Out-of-hospital cardiac arrest (OHCA) represents one of the most critical medical emergencies, with NHS ambulance services attempting resuscitation on approximately 30,000 people each year in the UK. The timeliness and accessibility of life-saving equipment such as automated external defibrillators (AEDs) are crucial for increasing the chances of survival. However, the data indicates that the use of public access defibrillators is surprisingly low, highlighting the need for a simpler and faster method for their use.
Analysis of OHCA Data
The annual incidence of OHCA is about 55 per 100,000 inhabitants, with the majority of cardiac arrests (72%) occurring at home and another 15% in the workplace. Despite half of all OHCA being witnessed by a bystander, CPR is only attempted in 7 out of 10 cases by those present. This immediate intervention is crucial but often insufficient without the aid of an AED.
( https://www.resus.org.uk/library/2021-resuscitation-guidelines/epidemiology-cardiac-arrest-guidelines )
The Importance of AED Accessibility
A particularly alarming statistic is that public access defibrillators are used in less than 1 in 10 OHCA cases. This low usage rate can be attributed to various factors, including the difficulty in quickly locating a defibrillator and the possible need for a code to access it. The recent case of a church in Belfast, unable to provide a life-saving defibrillator to a marathon runner in cardiac arrest due to the unregistered code, tragically underscores this issue.
( https://www.belfasttelegraph.co.uk/news/northern-ireland/church-bitterly-disappointed-after-failing-to-register-defibrillator-needed-during-belfast-marathon/a404896707.html )
Health Inequalities and Response Times
Health inequalities play a significant role in the incidence of cardiac arrests and the response to them. Deprived areas and those with a higher proportion of residents from ethnic minorities have a higher incidence of cardiac arrest, lower incidence of bystander CPR, and less access to public defibrillators. With an average ambulance response time of 6.9 minutes, every second counts.
Treatment Efficiency and Survival Rates
The initial rhythm is shockable in approximately 22-25% of OHCA cases, and a return of spontaneous circulation (ROSC) is achieved in about 30% of resuscitation attempts. However, only 9% of people survive to hospital discharge. In bystander-witnessed cases with a shockable initial rhythm, the survival rate increases to 29%. These data show that a rapid response and the use of AEDs can significantly impact outcomes.
Conclusion: Towards Better Access to Defibrillators
To improve OHCA survival rates, it is crucial to make AEDs easily accessible and usable without delays. AEDs should not be kept locked or require hard-to-obtain codes in emergency situations. Communities need to be educated about the use of defibrillators, and devices should be placed in strategic, easily accessible locations.
Implementing a system that allows quick and easy access to AEDs, without bureaucratic barriers, could save many lives. Technology should be a facilitator, not a hindrance, and increased awareness and preparation could transform the landscape of response to out-of-hospital cardiac arrests in the UK.