Public Access Defibrillation:Great benefit and potential but infrequently used

AbstractBackgroundIn Copenhagen, a volunteer-based Automated External Defibrillator (AED) network provides a unique opportunity to assess AED use.We aimed to determine the proportion of Out-of-Hospital Cardiac Arrest (OHCA) where an AED was applied before arrival of the ambulance, and the proportion of OHCA-cases where an accessible AED was located within 100m. In addition, we assessed 30-day survival.MethodsUsing data from the Mobile Emergency Care Unit and the Danish Cardiac Arrest Registry, we identified 521 patients with OHCA between October 1, 2011 and September 31, 2013 in Copenhagen, Denmark.ResultsAn AED was applied in 20 cases (3.8%, 95% CI [2.4 to 5.9]). Irrespective of AED accessibility, an AED was located within 100m of a cardiac arrest in 23.4% (n=102, 95% CI [19.5 to 27.7]) of all OHCAs. However, at the time of OHCA, an AED was located within 100m and accessible in only 15.1% (n=66, 95% CI [11.9 to 18.9]) of all cases.The 30-day survival for OHCA with an initial shockable rhythm was 64% for patients where an AED was applied prior to ambulance arrival and 47% for patients where an AED was not applied.ConclusionsWe found that 3.8% of all OHCAs had an AED applied prior to ambulance arrival, but 15.1% of all OHCAs occurred within 100m of an accessible AED. This indicates the potential of utilising AED networks by improving strategies for AED accessibility and referring bystanders of OHCA to existing AEDs

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

BACKGROUND: We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. METHODS: This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a Clavien–Dindo Class ≥III or death, within 30 days. RESULTS: intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05–1.19; P0.5, P=0.003. If PPI was ≤1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP ≤65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92–1.58; P=0.2]). CONCLUSIONS: Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated