The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Enrico Baldi^{1

2

3}, Niccolò B Grieco^{3

4}, Giuseppe Ristagno^{3

5}, Hajriz Alihodžić⁶, Valentine Canon^{7

8}, Alexei Birkun⁹, Ruggero Cresta^{10

11}, Diana Cimpoesu¹², Carlo Clarens¹³, Julian Ganter¹⁴, Andrej Markota^{15

16}, Pierre Mols¹⁷, Olympia Nikolaidou¹⁸, Martin Quinn¹⁹, Violetta Raffay^{20

21}, Fernando Rosell Ortiz²², Ari Salo²³, Remy Stieglis²⁴, Anneli Strömsöe^{25

26

27}, Ingvild Tjelmeland^{28

29

30}, Stefan Trenkler³¹, Jan Wnent^{30

32

33}, Jan-Thorsten Grasner^{30

32}, Bernd W Böttiger^{34

35}, Simone Savastano^{3

36}

Affiliations

¹ Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy.
² Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
³ Italian Resuscitation Council, 40128 Bologna, Italy.
⁴ Cardiology Department, Niguarda Hospital, 20162 Milan, Italy.
⁵ Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
⁶ Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' and Faculty of Medicine, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
⁷ CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, F-59000 Lille, France.
⁸ French National Out-of-Hospital Cardiac Arrest Registry-Registre Électronique des Arrêts Cardiaques, F-59000 Lille, France.
⁹ Medical Academy Named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University, 95000 Simferopol, Russia.
¹⁰ Quality and Research Division, Federazione Cantonale Ticinese Servizi Ambulanza (FCTSA), 6500 Bellinzona, Switzerland.
¹¹ Fondazione Ticino Cuore, 6900 Lugano, Switzerland.
¹² Emergency Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
¹³ Luxembourg Resuscitation Council, 2680 Luxembourg, Luxembourg.
¹⁴ Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Center Freiburg, 79085 Freiburg, Germany.
¹⁵ Slovenian Resuscitation Council, Slovenian Society of Emergency Medicine, 1000 Ljubljana, Slovenia.
¹⁶ Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia.
¹⁷ Service des Urgences et du SMUR, CHU Saint-Pierre, Université Libre de Bruxelles, 1000 Bruxelles, Belgium.
¹⁸ EMS-National Center for Emergency Care, 546 Thessaloniki, Greece.
¹⁹ Out-of-Hospital Cardiac Arrest Registry Steering Group, National University of Ireland, H91 CF50 Galway, Ireland.
²⁰ Department of Medicine, European University Cyprus, Nicosia 2404, Cyprus.
²¹ Serbian Resuscitation Council, 21102 Novi Sad, Serbia.
²² Servicio de Urgencias Médicas 061 La Rioja, 26007 Logroño, Spain.
²³ Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, 00530 Helsinki, Finland.
²⁴ Department of Cardiology, Amsterdam University Medical Center, Location AMC, 1105 Amsterdam, The Netherlands.
²⁵ School of Education, Health and Social Studies, Dalarna University, S-79188 Falun, Sweden.
²⁶ Centre for Clinical Research Dalarna, Uppsala University, S-79182 Falun, Sweden.
²⁷ Department of Prehospital Care, Region of Dalarna, S-79129 Falun, Sweden.
²⁸ Division of Prehospital Services, Oslo University Hospital, 0372 Oslo, Norway.
²⁹ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.
³⁰ Institute for Emergency Medicine, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
³¹ Department of Anaesthesiology and Intensive Medicine, Medical Faculty, P.J. Safarik University, 040 11 Kosice, Slovakia.
³² Department of Anesthesiology, University Hopspital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
³³ School of Medicine, University of Namibia, Windhoek 10005, Namibia.
³⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Cologne, 50931 Cologne, Germany.
³⁵ European Resuscitation Council (ERC), 2845 Niel, Belgium.
³⁶ Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

PMID: 34768537
PMCID: PMC8585055
DOI: 10.3390/jcm10215018

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Enrico Baldi et al. J Clin Med. 2021.

. 2021 Oct 28;10(21):5018.

doi: 10.3390/jcm10215018.

Authors

Affiliations

¹ Department of Molecular Medicine, Section of Cardiology, University of Pavia, 27100 Pavia, Italy.
² Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
³ Italian Resuscitation Council, 40128 Bologna, Italy.
⁴ Cardiology Department, Niguarda Hospital, 20162 Milan, Italy.
⁵ Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
⁶ Emergency Medical Service, Public Institution Health Centre 'Dr. Mustafa Šehović' and Faculty of Medicine, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
⁷ CHU Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, F-59000 Lille, France.
⁸ French National Out-of-Hospital Cardiac Arrest Registry-Registre Électronique des Arrêts Cardiaques, F-59000 Lille, France.
⁹ Medical Academy Named after S. I. Georgievsky of V. I. Vernadsky Crimean Federal University, 95000 Simferopol, Russia.
¹⁰ Quality and Research Division, Federazione Cantonale Ticinese Servizi Ambulanza (FCTSA), 6500 Bellinzona, Switzerland.
¹¹ Fondazione Ticino Cuore, 6900 Lugano, Switzerland.
¹² Emergency Department, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
¹³ Luxembourg Resuscitation Council, 2680 Luxembourg, Luxembourg.
¹⁴ Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Center Freiburg, 79085 Freiburg, Germany.
¹⁵ Slovenian Resuscitation Council, Slovenian Society of Emergency Medicine, 1000 Ljubljana, Slovenia.
¹⁶ Medical Intensive Care Unit, University Medical Centre Maribor, 2000 Maribor, Slovenia.
¹⁷ Service des Urgences et du SMUR, CHU Saint-Pierre, Université Libre de Bruxelles, 1000 Bruxelles, Belgium.
¹⁸ EMS-National Center for Emergency Care, 546 Thessaloniki, Greece.
¹⁹ Out-of-Hospital Cardiac Arrest Registry Steering Group, National University of Ireland, H91 CF50 Galway, Ireland.
²⁰ Department of Medicine, European University Cyprus, Nicosia 2404, Cyprus.
²¹ Serbian Resuscitation Council, 21102 Novi Sad, Serbia.
²² Servicio de Urgencias Médicas 061 La Rioja, 26007 Logroño, Spain.
²³ Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, 00530 Helsinki, Finland.
²⁴ Department of Cardiology, Amsterdam University Medical Center, Location AMC, 1105 Amsterdam, The Netherlands.
²⁵ School of Education, Health and Social Studies, Dalarna University, S-79188 Falun, Sweden.
²⁶ Centre for Clinical Research Dalarna, Uppsala University, S-79182 Falun, Sweden.
²⁷ Department of Prehospital Care, Region of Dalarna, S-79129 Falun, Sweden.
²⁸ Division of Prehospital Services, Oslo University Hospital, 0372 Oslo, Norway.
²⁹ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0372 Oslo, Norway.
³⁰ Institute for Emergency Medicine, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
³¹ Department of Anaesthesiology and Intensive Medicine, Medical Faculty, P.J. Safarik University, 040 11 Kosice, Slovakia.
³² Department of Anesthesiology, University Hopspital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany.
³³ School of Medicine, University of Namibia, Windhoek 10005, Namibia.
³⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty of Cologne, 50931 Cologne, Germany.
³⁵ European Resuscitation Council (ERC), 2845 Niel, Belgium.
³⁶ Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

PMID: 34768537
PMCID: PMC8585055
DOI: 10.3390/jcm10215018

Abstract

Introduction: The rapid use of an automated external defibrillator (AED) is crucial for increased survival after an out-of-hospital cardiac arrest (OHCA). Many factors could play a role in limiting the chance of an AED use. We aimed to verify the situation regarding AED legislation, the AED mapping system and first responders (FRs) equipped with an AED across European countries.

Methods: We performed a survey across Europe entitled "European Study about AED Use by Lay Rescuers" (ENSURE), asking the national coordinators of the European Registry of Cardiac Arrest (EuReCa) program to complete it.

Results: Nineteen European countries replied to the survey request for a population covering 128,297,955 inhabitants. The results revealed that every citizen can use an AED in 15 countries whereas a training certificate was required in three countries. In one country, only EMS personnel were allowed to use an AED. An AED mapping system and FRs equipped with an AED were available in only 11 countries. The AED use rate was 12-59% where AED mapping and FR systems were implemented, which was considerably higher than in other countries (0-7.9%), reflecting the difference in OHCA survival.

Conclusions: Our survey highlighted a heterogeneity in AED legislation, AED mapping systems and AED use in Europe, which was reflected in different AED use and survival.

Keywords: automated external defibrillator (AED) system; first responders; legislation; out-of-hospital cardiac arrest (OHCA).

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Conflict of interest statement

J.W. is member of the German Resuscitation Registry steering committee and EuReCa study management team and has no financial COIs to declare. J.-T.G. is member of the German Resuscitation Registry steering committee, EuReCa project leader and obtained funding for the Institute for Emergency Medicine, University Hospital Schleswig-Holstein from Corpuls (GS Stemple) and personal speaker fees and travel costs from ZOLL, Corpuls, Philips and Weinmann-emergency. B.W.B. is treasurer of the European Resuscitation Council (ERC), Chairman of the German Resuscitation Council (GRC), Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR), Member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the “Deutsche Stiftung Wiederbelebung”, Co-Editor of “Resuscitation”, Editor of the Journal “Notfall + Rettungsmedizin” and Co-Editor of the Brazilian Journal of Anesthesiology. He received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH and Bioscience Valuation BSV GmbH. The other authors reported no conflict of interest.

Figures

**Figure 1**
Graphical representation across the different European countries regarding who is, equipped with an AED, activated by the EMS, if there was an AED mapping system and who is allowed to use an AED.

See this image and copyright information in PMC

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The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Affiliations

The Automated External Defibrillator: Heterogeneity of Legislation, Mapping and Use across Europe. New Insights from the ENSURE Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources