The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. The Importance of the Legislation Rule
4.2. AED Mapping and First Responder Systems
4.3. Differences in AED Use, ROSC and Survival across Europe
4.4. Limitations
5. Conclusions
- To issue a law that allow all citizens, including untrained ones, to use an AED in the case of a suspected OHCA and protecting them against any legal consequences.
- To make an AED map compulsory that includes all public AEDs and that is linked to the emergency medical system dispatch center.
- To implement FR systems, including both citizens trained in CPR and professional FRs (i.e., police officers, firefighters, off-duty medical personnel) possibly equipped with an AED, to increase the rate of defibrillation before the arrival of the EMS.
- To unify cardiac arrest registries among European countries to harmonize data collection and better comprehend the European strategies to implement an improved OHCA survival.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Country | Is There Any Special Legislation on the Use of AEDs? | Who Is Allowed to Use an AED? | Has the Legislation Changed after December 2017? | Are There Legislation Differences in the Different Regions of Your Country? | Was There An aed Mapping System in Your Region/Country in the Study Period? | Did the (EMS) Activate FRS Equipped with an Aed in Your Region/Country in the Study Period? |
---|---|---|---|---|---|---|
Belgium | Yes | Everybody | No | No | No | No |
Bosnia and Herzegovina | No | Everybody | No | No | No | No |
Finland | No | Everybody | No | No | Yes | Yes |
France | Yes | Everybody | Yes ** | No | Yes, only in some areas | Yes |
Germany | No | Everybody | No | No | Yes, only in a few areas | Yes, only in a few areas |
Greece | Yes | Everybody trained * | No | No | No | No |
Ireland | No | Everybody | No | No | No | Yes |
Italy | Yes | Everybody trained | No *** | No | Yes | No |
Luxembourg | Yes | Everybody | No | No | Yes | Yes |
The Netherlands | No | Everybody | No | No | Yes, only in a few areas | Yes |
Norway | No | Everybody | No | No | Yes | Yes, only in a few areas |
Romania | Yes | Everybody | No | No | No | Yes |
Russian Federation | No | EMS providers only | No | No | No | No |
Serbia | No | Everybody | No | No | Unknown | No |
Slovakia | No | Everybody | No | No | Yes | Yes |
Slovenia | Yes | Everybody | No | No | Yes | Yes, only in a few areas |
Spain | Yes | Everybody trained | No | No | No | No |
Sweden | No | Everybody | No | No | Yes | Yes |
Switzerland | No | Everybody | No | No | Yes | Yes |
Country | Regional or National Registry | Population Covered (n) | Name of the Registry | OHCAs with EMS Attempted Resuscitation Occurring in the Period Oct 2017–Dec 2017 (EuReCa TWO Period) (n) | OHCAs in the Utstein Comparator Group (UCG) * (n, %) | OHCAs in Which an AED Was Attached before EMS Arrival (n, %) | OHCAs in Which the AED Was Attached by Firefighters, Police Officers or Other FRs (n, %) | OHCAs in Which the AED Was Attached by Bystanders (n, %) | OHCAs in Which an AED Was Attached before EMS Arrival and a Shock Was Delivered (n) | OHCAs in Which the Shock Was Delivered by Firefighters, Police Officers or Other FRs (%) | OHCAs in Which the Shock Was Delivered by Bystanders (%) | ROSC in the UCG (n, %) | Survival at Discharge in the UCG (n, %) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Belgium | National | 2,834,000 | Belgian Cardiac Registry (B-CAR) | 377 | 57 (15.1) | 26 (6.9) | 22 (84.6) | 4 (15.4) | 16 (4.2) | 12 (75) | 4 (25) | 31 (54.4) | 16 (28.1) |
Bosnia and Herzegovina | Regional | 110,979 | Utstein Resuscitation Registry | 22 | 1 (4.5) | 0 (0) | N/A | N/A | 0 (0) | N/A | N/A | 0 (0) | 0 (0) |
Finland | Regional | 655,395 | Helsinki out-of-hospital cardiac arrest registry | 76 | 19 (25) | 6 (7.9) | N/A | N/A | 3 (3.9) | N/A | N/A | 13 (68) | 7 (37) |
France | National | 17,833,002 | Electronic Registry of Cardiac Arrests (RéAC) | 2604 | 177 (6.8) | 2066 (79.3) ** | 1874 (90.7) | 192 (9.3) | 418 (16) | 368 (88) | 50 (12) | 95 (53.7) | 40 (22.6) |
Germany | National | 26,600,000 | Deutsches Reanimations Register (German Resuscitation Registry) | 6969 | 524 (7.5) | 0 (0) | N/A | N/A | 0 (0) | N/A | N/A | 372 (71) | 30 (17) |
Greece | Regional | 1,500,000 | National Center For Emergency Care (Northern Greece, Thessaloniki) | 71 | 22 (31) | 5 (7) | N/A | N/A | 1 (1.4) | N/A | N/A | 8 (36) | 1 (4.6) |
Ireland | National | 4,757,976 | Out-of-Hospital Cardiac Arrest Register (OHCAR) | 594 | 72 (12.1) | 21 (3.5) | 17 (81) | 4 (19) | 21 (3.5) | 15 (71.4) | 6 (28.6) | 28 (39) | 18 (25) |
Italy | Regional | 545,810 | Lombardia Cardiac Arrest Registry (LombardiaCARe) | 152 | 17 (11.2) | 4 (2.6) | 0 (0) | 4 (100) | 2 (1.3) | 0 (0) | 2 (100) | 9 (52.9) | 3 (17.6) |
Luxembourg | National | 602,005 | Cardlux | 140 | 24 (17.1) | 12 (8.6) | N/A | N/A | 5 (3.6) | N/A | N/A | 10 (41.6) | 4 (16.6) |
The Netherlands | Regional | 2,578,552 | Amsterdam Resuscitation Studies (ARREST) | 314 | 81 (25.8) | 183 (58.2) | 146 (79.8) | 37 (20.2) | 74 (23.6) | 52 (70) | 22 (30) | 5 (69) | 33 (40.7) |
Norway | National | 5,336,494 | Norwegian Cardiac Arrest Registry | 848 | 95 (11.2) | 103 (12.1) | 57 (55.3) | 46 (44.7) | 30 (3.5) | N/A | N/A | 56 (59) | 42 (44.2) |
Romania | National | 4,086,753 | Registrul Roman al Stopului Cardiac (Romanian Registry of Cardiac Arrest) | 512 | 30 (5.8) | 27 (5.3) | 27 (100) | 0 (0) | 12 (2.3) | 12 (100) | 0 (0) | N/A | N/A |
Russian Federation | Regional | 1,913,731 | Crimean Out-of-Hospital Cardiac Arrest and Resuscitation Registry (COHCARR) *** | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
Serbia | National | 1,227,069 | EuReCa Srbija | 409 | 42 (10.3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 8 (19.1) | 16 (38) |
Slovakia | Other | 3,300,000 | Ad hoc for EuReCa TWO | 693 | 93 (13.4) | 6 (0.9) | N/A | N/A | 2 (0.3) | N/A | N/A | 45 (48.4) | 24 (25.8) |
Slovenia | Other | 1,191,479 | Ad hoc for EuReCa TWO | 178 | 35 (19.7) | 13 (7.3) | 10 (76.9) | 3 (23.1) | 11 (6.2) | 8 (73) | 2 (18) | 22 (63) | 11 (31.4) |
Spain | National | 42,750,768 | Out-of-Hospital Spanish Registry of Cardiac Arrest (OHSCAR) | 2148 | 342 (15.9) | 75 (3.5) | 44 (58.7) | 31 (41.3) | 38 (1.8) | 13 (34.2) | 25 (65.8) | 209 (61.1) | 100 (29.2) |
Sweden | National | 10,120,242 | The Swedish Registry of Cardiopulmonary Resuscitation (SRCR) | 1466 | 171 (11.7) | 336 (25) | 269 (80) | 44 (13.1) | 84 (5.7) | 46 (55) | 27 (32) | 96 (56.1) | 101 (59.1) |
Switzerland | Regional | 353,700 | Ticino Registry Cardiac Arrest (TiReCA) | 53 | 9 (17) | 19 (35.8) | 12 (63.1) | 7 (36.8) | 2 (3.8) | 1 (50) | 1 (50) | 4 (44.4) | 2 (22.2) |
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Baldi, E.; Grieco, N.B.; Ristagno, G.; Alihodžić, H.; Canon, V.; Birkun, A.; Cresta, R.; Cimpoesu, D.; Clarens, C.; Ganter, J.; et al. The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study. J. Clin. Med. 2021, 10, 5018. https://doi.org/10.3390/jcm10215018
Baldi E, Grieco NB, Ristagno G, Alihodžić H, Canon V, Birkun A, Cresta R, Cimpoesu D, Clarens C, Ganter J, et al. The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study. Journal of Clinical Medicine. 2021; 10(21):5018. https://doi.org/10.3390/jcm10215018
Chicago/Turabian StyleBaldi, Enrico, Niccolò B. Grieco, Giuseppe Ristagno, Hajriz Alihodžić, Valentine Canon, Alexei Birkun, Ruggero Cresta, Diana Cimpoesu, Carlo Clarens, Julian Ganter, and et al. 2021. "The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study" Journal of Clinical Medicine 10, no. 21: 5018. https://doi.org/10.3390/jcm10215018