In Silico Trial of Optimized Versus Actual Public Defibrillator Locations

Christopher L F Sun; Lena Karlsson; Christian Torp-Pedersen; Laurie J Morrison; Steven C Brooks; Fredrik Folke; Timothy C Y Chan

doi:10.1016/j.jacc.2019.06.075

In Silico Trial of Optimized Versus Actual Public Defibrillator Locations

Christopher L F Sun, Lena Karlsson, Christian Torp-Pedersen, Laurie J Morrison, Steven C Brooks, Fredrik Folke, Timothy C Y Chan

Department of Cardiology

18 Citations (Scopus)

Abstract

BACKGROUND: Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices.

OBJECTIVES: This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs).

METHODS: The authors conducted the first retrospective in silico trial of an AED placement intervention. This study identified all public OHCAs of presumed cardiac cause and real AED deployed (control group) from 2007 to 2016 in Copenhagen, Denmark. Optimization models trained on historical OHCAs (1994 to 2007) were used to optimize an equal number of AEDs to the control group in locations with availabilities based on building hours (intervention #1) or 24/7 access (intervention #2). The 2 interventions and control scenario were compared using the number of OHCAs that occurred within 100 m of an accessible AED ("OHCA coverage") during the 2007 to 2016 period. Change in bystander defibrillation and 30-day survival were estimated using multivariate logistic regression.

RESULTS: There were 673 public OHCAs and 1,573 registered AEDs from 2007 to 2016. OHCA coverage of real AED placements was 22.0%. OHCA coverage of interventions #1 and #2 was significantly higher at 33.4% and 43.1%, respectively; relative gains of 52.0% to 95.9% (p < 0.001). Bystander defibrillation increased from 14.6% (control group) to 22.5% to 26.9% (intervention #1 to intervention #2); relative increase of 52.9% to 83.5% (p < 0.001). The 30-day survival rates increased from 31.3% (control group) to 34.7% to 35.4%, which is a relative increase of 11.0% to 13.3% (p < 0.001).

CONCLUSIONS: Optimized AED placements increased OHCA coverage by approximately 50% to 100% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.

Original language	English
Journal	Journal of the American College of Cardiology
Volume	74
Issue number	12
Pages (from-to)	1557-1567
Number of pages	11
ISSN	0735-1097
DOIs	https://doi.org/10.1016/j.jacc.2019.06.075
Publication status	Published - 24 Sept 2019

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10.1016/j.jacc.2019.06.075

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@article{cfeb81b9850140feb9dd315bbe45ed29,

title = "In Silico Trial of Optimized Versus Actual Public Defibrillator Locations",

abstract = "BACKGROUND: Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices.OBJECTIVES: This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs).METHODS: The authors conducted the first retrospective in silico trial of an AED placement intervention. This study identified all public OHCAs of presumed cardiac cause and real AED deployed (control group) from 2007 to 2016 in Copenhagen, Denmark. Optimization models trained on historical OHCAs (1994 to 2007) were used to optimize an equal number of AEDs to the control group in locations with availabilities based on building hours (intervention \#1) or 24/7 access (intervention \#2). The 2 interventions and control scenario were compared using the number of OHCAs that occurred within 100 m of an accessible AED ({"}OHCA coverage{"}) during the 2007 to 2016 period. Change in bystander defibrillation and 30-day survival were estimated using multivariate logistic regression.RESULTS: There were 673 public OHCAs and 1,573 registered AEDs from 2007 to 2016. OHCA coverage of real AED placements was 22.0\%. OHCA coverage of interventions \#1 and \#2 was significantly higher at 33.4\% and 43.1\%, respectively; relative gains of 52.0\% to 95.9\% (p < 0.001). Bystander defibrillation increased from 14.6\% (control group) to 22.5\% to 26.9\% (intervention \#1 to intervention \#2); relative increase of 52.9\% to 83.5\% (p < 0.001). The 30-day survival rates increased from 31.3\% (control group) to 34.7\% to 35.4\%, which is a relative increase of 11.0\% to 13.3\% (p < 0.001).CONCLUSIONS: Optimized AED placements increased OHCA coverage by approximately 50\% to 100\% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.",

author = "Sun, \{Christopher L F\} and Lena Karlsson and Christian Torp-Pedersen and Morrison, \{Laurie J\} and Brooks, \{Steven C\} and Fredrik Folke and Chan, \{Timothy C Y\}",

year = "2019",

month = sep,

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doi = "10.1016/j.jacc.2019.06.075",

language = "English",

volume = "74",

pages = "1557--1567",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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TY - JOUR

T1 - In Silico Trial of Optimized Versus Actual Public Defibrillator Locations

AU - Sun, Christopher L F

AU - Karlsson, Lena

AU - Torp-Pedersen, Christian

AU - Morrison, Laurie J

AU - Brooks, Steven C

AU - Folke, Fredrik

AU - Chan, Timothy C Y

PY - 2019/9/24

Y1 - 2019/9/24

N2 - BACKGROUND: Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices.OBJECTIVES: This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs).METHODS: The authors conducted the first retrospective in silico trial of an AED placement intervention. This study identified all public OHCAs of presumed cardiac cause and real AED deployed (control group) from 2007 to 2016 in Copenhagen, Denmark. Optimization models trained on historical OHCAs (1994 to 2007) were used to optimize an equal number of AEDs to the control group in locations with availabilities based on building hours (intervention #1) or 24/7 access (intervention #2). The 2 interventions and control scenario were compared using the number of OHCAs that occurred within 100 m of an accessible AED ("OHCA coverage") during the 2007 to 2016 period. Change in bystander defibrillation and 30-day survival were estimated using multivariate logistic regression.RESULTS: There were 673 public OHCAs and 1,573 registered AEDs from 2007 to 2016. OHCA coverage of real AED placements was 22.0%. OHCA coverage of interventions #1 and #2 was significantly higher at 33.4% and 43.1%, respectively; relative gains of 52.0% to 95.9% (p < 0.001). Bystander defibrillation increased from 14.6% (control group) to 22.5% to 26.9% (intervention #1 to intervention #2); relative increase of 52.9% to 83.5% (p < 0.001). The 30-day survival rates increased from 31.3% (control group) to 34.7% to 35.4%, which is a relative increase of 11.0% to 13.3% (p < 0.001).CONCLUSIONS: Optimized AED placements increased OHCA coverage by approximately 50% to 100% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.

AB - BACKGROUND: Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices.OBJECTIVES: This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs).METHODS: The authors conducted the first retrospective in silico trial of an AED placement intervention. This study identified all public OHCAs of presumed cardiac cause and real AED deployed (control group) from 2007 to 2016 in Copenhagen, Denmark. Optimization models trained on historical OHCAs (1994 to 2007) were used to optimize an equal number of AEDs to the control group in locations with availabilities based on building hours (intervention #1) or 24/7 access (intervention #2). The 2 interventions and control scenario were compared using the number of OHCAs that occurred within 100 m of an accessible AED ("OHCA coverage") during the 2007 to 2016 period. Change in bystander defibrillation and 30-day survival were estimated using multivariate logistic regression.RESULTS: There were 673 public OHCAs and 1,573 registered AEDs from 2007 to 2016. OHCA coverage of real AED placements was 22.0%. OHCA coverage of interventions #1 and #2 was significantly higher at 33.4% and 43.1%, respectively; relative gains of 52.0% to 95.9% (p < 0.001). Bystander defibrillation increased from 14.6% (control group) to 22.5% to 26.9% (intervention #1 to intervention #2); relative increase of 52.9% to 83.5% (p < 0.001). The 30-day survival rates increased from 31.3% (control group) to 34.7% to 35.4%, which is a relative increase of 11.0% to 13.3% (p < 0.001).CONCLUSIONS: Optimized AED placements increased OHCA coverage by approximately 50% to 100% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.

UR - https://www.scopus.com/pages/publications/85071942439

U2 - 10.1016/j.jacc.2019.06.075

DO - 10.1016/j.jacc.2019.06.075

M3 - Journal article

C2 - 31537265

SN - 0735-1097

VL - 74

SP - 1557

EP - 1567

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 12

ER -

In Silico Trial of Optimized Versus Actual Public Defibrillator Locations

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