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. 2025 Jan 27;22(2):173.
doi: 10.3390/ijerph22020173.

Out-of-Hospital Cardiac Arrest Ambulance Delay Zones and AED Placement in a Southern Brazilian City

Marcos Rogério Bitencourt  1 , Mariá Romanio Bitencourt  2 , Lincoln Luís Silva  1   3 , Amanda Gubert Alves Dos Santos  4 , Pedro Iora  2 , José Anderson Labbado  1 , Mauricio Medeiros Lemos  1 , Luiz Gustavo de Paulo  5 , Júlia Loverde Gabella  2 , Juliana Lourenço Lopes Costa  5 , Hideky Ikeda Dolci  5 , Vinicius Giacomin  1 , Sandra Marisa Pelloso  1 , Maria Dalva de Barros Carvalho  1 , Luciano de Andrade  1   2
Affiliations

Out-of-Hospital Cardiac Arrest Ambulance Delay Zones and AED Placement in a Southern Brazilian City

Marcos Rogério Bitencourt et al. Int J Environ Res Public Health. .

Abstract

Out-of-hospital cardiac arrests (OHCAs) have high mortality rates, worsened by limited access to automated external defibrillators (AEDs). This study analyzed OHCA response times, identified areas with prolonged ambulance travel times, and proposed optimal AED locations in a medium-sized city in southern Brazil. Data from 278 non-traumatic OHCA cases (2019-2022) in patients over 18 years old, with ambulance response times under 20 min, were included. Spatial survival analysis assessed the probability of exceeding the recommended 5-min (300 s) ambulance response time. The maximal covering location problem identified 100 strategic AED sites within a 150-s reach for bystanders. AED and ambulance travel times were compared using the Wilcoxon test (p < 0.01). Defibrillation occurred in 89 cases (31.01%), and bystander CPR was performed in 149 cases (51.92%). Despite these efforts, 77% of patients died. The median ambulance response time was 11.63 min, exceeding 5 min in most cases, particularly at peak times like 11 a.m. AED placement in selected locations could cover 76% of OHCA occurrences, with a mean AED travel time of 320 s compared to 709 s for ambulances. Strategic AED placement could enhance early defibrillation and improve survival outcomes.

Keywords: automated external defibrillators; cardiopulmonary resuscitation; computer simulation; out-of-hospital cardiac arrest; spatial analysis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Population density, location, and service area coverage of SAMU units.
Figure 2
Figure 2
Methodological workflow of this study.
Figure 3
Figure 3
Relative risk and frequency of daily out-of-hospital cardiac arrest (OHCA) occurrences. (A) Relative risk of occurrences attended by SAMU over a 24-h period. (B) Frequency of daily occurrences across the 24-h period.
Figure 4
Figure 4
Spatial distribution of out-of-hospital cardiac arrest (OHCA) occurrences attended by SAMU and ambulance service area.
Figure 5
Figure 5
Posterior exceedance probability (PEP) areas of SAMU.
Figure 6
Figure 6
Allocation of AEDs and coverage. The lightning bolt symbol represents the location selected for AED placement.
Figure 7
Figure 7
Comparison of coverage times: (A) Difference between response times with ambulance and with AED implementation; (B) Variation in coverage times with different AED availability.
See this image and copyright information in PMC

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