• Lena Karlsson, Malta Hansen Carolina C Emergency Medical Services Copenhagen, University of Copenhagen, Denmark; Department of Cardiology, Nephrology, and Endocrinology, Copenhagen Univ, Mads Wissenberg, Møller Hansen Steen S Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark., Freddy K Lippert, Shahzleen Rajan, Kristian Kragholm, Sidsel G Møller, Bach Søndergaard Kathrine K Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark., Gunnar H Gislason, Christian Torp-Pedersen, and Fredrik Folke.
• Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark; Emergency Medical Services Copenhagen, University of Copenhagen, Denmark. Electronic address: limkarlsson@gmail.com.
• Resuscitation. 2019 Mar 1; 136: 30-37.

AimsOptimization of automated external defibrillator (AED) placement and accessibility are warranted. We examined the associations between AED accessibility, at the time of an out-of-hospital cardiac arrest (OHCA), bystander defibrillation, and 30-day survival, as well as AED coverage according to AED locations.MethodsIn this registry-based study we identified all OHCAs registered by mobile emergency care units in Copenhagen, Denmark (2008-2016). Information regarding registered AEDs (2007-2016) was retrieved from the nationwide Danish AED Network. We calculated AED coverage (AEDs located ≤200 m route distance from an OHCA) and, according to AED accessibility, the likelihoods of bystander defibrillation and 30-day survival.ResultsOf 2500 OHCAs, 22.6% (n = 566) were covered by a registered AED. At the time of OHCA, <50% of these AEDs were accessible (n = 276). OHCAs covered by an accessible AED were nearly three times more likely to receive bystander defibrillation (accessible: 13.8% vs. inaccessible: 4.8%, p < 0.001) and twice as likely to achieve 30-day survival (accessible: 28.8% vs. inaccessible: 16.4%, p < 0.001). Among bystander-witnessed OHCAs with shockable heart rhythms (accessible vs. inaccessible AEDs), bystander defibrillation rates were 39.8% vs. 20.3% (p = 0.01) and 30-day survival rates were 72.7% vs. 44.1% (p < 0.001). Most OHCAs were covered by AEDs at offices (18.6%), schools (13.3%), and sports facilities (12.9%), each with a coverage loss >50%, due to limited AED accessibility.ConclusionsThe chance of a bystander defibrillation was tripled, and 30-day survival nearly doubled, when the nearest AED was accessible, compared to inaccessible, at the time of OHCA, underscoring the importance of unhindered AED accessibility.Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.

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