doi: 10.1056/NEJMoa0906644
7	Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2017; 120:77-87. doi: S0300-9572(17)30602-0 pmid: 28888810
8	Ringh M, Jonsson M, Nordberg P, Fredman D, Hasselqvist-Ax I, Håkansson F, et al. Survival after public access defibrillation in Stockholm, Sweden - A striking success. Resuscitation. 2015; 91:1-7. doi: 10.1016/j.resuscitation.2015.02.032
9	Dong XJ, Zhang L, Yu YL, Shi SX, Yang XC, Zhang XQ, et al. The general public’s ability to operate automated external defibrillator: a controlled simulation study. World J Emerg Med. 2020; 11(4):238-45. doi: 10.5847/wjem.j.1920-8642.2020.04.006
10	Savastano S, Vanni V, Burkart R, Raimondi M, Canevari F, Molinari S, et al. Comparative performance assessment of commercially available automatic external defibrillators: a simulation and real-life measurement study of hands-off time. Resuscitation. 2017; 110:12-7. doi: S0300-9572(16)30509-3 pmid: 27780740
11	Roccia WD, Modic PE, Cuddy MA. Automated external defibrillator use among the general population. J Dent Educ. 2003; 67(12):1355-61. pmid: 14733268
12.	Woollard M, Whitfield R, Newcombe RG, Colquhoun M, Vetter N, Chamberlain D. Optimal refresher training intervals for AED and CPR skills: a randomised controlled trial. Resuscitation. 2006; 71(2):237-47. pmid: 17010497
13	Bhanji F, Donoghue AJ, Wolff MS, Flores GE, Halamek LP, Berman JM, et al. Part 14: Education: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(18 Suppl 2):S561-73. doi: 10.1161/CIR.0000000000000268
14	Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Education and implementation of resuscitation section Collaborators, Collaborators. European Resuscitation Council guidelines for resuscitation 2015: Section 10. Education and implementation of resuscitation. Resuscitation. 2015; 95:288-301. doi: 10.1016/j.resuscitation.2015.07.032
15	Eames P, Larsen PD, Galletly DC. Comparison of ease of use of three automated external defibrillators by untrained lay people. Resuscitation. 2003; 58(1):25-30. pmid: 12867306
16	Mosesso VN Jr, Shapiro AH Jr, Stein K Jr, Burkett K Jr, Wang H Jr. Effects of AED device features on performance by untrained laypersons. Resuscitation. 2009; 80(11):1285-9. doi: 10.1016/j.resuscitation.2009.07.016
17	Percival NB, Pearson A, Jones J, Wilkins M, Caird JK. Ease of use of automated external defibrillators (AEDs) by older adults. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2012; 56(1):906-10.
18	Alliance GR. the WeCan CPR Training Program in China. 2020. Available at: https://www.globalresuscitationalliance.org/wp-content/uploads/2019/12/China_Community_Training.pdf .
19	Deakin CD, Nolan JP, Soar J, Sunde K, Koster RW, Smith GB, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010; 81(10):1305-52. doi: 10.1016/j.resuscitation.2010.08.017
20	Andre AD, Jorgenson DB, Froman JA, Snyder DE, Poole JE. Automated external defibrillator use by untrained bystanders: Can the public-use model work? Prehospital Emerg Care. 2004; 8(3):284-91.
21	Kleinman ME, Brennan EE, Goldberger ZD, Swor RA, Terry M, Bobrow BJ, et al. Part 5: adult basic life support and cardiopulmonary resuscitation quality: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(18 Suppl 2):S414-35. doi: 10.1161/CIR.0000000000000259

Features		AED1	AED2
Power-on mechanism		On/off button inside of zippered box	On/off button outside of clamshell box
Pad design		Two-piece in an individual bag; Manually connected plug	One-piece; Pre-connected plug
Visual prompts		On pads, device, and handbook	On pads and device only; No handbook
Voice instructions
	Self-check	/	Units OK
	Response check	/	Check patient response
	Call for help	/	Call for help
	Pad placement	Place pads as figure shown. Insert the plug into the lighting socket. Place the pads and insert the plug (3 times). Place the pads and firmly press the plug.	Place the pads. (repeating every 8 s)
	Rhythm analysis	“Don’t touch the patient. Rhythm analysis in progression (twice).”	“Rhythm analysis in progression. Don’t touch the patient.”
	Defibrillation prompt	“Defibrillation recommended. Don’t touch the patient.”	“Defibrillation recommended. Charging now. Don’t touch the patient.”
	Shock delivery	“Press defibrillation button.” (button lighting and then sounding)	“Defibrillation now. Press the orange button.” (sounding and then button lighting)
	Resuming CPR	“Shock completed.” Pause “Start CPR if necessary.”	“Shock completed. Resume CPR please.” (compression tone sounding)

[1]	Young Min Kim, Hyun Seok Chai, Gwan Jin Park, Sang Chul Kim, Hoon Kim, Seok Woo Lee, Hyeon Jeong Park, Han Bit Kim, Hyo Been Lee, Ji Han Lee. Effect of bag valve ventilation versus mechanical ventilation after endotracheal intubation during cardiopulmonary resuscitation on outcomes following out-of-hospital cardiac arrest: a propensity score analysis [J]. World Journal of Emergency Medicine, 2025, 16(4): 313-320.
[2]	Rui Shao, Chenchen Hang, Xingsheng Wang, Luying Zhang, Fei Shao, Ziren Tang. The “SOOTEST-ICU” bundle for optimizing cerebral hypoxia and reperfusion to minimize brain injury after resuscitation from cardiac arrest [J]. World Journal of Emergency Medicine, 2025, 16(3): 206-211.
[3]	Jie Chen, Zhonghao Li, Xiaoyu Liu, Tianpeng Hu, Nan Gao, Weijian Zhang, Guoqiang Zhang. Potential common key genes associated with myocardial dysfunction and brain injury following cardiac arrest resuscitation in a rat model [J]. World Journal of Emergency Medicine, 2025, 16(3): 231-238.
[4]	Tingting Xu, Shaokun Wang, Liqiang Zhao, Jiawen Wang, Jihong Xing. A two-sample Mendelian randomization study on the relationship of body weight, body mass index, and waist circumference with cardiac arrest [J]. World Journal of Emergency Medicine, 2025, 16(2): 129-135.
[5]	Wachira Wongtanasarasin, Daniel K. Nishijima, Wanrudee Isaranuwatchai, Jeffrey S. Hoch. Real-world cost-effectiveness of targeted temperature management in out-of-hospital cardiac arrest survivors: results from an academic medical center [J]. World Journal of Emergency Medicine, 2025, 16(1): 28-34.
[6]	Subi Abudurexiti, Shihai Xu, Zhangping Sun, Yi Jiang, Ping Gong. Glucose metabolic reprogramming-related parameters for the prediction of 28-day neurological prognosis and all-cause mortality in patients after cardiac arrest: a prospective single-center observational study [J]. World Journal of Emergency Medicine, 2024, 15(3): 197-203.
[7]	Jing Yang, Hanqi Tang, Shihuan Shao, Feng Xu, Yangyang Fu, Shengyong Xu, Chen Li, Yan Li, Yang Liu, Joseph Harold Walline, Huadong Zhu, Yuguo Chen, Xuezhong Yu, Jun Xu. A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study [J]. World Journal of Emergency Medicine, 2024, 15(1): 16-22.
[8]	Rashed Alremeithi, Quincy K. Tran, Megan T. Quintana, Soroush Shahamatdar, Ali Pourmand. Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers [J]. World Journal of Emergency Medicine, 2024, 15(1): 3-9.
[9]	Ganying Huang, Huijie Yang, Huan Yao, Xinxin Fan, Wenqin Xia, Yuansheng Xu, Xiaoling Shen, Xue Zhao. Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project [J]. World Journal of Emergency Medicine, 2024, 15(1): 41-46.
[10]	Gannan Wang, Zhe Wang, Yi Zhu, Zhongman Zhang, Wei Li, Xufeng Chen, Yong Mei. The neuro-prognostic value of the ion shift index in cardiac arrest patients following extracorporeal cardiopulmonary resuscitation [J]. World Journal of Emergency Medicine, 2023, 14(5): 354-359.
[11]	Qiang Zhou, Xuejie Dong, Wei Zhang, Rengyu Wu, Kaizhu Chen, Hongjuan Zhang, Zhijie Zheng, Lin Zhang. Effect of a low-cost instruction card for automated external defibrillator operation in lay rescuers: a randomized simulation study [J]. World Journal of Emergency Medicine, 2023, 14(4): 265-272.
[12]	Guang-qi Guo, Yan-nan Ma, Shuang Xu, Hong-rong Zhang, Peng Sun. Effect of post-rewarming fever after targeted temperature management in cardiac arrest patients: a systematic review and meta-analysis [J]. World Journal of Emergency Medicine, 2023, 14(3): 217-223.
[13]	Gan-nan Wang, Zhong-man Zhang, Wen Chen, Xiao-quan Xu, Jin-song Zhang. Timing of brain computed tomography for predicting neurological prognosis in comatose cardiac arrest survivors: a retrospective observational study [J]. World Journal of Emergency Medicine, 2022, 13(5): 349-354.
[14]	Shi-jiao Yan, Mei Chen, Jing Wen, Wen-ning Fu, Xing-yue Song, Huan-jun Chen, Ri-xing Wang, Mei-ling Chen, Xiao-tong Han, Chuan-zhu Lyu. Global research trends in cardiac arrest research: a visual analysis of the literature based on CiteSpace [J]. World Journal of Emergency Medicine, 2022, 13(4): 290-296.
[15]	Hong-li Xiao, Lian-xing Zhao, Jun Yang, Nan Tong, Le An, Guo-xing Wang, Miao-rong Xie, Chun-sheng Li. Increasing angiotensin-converting enzyme (ACE) 2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest [J]. World Journal of Emergency Medicine, 2022, 13(3): 208-214.