Drone-Delivered AEDs Are the Future of Out-Of-Hospital Cardiac Arrest

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Telemedicine is often thought of as a convenient video visit by a provider from your home, or a video consultation with a specialist while hospitalized in a community hospital. Remote video doctor visits to a cruise ship or an oil rig also come to mind. Telemedicine, however, does not require a screen nor a face-to-face virtual examination. What about actual care brought right to the patient?

There is not a more compelling use for drone technology in healthcare than rapid delivery of an automated external defibrillator (AED). AEDs have been incorporated into the American Red Cross CPR course since 1999. In the following years, AEDs have been deployed wherever people gather, including schools, malls, airports, airplanes and stadiums. According to a study on out-of-hospital cardiac arrest from 2015, one of the factors associated with improved survival was use of an AED. The other factors were: younger age, cardiac arrest in public area, witnessed cardiac arrest, cardiac origin with a shockable rhythm, shorter time until return of spontaneous circulation, Glasgow Coma Scale (GCS) ≥13 during transport and longer length of hospital stay. [1] All that to say: time to defibrillation is critically important.

In spite of efforts to disseminate AEDs to public places, many out-of-hospital arrest victims are not receiving rapid defibrillation. Many times, arrest victims are not reasonably near a known AED location and in both rural and urban locations, EMS response times can be too long. The most common location for out-of-hospital cardiac arrest is the home. [2]

A study published in JAMA in 2017 compared AED delivery times using an 8-rotor drone compared to standard EMS response times for out of hospital cardiac arrest. [3] This was performed in Norrtälje which is a municipality north of Stockholm, Sweden with a moderate population. The drone flew to the GPS coordinates for the simulated cardiac arrest in an automated fashion using GPS, on board camera and autopilot flight software. All locations were within 10-km radius from the dispatching fire house. The primary endpoint was time of dispatch to time of arrival on scene. The times were compared to ground based EMS responses to actual cardiac arrests that occurred at these locations.

Results of this study demonstrate a median reduction in response times of 16:39 minutes for AED drone compared to ground-based EMS response times. The median time from dispatch to arrival of the drone AED was 5:21. The time from dispatch to drone launch was 3 seconds where median time from call to EMS dispatch was 3:00 minutes.

This study demonstrates that AED drone dispatch is feasible. In fact, using a network of AED drones across a geographic area could lead to even faster response times. Faster response times should lead to higher survival rates in out-of-hospital cardiac arrest but we need further studies to bear this out. Limiting factors for such a system would potentially be weather, restricted airspace, technical expertise to maintain such a system, and cost. As the FAA and drone industry works to make routine autonomous flights a reality, more real world studies could be done to further determine response times and survival rates.

REFERENCES

1. Boyce, L. W. et al. “High Survival Rate of 43% in out-of-Hospital Cardiac Arrest Patients in an Optimised Chain of Survival.” Netherlands Heart Journal1 (2015): 20–25. PMC. Web. 12 Feb. 2018.

2. Engdahl J, Holmberg M, Karlson BW, Luepker R, Herlitz J. The epidemiology of out-of-hospital ‘sudden’ cardiac arrest. 2002;52:235–45.

3. Claesson A, Bäckman A, Ringh M, Svensson L, Nordberg P, Djärv T, Hollenberg J. Time to Delivery of an Automated External Defibrillator Using a Drone for Simulated Out-of-Hospital Cardiac Arrests vs Emergency Medical Services. 2017;317(22):2332–2334.

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