The Role of Automated External Defibrillator Use in the Out-of-Hospital Cardiac Arrest Survival Rate and Outcome: A Systematic Review

Abstract

Out-of-hospital cardiac arrest (OHCA) remains a significant cause of death. The chance of survival significantly increases when immediate defibrillation with an on-site automated external defibrillator (AED) is available. Our aim is to systematically evaluate the impact of public access defibrillators (PAD) on the outcomes of outpatient cardiac arrest. We conducted a systematic review of the data from global studies on the role of bystander and emergency medical service (EMS) interventions, primarily focusing on the usage of AEDs, during OHCA events. The results highlight the critical significance of PADs in improving survival outcomes in OHCA settings. The majority of OHCA incidents occurred in private residences, but public spaces such as schools and airports had better outcomes, likely due to AED accessibility and trained individuals. Placing AEDs in public areas, especially high-risk zones, can boost survival chances. Timely defibrillation, particularly by bystanders, correlated with better survival and neurological conditions. The review emphasizes the importance of widespread cardiopulmonary resuscitation (CPR) and AED training, strategic AED placement, and continuous monitoring of interventions and outcomes to enhance survival rates and neurological recovery after OHCAs. This systematic review showed that bystander interventions, including CPR and AED usage, significantly increased the survival rate. Overall, immediate response and accessibility to AEDs in public areas can significantly improve outcomes in OHCA events.

Keywords: aed; automated external defibrillator; cpr; ems; ohca; out of hospital cardiac arrest; out patient cardiac arrest; pad; public access defibrillation; ventricular fibrillation.

Figure 1. Prisma flow chart

Figure 2. Comparison between bystander and EMS survival

The data have been represented as percentages (%). EMS: Emergency medical service Myerburg et al. 2002 [5], Nakahara et al. 2015 [6], Kiyohara et al. 2017 [8], Nakashima et al. 2019 [11], Caffrey et al. 2002 [14], Haskins et al. 2020 [16], Kiguchi et al. 2019 [17], Kitamura et al. 2010 [18], Ringh et al. 2015 [21], Capucci et al. 2016 [26], Tourney et al. 2020 [27], Iwami 2012 [28], Haskins et al. 2022 [31], Odom et al. 2022 [34]

Figure 3. Comparison of neurological outcome between bystander and EMS

The data have been represented as percentages (%). EMS: Emergency medical service Mitani et al. 2014 [7], Myat et al. 2019 [10], Kishimori et al. 2020 [12], Kitamura et al. 2016 [18], Kiyohara et al. 2016 [19]