Missel Amanda L, Gomez Alejandro, Dowker Stephen R, Rizk Daniel, Neumar Robert W, Hunt Nathaniel
Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan.
University of Michigan Medical School, Ann Arbor, Michigan.
Prehosp Emerg Care. 2025 Jan 13:1-4. doi: 10.1080/10903127.2024.2438394.
Out-of-hospital cardiac arrest (OHCA) victims receiving defibrillation from an automated external defibrillator (AED) placed early in the chain of survival are more likely to survive. We sought to explore the accuracy of AED pad placement for lay rescuers (LR) and first responders (FR).
We conducted a secondary analysis of data collected during randomized OHCA simulation trials involving LRs and FRs. The LRs received hands-only CPR and AED guidance from a simulated 9-1-1 telecommunicator. The FRs did not receive telecommunicator instruction. Participants were surveyed about medical training and experience. Correct AED pad placements (anterior: AP, lateral: LP) were individually determined from video abstraction based on manufacturer's recommendations and distance to anatomical landmarks. Incorrect AP placement was defined as the upper edge of the pad past the crest of the trapezius, the medial edge past midline, or the lower edge beyond the nipple line. Incorrect LP placement was defined as the upper edge of the pad past the nipple line, the medial edge past midline, or the lower edge beyond the navel line. We examined the association between correct pad placement and previous CPR training (current, expired, or never) for LR and correct pad placement and self-reported recent field experience (<1 year) with AED application for FR using Fisher's exact.
Lay rescuers correctly placed the AP in 30/38 (78.9%) and the LP 30/38 (78.9%) simulations. Application did not differ significantly based on previous CPR training (AP = .236, LP = .621). The most common incorrect placement was too low for both AP (5/8, 62.5%) and LP (4/8, 50.0%). First responders applied the AP correctly in 16/18 (88.9%) and the LP in 14/18 (77.8%) simulations. Among FRs, correct pad application did not differ significantly based on recent field experience (AP = .497, LP = .119). The most common incorrect placement was too low for both AP (2/2, 100.0%) and LP (3/4, 75.0%).
There is an opportunity for improvement for both LRs and FRs to apply AEDs per manufacturer's recommendations. Further research is needed to improve instructions and follow-up training to ensure accurate AED pad placement.
在生存链早期使用自动体外除颤器（AED）进行除颤的院外心脏骤停（OHCA）患者存活可能性更大。我们试图探究非专业救援人员（LR）和急救人员（FR）放置AED电极片的准确性。
我们对在涉及LR和FR的随机OHCA模拟试验期间收集的数据进行了二次分析。LR接受来自模拟911接线员的单纯胸外按压心肺复苏术及AED指导。FR未接受接线员指导。对参与者进行了医学培训和经验方面的调查。根据制造商的建议及与解剖学标志的距离，通过视频提取分别确定AED电极片的正确放置位置（前位：AP，侧位：LP）。AP放置错误定义为电极片上缘超过斜方肌嵴、内侧缘超过中线或下缘超过乳头线。LP放置错误定义为电极片上缘超过乳头线、内侧缘超过中线或下缘超过脐线。我们使用Fisher精确检验研究LR正确放置电极片与先前心肺复苏培训（当前、过期或从未接受过）之间的关联，以及FR正确放置电极片与自我报告的近期AED应用现场经验（<1年）之间的关联。
非专业救援人员在38次模拟中有30次（78.9%）正确放置了AP电极片，38次模拟中有30次（78.9%）正确放置了LP电极片。基于先前的心肺复苏培训，放置情况无显著差异（AP = 0.236，LP = 0.621）。最常见的放置错误是AP和LP放置位置均过低（AP为5/8，62.5%；LP为4/8，50.0%）。急救人员在18次模拟中有16次（88.9%）正确放置了AP电极片，18次模拟中有14次（77.8%）正确放置了LP电极片。在急救人员中，基于近期现场经验，电极片正确应用情况无显著差异（AP = 0.497，LP = 0.119）。最常见的放置错误是AP和LP放置位置均过低（AP为2/2，100.0%；LP为3/4，75.0%）。
非专业救援人员和急救人员按照制造商建议应用AED方面均有改进空间。需要进一步研究以改进指导和后续培训，确保AED电极片准确放置。
