Automated external defibrillator delivery by a drone in a mountainous region to treat sudden cardiac arrest

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): ZOLL INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) poses a tough medical challenge with poor survival rates. Factors that may enable survival include resuscitation measures initiated by a bystander, early use of an automated external defibrillator (AED), and further performance of advanced life support. The latter will arrive on scene with an inevitable time-delay due to logistics challenges and potential AED unavailability, especially in rural areas. Here, drones might deliver an AED in order to increase the probability of survival. METHODS: Ten paramedics and nineteen medical laypersons were confronted with a person suffering from OHCA within a field test scenario in a mountainous region (Bodental, Carinthia, Austria) without detailed information. The scenario included a mock-call to the emergency response center responsible for the Austrian State Carinthia that dispatched a semi-autonomously flying drone towards the caller’s GPS coordinates. During the emergency call, participants should perform cardiopulmonary resuscitation (CPR) measures and were informed that a drone delivers a training-AED. Various timepoints (time to (tt) emergency call, tt start CPR, tt drone start, tt first shock, hands-off times) as well as CPR quality were subject of analysis. RESULTS: The paramedics realized the cardiac arrest after 21 ± 11 seconds, the emergency call was performed after 40 ±43 seconds, the drone started after 5:15 ± 2:11 minutes and dropped off the AED after 10:52 ± 2:06 minutes, and the first shock was delivered after 12:15 ± 2:03 minutes. 70 % performed adequate chest compressions and 50 % provided sufficient mouth-to-mouth ventilation. Hands-off times were 50 ± 22 seconds. Only 37 % of the medical laypersons reported to know the algorithms for basic life support while 32 % performed adequate chest compressions and 68 % performed adequate mouth-to-mouth ventilation. In this group, the cardiac arrest was realized after 51 ±40 seconds, the emergency call was performed after 53 ±43 seconds, the drone started after 6:15 ± 1:33 minutes and dropped off the AED after 10:54 ± 1:56 minutes, and the first shock was delivered after 14:04 ± 2:10 minutes. Hands-off times were 2:11 ± 0:39 minutes. CONCLUSION: The delivery and usage of an AED via a semi-autonomously flying drone in a remote region is feasible and safe. The drone delivery of an AED in mountainous regions can lead to early application of shocks. CPR quality performed by medical laypersons is suboptimal and emphasises the need for regular trainings. [Figure: see text] [Figure: see text]