Authors (including presenting author) :
Kwan KY, Leung YW, Choi WK, Chiu HY, Yue CS, Ng YB
Affiliation :
Division of Cardiology, Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Defibrillation is essential in “chain of survival” of in-hospital resuscitation; much higher survival rate is achieved with immediate cardiopulmonary resuscitation (CPR) and early defibrillation.
Cardiac rehabilitation (CR) reduces recurrent cardiovascular event and its mortality after revascularization. Patients are at risk of arrhythmia during stress CR training. Experience from our past CPR drill, earliest response time from witnessed arrest to manual defibrillation was 6 minutes; whereas chance of survival drops by 7-10% per minute without bystander CPR.
Objectives :
Shorten time to defibrillation prior to advanced life support rescuer arrival.
Enhance staff’s competence of using AED mode for defibrillation.
Methodology :
Early defibrillation using automated external defibrillator (AED) mode of manual defibrillator machine by accredited therapists in our CR Centre is authorized by our Division of Cardiology under periodical review, when qualified manual defibrillator is not available on-site during CR program. 2-hour workshop comprising of theoretical lecture and scenario-based practice had been held in December 2022. Targeted trainees were therapists and nurses with service covering cardiac rehabilitation who were Basic Life Support (BLS) provider. Online survey about staff’s competency and knowledge test of using AED were performed before and after workshop.
Result & Outcome :
Total 11 therapists were authorized to use AED mode for defibrillation in CR Centre after workshop. During hands-on practice, time to defibrillation using AED mode was markedly shortened to 2 minutes.
All therapists agreed that early defibrillation was crucial for witnessed cardiac arrest. However, they could not implement early defibrillation. Major barriers included liability, feeling anxiety, lack of training and equipment concerns. Significant improvement in staff’s competence level had been demonstrated from 5.25 to 8 using 10-point scale. 97.5% of them agreed that workshop was practical and empowering their confidence in using AED.
While AED can be used by anyone at anywhere during CPR, it is not commonly used in hospital where cardiac arrest often happens with most staff are BLS providers. Instilling competence with adequate training allows us to act swiftly and save lives. Such intuitive visual-verbal prompting practice can be further promulgated in clinical areas where cardiac arrest seldom found with low competence.
