Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

Fredrik Folke; Freddy Knudsen Lippert; Søren Loumann Nielsen; Gunnar Hilmar Gislason; Morten Lock Hansen; Tina Ken Schramm; Rikke Sørensen; Emil Loldrup Fosbøl; Søren Skøtt Andersen; Søren Rasmussen; Lars Køber; Christian Torp-Pedersen; Fredrik Folke; Freddy Lippert; Søren Loumann Nielsen; Gunnar Hilmar Gislason; Morten Lock Hansen; Tina Ken Schramm; Rikke Sørensen; Emil Loldrup Fosbøl; Søren Skøtt Andersen; Søren Rasmussen; Lars Køber; Christian Torp-Pedersen

doi:10.1161/CIRCULATIONAHA.108.843755

Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

Fredrik Folke, Freddy Knudsen Lippert, Søren Loumann Nielsen, Gunnar Hilmar Gislason, Morten Lock Hansen, Tina Ken Schramm, Rikke Sørensen, Emil Loldrup Fosbøl, Søren Skøtt Andersen, Søren Rasmussen, Lars Køber, Christian Torp-Pedersen, Fredrik Folke, Freddy Lippert, Søren Loumann Nielsen, Gunnar Hilmar Gislason, Morten Lock Hansen, Tina Ken Schramm, Rikke Sørensen, Emil Loldrup FosbølSøren Skøtt Andersen, Søren Rasmussen, Lars Køber, Christian Torp-Pedersen

143 Citations (Scopus)

Abstract

BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. CONCLUSIONS: To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.

Original language	English
Journal	Circulation
Volume	120
Issue number	6
Pages (from-to)	510-7
Number of pages	8
ISSN	0009-7322
DOIs	https://doi.org/10.1161/CIRCULATIONAHA.108.843755 https://doi.org/10.1161/CIRCULATIONAHA.108.843755
Publication status	Published - 11 Aug 2009

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Folke, F., Lippert, F. K., Nielsen, S. L., Gislason, G. H., Hansen, M. L., Schramm, T. K., Sørensen, R., Fosbøl, E. L., Andersen, S. S., Rasmussen, S., Køber, L., Torp-Pedersen, C., Folke, F., Lippert, F., Nielsen, S. L., Gislason, G. H., Hansen, M. L., Schramm, T. K., Sørensen, R., ... Torp-Pedersen, C. (2009). Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations. Circulation, 120(6), 510-7. https://doi.org/10.1161/CIRCULATIONAHA.108.843755, https://doi.org/10.1161/CIRCULATIONAHA.108.843755

Folke, F, Lippert, FK, Nielsen, SL, Gislason, GH, Hansen, ML, Schramm, TK, Sørensen, R, Fosbøl, EL, Andersen, SS, Rasmussen, S, Køber, L , Torp-Pedersen, C, Folke, F, Lippert, F, Nielsen, SL, Gislason, GH, Hansen, ML, Schramm, TK, Sørensen, R, Fosbøl, EL, Andersen, SS, Rasmussen, S, Køber, L & Torp-Pedersen, C 2009, 'Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations', Circulation, vol. 120, no. 6, pp. 510-7. https://doi.org/10.1161/CIRCULATIONAHA.108.843755, https://doi.org/10.1161/CIRCULATIONAHA.108.843755

@article{b3d8ac70117d11df803f000ea68e967b,

title = "Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations",

abstract = "BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. CONCLUSIONS: To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.",

author = "Fredrik Folke and Lippert, {Freddy Knudsen} and Nielsen, {S{\o}ren Loumann} and Gislason, {Gunnar Hilmar} and Hansen, {Morten Lock} and Schramm, {Tina Ken} and Rikke S{\o}rensen and Fosb{\o}l, {Emil Loldrup} and Andersen, {S{\o}ren Sk{\o}tt} and S{\o}ren Rasmussen and Lars K{\o}ber and Christian Torp-Pedersen and Fredrik Folke and Freddy Lippert and Nielsen, {S{\o}ren Loumann} and Gislason, {Gunnar Hilmar} and Hansen, {Morten Lock} and Schramm, {Tina Ken} and Rikke S{\o}rensen and Fosb{\o}l, {Emil Loldrup} and Andersen, {S{\o}ren Sk{\o}tt} and S{\o}ren Rasmussen and Lars K{\o}ber and Christian Torp-Pedersen",

note = "Keywords: Adult; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Cost-Benefit Analysis; Defibrillators; Denmark; Electric Countershock; Emergency Medical Services; Female; Health Planning Guidelines; Health Services Accessibility; Heart Arrest; Humans; Incidence; Male; Middle Aged; Public Facilities; Urban Population",

year = "2009",

month = aug,

day = "11",

doi = "10.1161/CIRCULATIONAHA.108.843755",

language = "English",

volume = "120",

pages = "510--7",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

number = "6",

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TY - JOUR

T1 - Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

AU - Folke, Fredrik

AU - Lippert, Freddy Knudsen

AU - Nielsen, Søren Loumann

AU - Gislason, Gunnar Hilmar

AU - Hansen, Morten Lock

AU - Schramm, Tina Ken

AU - Sørensen, Rikke

AU - Fosbøl, Emil Loldrup

AU - Andersen, Søren Skøtt

AU - Rasmussen, Søren

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Folke, Fredrik

AU - Lippert, Freddy

AU - Nielsen, Søren Loumann

AU - Gislason, Gunnar Hilmar

AU - Hansen, Morten Lock

AU - Schramm, Tina Ken

AU - Sørensen, Rikke

AU - Fosbøl, Emil Loldrup

AU - Andersen, Søren Skøtt

AU - Rasmussen, Søren

AU - Køber, Lars

AU - Torp-Pedersen, Christian

N1 - Keywords: Adult; Aged; Aged, 80 and over; Cardiopulmonary Resuscitation; Cost-Benefit Analysis; Defibrillators; Denmark; Electric Countershock; Emergency Medical Services; Female; Health Planning Guidelines; Health Services Accessibility; Heart Arrest; Humans; Incidence; Male; Middle Aged; Public Facilities; Urban Population

PY - 2009/8/11

Y1 - 2009/8/11

N2 - BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. CONCLUSIONS: To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.

AB - BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249) and 66.8% (n=851) of all cardiac arrests, respectively. The excessive cost of such AED deployments was estimated to be $33 100 or $41 000 per additional quality-adjusted life year, whereas unguided AED placement covering the entire city had an estimated cost of $108 700 per quality-adjusted life year. Areas with major train stations (1.8 arrests every 5 years per area), large public squares, and pedestrianized areas (0.6 arrests every 5 years per area) were main predictors of frequent cardiac arrests. CONCLUSIONS: To achieve wide AED coverage, AEDs need to be more widely distributed than recommended by the European Resuscitation Council guidelines but consistent with the American Heart Association guidelines. Strategic placement of AEDs is pivotal for public-access defibrillation, whereas with unguided initiatives, AEDs are likely to be placed inappropriately.

U2 - 10.1161/CIRCULATIONAHA.108.843755

DO - 10.1161/CIRCULATIONAHA.108.843755

M3 - Journal article

C2 - 19635969

SN - 0009-7322

VL - 120

SP - 510

EP - 517

JO - Circulation

JF - Circulation

IS - 6

ER -

Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

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