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Summary: Aim of the study: To analyse 2 years of experience after introducing automated external defibrillators (AED) all over Austria. Materials and methods: This observational study evaluated the number of privately purchased devices and the rate of local bystander-triggered AED deployments from November 2002 to December 2004. As outcome measurements, the hospital discharge rate and neurological condition were recorded. Arrival times of the emergency medical service (EMS) on scene and the time intervals until shock decisions were made were calculated. Shock decisions were verified according to ECG downloads. Results were compared with historical data if applicable. Results: During the study period, 1865 devices were installed. Seventy-three AED deployments were recorded. Eleven cases were excluded from the study because bystanders were part of the local EMS. Seventeen out of the remaining 62 (27%) compared to a historical 27 out of 623 (4.3%) individuals were discharged alive from hospital. Fourteen out of 26 (54%) patients who were found with a shockable rhythm survived to hospital discharge. Fifteen of our patients survived in good neurological condition (CPC I and II), two suffered from severe neurological deficit (CPC III and IV) and 45 people died. The median “call-to-AED advice interval” was 3.5min (IQR 2–6min; N =24). In two cases, the AED made inappropriate decisions because of artefacts. Conclusions: Compared to historical data, short ‘intervals to shock’ delivery and the frequent start of basic life support resulted in an increased hospital discharge rate in good neurological condition. Despite the relatively high number of installed devices, the number of patients reached remained small. [Copyright &y& Elsevier]

Summary: Public access defibrillation (PAD) is a promising strategy to fight sudden cardiac death. The Austrian Red Cross provided automated external defibrillators (AEDs) and basic life support (BLS) training as an “all inclusive package” combined with on site consultation and maintenance with annual retraining as a part of a nationwide PAD programme. A multi media campaign was started to promote the package and to increase awareness about sudden cardiac death. Data about the campaign, its recognition by the public in Austria and the number of packages were recorded. Sixty-eight percent of the Austrian public above the age of 15 years were able to recall the multi media campaign. Comparing the periods before and after the campaign, the number of website hits climbed significantly from 2931 hits/month (1866–6168) to 4812 hits/month (3432–13,434) (p =0.0276). The number of AED services implemented before the campaign increased significantly (p =0.0026) in the time after the campaign. Therefore, we conclude that a multi media campaign is useful to stimulate public discussion and it encourages companies to buy “all inclusive packages” containing AEDs, BLS training, on site consultation and maintenance. These measures represent a possible first step in introducing PAD but it seems that they have to be continued on a constant basis. [Copyright &y& Elsevier]

Introduction: In general automated external defibrillators (AED) are handled easily, but some untrained lay rescuers may have major problems with the use of such products. This may result in delayed shock delivery and delay in basic life support (BLS) after use of the AED. To study the effect of voice prompts and design solutions we tested the time from the first shock to the initiation of BLS for six defibrillators available in Austria. Methods: Volunteers, who had no AED training, were evaluated to see when they delivered the first shock and how often BLS was started after the voice prompts were given by the defibrillators. Results: Time to first shock delivered ranged from 78 (95% CI: 68–89) to 128 (95% CI: 110–146) s. The defibrillator-type had a significant influence on the time to first shock delivered (P < 0.0001). The proportion of volunteers who started BLS after defibrillation ranged from 93 to 33% and differed significantly between the AEDs used (P < 0.03). Conclusions: We demonstrated that there are significant differences between AEDs, concerning important operational outcomes like time to first shock and the start of BLS. Further research and development is urgently required to optimise user-friendliness and operational outcomes. [Copyright &y& Elsevier]

Abstract: Introduction: The first-aid training necessary for obtaining a drivers license in Austria has a regulated and predefined curriculum but has been targeted for the implementation of a new course structure with less theoretical input, repetitive training in cardiopulmonary resuscitation (CPR) and structured presentations using innovative media. Methods: The standard and a new course design were compared with a prospective, participant- and observer-blinded, cluster-randomized controlled study. Six months after the initial training, we evaluated the confidence of the 66 participants in their skills, CPR effectiveness parameters and correctness of their actions. Results: The median self-confidence was significantly higher in the interventional group [IG, visual analogue scale (VAS:“0” not-confident at all,“100” highly confident):57] than in the control group (CG, VAS:41). The mean chest compression rate in the IG (98/min) was closer to the recommended 100bpm than in the CG (110/min). The time to the first chest compression (IG:25s, CG:36s) and time to first defibrillator shock (IG:86s, CG:92s) were significantly shorter in the IG. Furthermore, the IG participants were safer in their handling of the defibrillator and started with countermeasures against developing shock more often. The management of an unconscious person and of heavy bleeding did not show a difference between the two groups even after shortening the lecture time. Conclusions: Motivation and self-confidence as well as skill retention after six months were shown to be dependent on the teaching methods and the time for practical training. Courses may be reorganized and content rescheduled, even within predefined curricula, to improve course outcomes. [Copyright &y& Elsevier]

Summary: Aim of the study: Endotracheal intubation is the preferred method to ensure proper artificial ventilation. Early detection of esophageal intubation is important for an individual patient''s outcome. The aim of the study was to see if impedance measurements can be used to detect esophageal intubation, using the impedance measurement system of an experimental defibrillator. Materials and methods: Patients who died at the emergency department of a tertiary care hospital were eligible to be studied. After death was declared, patients were ventilated with a predefined tidal volume alternately via the conventional tracheal tube and via an additionally tube placed into the esophagus. The lowest and respectively highest median impedance amplitude for the first three ventilations was used as cut-off to calculate predictive values. Results: We enrolled 10 patients (mean age 65 years (S.D. 14), 7 male) of whom 9 underwent CPR prior to death, 30% of the patients had a BMI>30. Severe lung-edema was present in 2 cases. The lowest tracheal impedance value was 0.736Ω and the highest esophageal was 0.496Ω. A ROC curve for this individualised approach gave an area under the curve of 1 (95% CI 0.001, 0.249). Conclusion: There is a large and significant reduction in transthoracic impedance when the tube is malpositioned in the esophagus. It may therefore be feasible to detect malintubation via thoracic impedance changes as an aid to improve the survival of critical ill patients. Further investigations on a larger population are needed. [Copyright &y& Elsevier]