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Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews; why not always use an AED?

      Keywords

      Abbreviations:

      KNRM (Royal Dutch Lifeboat Institution), CPR (cardiopulmonary resuscitation), AED (automated external defibrillators), PAD (Public Access Defibrillator), OHCA (Out of Hospital Cardiac Arrest), ROSC (return of spontaneous circulation), EMS (Emergency Medical Services)
      To the editor,
      We were recently contacted by the International Liaison Committee on Resuscitation (ILCOR) Basic Life Support task force to provide further information about our study addressing the use of automated external defibrillators (AEDs) by lifeboat crews.
      • Seesink J.
      • Nieuwenburg S.A.V.
      • van der Linden T.
      • Bierens J.J.L.M.
      Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews.
      It was debated if AEDs on board of all lifeboats in one country could be considered as a variant on a Public Access Defibrillator (PAD) programs for drowning resuscitation. For that, the task force has asked us to provide further information about why the lifeboat AED had not been used in half of the analysed resuscitations, while an AED was available on board.
      Our study described 37 resuscitations where lifeboat crews were involved. In 19 resuscitations (51.3%), an AED was connected of which 12 (32.4%) were from the lifeboat. During the other seven resuscitations (18.9%) an AED of various organisations also present at the scene was connected (beach lifeguards, firefighters, pilots at sea, public water management employers, sailing competition jury, commercial shipping). During 15 resuscitations (40.5%) the AED was not connected. In these situations, the defibrillator (non-AED) of ambulance crews were used, either because they were on board of the lifeboat (n = 4; 26.7%) or external circumstances (such as weather, distance to shore or waves) resulted in a decision to immediately go ashore where ambulance crews were known to be present (n = 8; 53.3%). Of the remaining three resuscitations, the reason for not using the AED on board of the lifeboat was unknown. All 12 lifeboat AEDs were analysed in which one shockable rhythm (8.3%) was observed and it did not lead to return of spontaneous circulation (ROSC).
      A recent summary of evidence concluded that AEDs are connected in 5–32% of drowning cases before the arrival of the Emergency Medical Services (EMS) and that a shockable rhythm is observed in 2–14%.
      • Wyckoff M.H.
      • Singletary E.M.
      • Soar J.
      • et al.
      2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
      • Bierens J.
      • Barcala-Furelos R.
      • Beerman S.
      • et al.
      Resuscitation and emergency care in drowning: A scoping review.

      Bierens J, Barcala-Furelos R, Beerman S, et al. International Liaison Committee on Resuscitation Basic Life Support Task Force. Automated external defibrillator use in drowning AED use (BLS #856): scoping review. Accessed March 4, 2021. https://costr.ilcor.org/document/bls-856-automated-external-defibrillator-use-in-drowning-aed-use-tf-scoping-review.

      The use of AEDs on board of lifeboats has been proven feasible.
      • De Vries W.
      • Bierens J.J.
      • Maas M.W.
      Moderate sea states do not influence the application of an AED in rigid inflatable boats.
      However, the effectiveness of an AED on board of lifeboats as part of a PAD program is dependent on various conditions. Our main reason for not using the AED available on board of lifeboats is overlap with other organisations that have an AED available and sometimes were faster at the scene. However, the Netherlands has a high coverage of AEDs so this might not be applicable for other countries.
      • Bak M.A.R.
      • Blom M.T.
      • Koster R.W.
      • Ploem M.C.
      Resuscitation with an AED: putting the data to use.
      A second reason might be the challenging circumstances of resuscitations at sea. It is advised by the ILCOR statement on the use of an AED that the connection of an AED should not interrupt the CPR.
      • Wyckoff M.H.
      • Singletary E.M.
      • Soar J.
      • et al.
      2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
      • Bierens J.
      • Barcala-Furelos R.
      • Beerman S.
      • et al.
      Resuscitation and emergency care in drowning: A scoping review.

      Bierens J, Barcala-Furelos R, Beerman S, et al. International Liaison Committee on Resuscitation Basic Life Support Task Force. Automated external defibrillator use in drowning AED use (BLS #856): scoping review. Accessed March 4, 2021. https://costr.ilcor.org/document/bls-856-automated-external-defibrillator-use-in-drowning-aed-use-tf-scoping-review.

      . Therefore, in specific situations it might be more efficient to immediately go ashore. Lastly, the frequency of a shockable rhythm of drowning victims is low. When considering the need for an AED on lifeboats as part of a PAD program, all this must be taken into account.

      Conflict of interest

      T. van der Linden and J. Bierens are responsible for the content and structure of the medical training of KNRM lifeboat crews. They receives payment from the KNRM for coordinating the training programme. No other conflict of interest was reported.

      Declaration of funding sources

      The cost of publishing open access is covered under the terms of an agreement between Erasmus MC University Medical Center and Elsevier.

      References

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        Circumstances, outcome and quality of cardiopulmonary resuscitation by lifeboat crews.
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