In Silico Trial of Optimized Versus Actual Public Defibrillator Locations

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. This study sought to determine whether, compared with real AED locations, optimi...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2019-09, Vol.74 (12), p.1557-1567
Main Authors: Sun, Christopher L.F., Karlsson, Lena, Torp-Pedersen, Christian, Morrison, Laurie J., Brooks, Steven C., Folke, Fredrik, Chan, Timothy C.Y.
Format: Article
Language:English
Subjects:
Accessibility
Aged
automated external defibrillator
Automation
Cardiac arrest
Cardiology
Clinical trials
Computer Simulation
Defibrillators
Denmark
Drug overdose
Emergency medical care
Female
Health Services Accessibility
Heart
Humans
Intervention
Male
Mathematical models
Middle Aged
Opening hours
Optimization
Out-of-Hospital Cardiac Arrest - therapy
public access defibrillation
Public Facilities
resuscitation
Retrospective Studies
Survival
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Summary: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. This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs). 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. 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 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2019.06.075