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Barriers and facilitators for successful AED usage during in-situ simulated in-hospital cardiac arrest

Mathilde Stærk1,2, Kasper G Lauridsen3,4,5, Julie Niklassen6

  • 1Department of Medicine, Randers Regional Hospital, Denmark.

Resuscitation Plus
|June 9, 2022
PubMed

Insights

Early defibrillation is crucial for survival after in-hospital cardiac arrest (IHCA). This study found that while automated external defibrillators (AEDs) were often used, delays and barriers like teamwork and knowledge impacted timely defibrillation.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Resuscitation Science

Background:

  • Early defibrillation significantly improves survival rates for in-hospital cardiac arrest (IHCA).
  • Despite the availability of automated external defibrillators (AEDs), achieving early defibrillation in IHCA remains a challenge.
  • Understanding the practical use of AEDs, including barriers and facilitators, is critical for optimizing patient outcomes.

Purpose of the Study:

  • To investigate the utilization patterns of automated external defibrillators (AEDs) during in-hospital cardiac arrests (IHCAs).
  • To identify the key barriers and facilitators influencing the successful and timely use of AEDs in simulated IHCA events.

Main Methods:

  • Conducted 36 unannounced, full-scale in-situ simulations of IHCAs in hospital wards.
  • Utilized video recording of simulations and subsequent debriefings for qualitative analysis of AED use.
  • Transcribed debriefings to identify themes related to barriers and facilitators of AED deployment and function.

Main Results:

  • Automated external defibrillators (AEDs) were used in 98% of simulated IHCAs.
  • Significant delays were observed, with the first shock delivered a median of 221 seconds after cardiac arrest diagnosis.
  • Key barriers included teamwork issues, knowledge gaps, and lack of contextualized training; facilitators were recent training, prior experience, and effective leadership.

Conclusions:

  • Time to defibrillation often exceeded 3 minutes in simulated IHCAs, with most delays occurring post-AED retrieval.
  • Non-technical skills and inadequate contextualized training represent major perceived barriers to effective AED use.
  • Recent resuscitation training, prior experience, and strong leadership were identified as facilitators for successful AED implementation.
Abstract

Keywords:
Automated external defibrillatorIn-hospital cardiac arrestIn-situ simulation

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