Tracking cardiac arrest outcomes with Professor Terry Brown

In episode #43, Paul talks with assistant Professor Terry Brown on the out of hospital outcomes registry which is a project conducted by The University of Warwick medical school.

Terry takes us through what the registry is and how it fits in internationally (CARES, EURECA, PAROS), what information they collect and some of the projects that they have been looking at.

From the data they have collated from the 11 ambulance services in England they have produced a number of outputs and have calculated the stats that are commonly quoted such as the survival rate of 8-10%.

Terry also talks about how the data from the registry is helping to shape the future by guiding them on what areas of the country need better coverage of defibrillators and CPR training and how drones may deliver AED’s to needy areas.

Available to listen on the link below or Spotify, Apple , Google, YouTube and your favourite podcast player.

#043 Tracking cardiac arrest outcomes with Professor Terry Brown

Paul Swindell: [00:00:11] Hello and welcome to another episode of the Life After Cardiac Arrest podcast with me, your host, Paul Swindell.

Today I'm speaking with Terry Brown, who is an assistant professor at the Warwick University clinical trials unit and has a deep interest in cardiac arrest survival and their outcomes and is currently working on the out of hospital cardiac arrest outcomes registry.

So welcome Terry on this beautiful sunny day.

Professor Terry Brown: [00:00:38] Good morning, Paul. It is a

Paul Swindell: [00:00:39] I hope it, I hope it's sunny where you are. It's sunny where I am.

Professor Terry Brown: [00:00:43] It is sunny now after early morning fog when I got up early. So yeah, it is bright sunshine now.

Paul Swindell: [00:00:49] And you work at Warwick university, clinical trials unit, and I see quite often a lot of, research on cardiac arrest comes from Warwick university. Why is that?

Professor Terry Brown: [00:00:59] It's mainly because Professor Gavin Perkins, who's a director of the clinical trials unit is sort of a world leader. In the area of, out of, out of hospital, cardiac arrest, resuscitation care, critical care.

He's on the national committees and the international committees. There's the International Relation Committee on Resuscitation (ILCOR).

So yeah, Gavin is, a major leader in the research on out of hospital cardiac arrest.

Paul Swindell: [00:01:26] So he pulls in projects and et cetera, and into your area.

So, I mean, you're, you're a researcher, is that right?

Professor Terry Brown: [00:01:34] I am, yeah. My, background is, epidemiology statistics. prior to Warwick, I've worked at numerous universities and for health and safety laboratory, health and safety executive. So, background in occupational, environmental, and public health epidemiology.

Paul Swindell: [00:01:52] I see that you have done quite a few, projects over your, time relating to cardiac arrest. Could you sort of briefly mention about those?

Professor Terry Brown: [00:02:01] Well, I've been with Warwick for nearly five years now, and I started with the registry to look at, changes in bystander CPR rates on how they have changed. So initial project was looking at, as I say, bystander CPR, and how it varies, has varied over time within England. It�s mainly looking at English data because of how the OHCAO registry is set up.

So, we're looking at the variation over time and also how it's varied during the daytime and what impact it has on survival. So, the research that I've carried out is looking at the characteristics of neighbourhoods of where bystander CPR occurs, and there�s a paper that had published last year.

And then more recently is looking at public access, defibrillation.

Where are the defibrillators in the community?

Are they in the right place?

And in the right place to sort of treat or be available to treat any out of hospital cardiac arrest.

So those are the main two areas, but there's other bits of areas that we look been involved in, looking at attitudes towards CPR, training, and issues like that.

We've been very busy with sorting out the registry and getting all the data cleaned up and producing our annual reports. That, we've not, sort of produced that many publications from the data, but we have planned to do that, but we are, we do encourage external researchers to get in touch with the registry to do their own research using the data from the registry.

But yeah, we have, the data. We have little projects that we'd like to get going. And, you know, there's many thoughts on what we can do with the data, that it�s just finding enough time to sort of look at them as I said.

There's small projects that I'm interested in looking at, as I mentioned earlier, a patient being administered to cardiac arrest centres in England and the UK, and it's in line with what Tom Keeble does at Essex Cardiothoracic centre, looking at those patients, and then also looking at termination of resuscitation rules.

So, there's little projects that we can get involved in. It's just a finding the matter of time and to analyze the data.

Paul Swindell: [00:04:25] Okay, so on this podcast, we're be talking about the out of hospital cardiac arrest registry (OHCAO).

Can you tell me what this registry is and what is the point of it?

Professor Terry Brown: [00:04:36] The background of the registry is to standardize the care of out of hospital cardiac arrests to see what the variation is with regards to treatment and outcomes.

The feasibility of setting up the registry was carried out in, 2013. And then the data collection really started in, 2014, and since then we collected data on an annual basis, but as of April of last year, the data comes into the registry on a monthly basis.

So, as I say, we have data from 2014 and it's looks at patient characteristics, ambulance indicators.

So, with regards to characteristics, we have information on patient's age, and gender, those sorts of things.

With regards to ambulance service information, we have Information on where the arrest occurred, all the call times, so when the call was made to nine, nine, nine. Call was connected to the ambulance dispatch centre, when they arrived on scene, and then basic information on the etiology. So, what caused the cardiac arrest, whether it was of cardiac origin?

Also have information on whether it was a result of trauma, drowning, drug overdose, and then what was the initial cardiac, rhythm. That was measured by the paramedics, whether the event was witnessed or not, who witnessed it, whether the bystander CPR was carried out.

And then information that, the ambulance staff provide with regards to administration of drugs. Whether intubation was carried out, whether they applied a defibrillator, where the shocks were given. And then as a result of that, whether there is a return of spontaneous circulation or a patient was declared deceased, and whether the patient was admitted to the hospital with or without a ROSC.

And then the ambulance staff have been collecting on whether patient has been discharged, from the hospital alive or not.

Paul Swindell: [00:06:42] So it's quite, there's quite a lot of data you're collecting there, isn't there? Perhaps we can, we can sort of delve down into that a little bit later, but to sort of put it into context, I think, you mentioned this is NHS England. Are you collecting information from the other parts of the UK and where does this fit in, say a world program?

Is this such a thing as a world program or other countries doing similar things?

Professor Terry Brown: [00:07:06] There are a number of other registries around the world, the main ones, there's North America, which is the CARES registry. There are small registries all around Europe. There is a project called EURECA, which is the EUropean REgistry of Cardiac Arrest and the papers just been published from EURECA 2. And in that study there was data submitted from 27 registries.

And then worldwide, there is the Victorian ambulance registry in Australia. And don't quote me on this, I think there is a similar registry for Western Australia.

There's the Australia New Zealand registry.

There's PAROS which is a collection of Asian registries, and that covers Singapore, Japan, and a number of other countries.

So there, other registries around the world, and we've had, two meetings now to discuss What data to collect and how we should collect the data and what research we need to need to carry out.

Within the UK, the registry only collects information from English ambulance services, we're sorting out, the Welsh data. Northern Ireland are very keen to be involved as well, but they have, personnel/logistic problems.

Scotland, have their own registry, but we can't access the raw data, because of data confidentiality.

Paul Swindell: [00:08:36] You mentioned that you�ve had two get togethers as with the people behind the registries. I guess the idea is to try and get some new unified format so that you can understand each other's results and improvements perhaps?

Professor Terry Brown: [00:08:49] Yes.

So, there are a set of guidelines that's called the UTSTEIN guidelines, and that basically tells you what information is required. So that we have a definitive set of key variables that we ask the ambulance services to provide. And then there's supplementary information and then additional information that we ask for.

Paul Swindell: [00:09:09] Can we compare results from the UK with another country?

When we say that the average is 8% survival in the UK, and, and they quote I think is about 25% for somewhere like Norway. Are we quoting apples with apples or is it slightly different?

Professor Terry Brown: [00:09:26] It does vary with regards to how you define a case. Some look at the survival overall. So overall, our survival, in England is, about 8 to 10%, and that's all cases.

If you then dig down deeper into if the case was witnessed?

Did they receive bystander CPR?

Was the initial rhythm shockable?

If you look at more specific cases, then the survival goes up.

So, survival, for all cases, ROSC at hospital handover, for all patients is about 20%.

For those that the first rhythm is shockable the ROSC hospital handover is 52%.

So, there's a big, difference.

And then if you look at survival to discharge, in a shockable rhythm, their survival to discharge is nearly 30%.

The earlier you get to a cardiac arrest and CPR is applied and treatment starts, then the more chance that that patient is in a shockable rhythm.

So, you know, it is important.

Paul Swindell: [00:10:36] It is, it is just to take a step back a bit, we're just talking about England, aren't we at the moment because that�s all you collect the data for?

Professor Terry Brown: [00:10:43] Yeah, it�s just England at the moment, yeah.

Paul Swindell: [00:10:46] And how many ambulance services are there, is it?

Professor Terry Brown: [00:10:50] It�s 11.

Paul Swindell: [00:10:51] 11 is it, okay.

Professor Terry Brown: [00:10:54] If we include the Isle of Wight

Paul Swindell: [00:10:54] Okay, so we�ve got 11, ambulance services feeding data into you, and they go out to a cardiac arrest, how many of those are we talking about roughly every year within England, the ambulance attend?

Professor Terry Brown: [00:11:08] So for 2018, we had just under 31,000 cases submitted to the registry. That does not include three months data from two registries. On that basis it's about another 500 cases.

But in addition to those, there are those that they don't attempt resuscitation. So, the ambulance services also send information on the total number of cases that are attended.

And it works out for the whole of the country about 80,000.

So, there are about 80,000 cardiac arrests in England, in 2018 of which only about 31,000, received, resuscitation attempts by ambulance staff.

Paul Swindell: [00:11:55] We've got 11 ambulance services and in England there�s 80,000 cardiac arrest of which 31,000 are attempted resuscitations.

And what's the average, success rate?

Professor Terry Brown: [00:12:10] ROSC at hospital is about 20%. And survival to discharge is just under 10%

Paul Swindell: [00:12:18] So basically that translates as, if you get to hospital alive, you�ve got a 50/50 chance of coming out alive.

Professor Terry Brown: [00:12:25] Yeah, that's about it.

Paul Swindell: [00:12:26] That�s roughly it.

Professor Terry Brown: [00:12:27] Yeah.

Paul Swindell: [00:12:28] That equates to something similar that Dr Keeble said to me before actually.

Professor Terry Brown: [00:12:33] Of course. It varies with age and gender.

Paul Swindell: [00:12:36] Okay, can you tell me a little bit about variability in different ambulance services?

Professor Terry Brown: [00:12:41] I think the original quote was about 8 to 24%. There was a significant variation, but it too, to an extent is that was because how, the ambulance services was submitting the data, who they were submitting the data on and who they were not submitting the data on.

So, the actual variation is, about 5 or 6% between the ambulance services. Again, these, down to the resources, you know, the locality of, where the events occur.

If you think about, the more rural communities, you know, people that have a cardiac arrest up in the middle of the Lake District and get into them is very difficult.

But they might say, sometimes it's more difficult to get to a cardiac arrest in, in the middle of London, than it is in rural communities. We're trying to sort of make adjustments to the information and looking at what impacts survival rates. So, they're basically, they're doing the same thing. It's just that there are things beyond their control that they can't allow for.

Paul Swindell: [00:13:42] I guess from what you're doing, you can learn from the data where perhaps the best place where public access to defibrillators are, or perhaps more training of the community and CPR skills comes into play

Professor Terry Brown: [00:13:55] We had a paper published the beginning of last year looking at the neighbourhood characteristics of where there is a high incidence of cardiac arrest and where bystander CPR rates are low.

So those communities, the more, more deprived areas of the country. Where there is sort of a more ethnic diverse population, where there's more older people, more unemployment, things like that.

So those, those areas where we've identified where incidence is high and bystander CPR rates are low. We've identified these hotspot areas and some preliminary work has been done with Andy Lockie and the University of Leeds medical school to target hotspot areas in West Yorkshire.

So, target those areas for CPR training. And some similar workers just starting for a West Midlands as well. And this is sort of in addition to the training that goes on as part of Restart a Heart Day, and other training that goes on, on an ad hoc basis throughout the country.

Paul Swindell: [00:15:02] So is there anyone actually sort of coordinating all of that training that goes on is, or is it very much ad hoc?

Professor Terry Brown: [00:15:09] The Restart a Heart Day is a very coordinated training day. It's coordinated mainly through a Yorkshire ambulance service and Resuscitation Council UK. It's Dr Andy Lockie, and Jason Carline who works for Yorkshire ambulance service.

It's all coordinated through the ambulance services to an extent. And, so it's normally 16th of October every year. People go into, mainly schools at the moment. They go into schools, secondary schools and do sort of mass CPR training. And last year, I think it was nearly 300,000 children.

So that anybody who wants training, if they get in touch with, the of ambulance service, there is somebody that coordinates training who'll be able to help.

Paul Swindell: [00:15:55] Is all this extra training in the public showing any dividends yet?

Professor Terry Brown: [00:15:59] When we did some analysis, a couple of years ago, presented a paper at the European Resuscitation Council annual conference, in about 2014, 15, the bystander CPR rates were about 50-55%, of those cases that were witnessed by a bystander. Last year, of all the cases that were witnessed the bystander CPR rate was about 74%.

So, it's a significant improvement in bystander CPR rates, if the case was witnessed.

Paul Swindell: [00:16:31] Wow. Yeah, that that really surprises me. It's that high, but I guess we got to put them into context where, whereabouts all these cardiac risks happening. When we say, 74%, is that all of 74% of people in the street who has a cardiac arrest?

Professor Terry Brown: [00:16:48] Those cardiac arrests that occur in a public place are more likely to receive bystander CPR. A bystander can mean anybody really, we don't distinguish who the bystander is.

But about 80% of out of hospital cardiac arrest occur in place of residence. And for some reason, the, CPR rates in, those are lower, because a lot of, cardiac arrests that occur in the home are not witnessed, or there is a reluctance for members of the family to perform CPR on a relative.

Paul Swindell: [00:17:22] I mean, that's really interesting, isn't it?

Professor Terry Brown: [00:17:24] A lot of arrests are unwitnessed in places of residence. Cause they you know will occur in the middle of the night and you know the relative will not know.

Paul Swindell: [00:17:34] That�s interesting in itself, what you just said there. So, they're in bed asleep and they have a cardiac arrest, even though there's someone next to them that that's counted as unwitnessed, I guess, because they're asleep.

Professor Terry Brown: [00:17:45] Yeah, basically that, you know, they have not witnessed the patient having the arrest.

Paul Swindell: [00:17:49] Do we know how many occur like that?

Professor Terry Brown: [00:17:51] I how don't know offhand.

Paul Swindell: [00:17:54] Presumably you have the, the time of day that the event occurred.

Professor Terry Brown: [00:17:57] There�s a small, paper looking at the time of day the events occurred and the bystander CPR rates, vary during the day. if I can remember rightly, the bystander CPR rates are low overnight.

Then they pick up, during the morning, and then they peak at about midafternoon, and then after midafternoon until early evening, and then they drop off again overnight.

Paul Swindell: [00:18:22] Is that reflective of when cardiac arrest happened or are cardiac arrests, sort of steady throughout the 24-hour day.

Professor Terry Brown: [00:18:30] No, there is a variation of when they arrest occur, but it�s all to do with, I think where people have their arrests.

Paul Swindell: [00:18:38] I did read a while ago that there was a, propensity for people to have a cardiac arrest on a Monday morning but I think that's less than now.

Professor Terry Brown: [00:18:46] Yes. Yeah. Yeah. I there is some variation during the week. It's Monday morning and it's quieter over the weekend. It's going back to work on a Monday morning events and there is some variation in the day of the week, and they'll show there's some variation over the year as well.

Paul Swindell: [00:19:01] Okay. Seasonal factors come into play, the cold or extreme cold and heat and extreme heat play a factor?

Professor Terry Brown: [00:19:09] And you said we weren't going to mention COVID 19, but infections and things like that place, a burden on the heart. And if there's a heavy flu outbreak over the winter, that will impact on the number of cases that will, suffer a cardiac arrest as a result of any infection

Paul Swindell: [00:19:23] So, what are the outputs of your project?

Professor Terry Brown: [00:19:28] The main output for the registry is an annual epidemiology report. So, over the past three, four years, we have looked at, foreach ambulance service that are submitting data to the registry.

So, we look at, well, you probably know the Chain of Survival.

So, we look the incidents of events in the year.

So, looking at, the incidence of adult and pediatric events, the demographics of them, sort of, age, sex distribution, the etiology, which is what caused the cardiac arrest. In most cases, it will be of cardiac origin.

And I think there's, I mentioned earlier, we do receive, information on traumatic and drug overdose events.

Where the event occurs.

So, if it's occurs in a rural community or in urban environments, and then going for the Chain of Survival, looking at the scene outcomes.

So, whether a patient was declared deceased on scene, whether they were transported to hospital and when they were transported to the hospital, whether it was, a ROSC had been achieved or ongoing CPR with was being carried out.

And then we look at, the initial rhythm. I'm looking at whether it's shockable and the outcomes from that.

How many cases were witnessed as how many received bystander CPR and then the main outcomes that we have, we have three really, although we only really present information on two, we have information on whether a ROSC.

And I assume, hopefully all your listeners know what ROSC is.

Paul Swindell: [00:21:04] You should probably just remind us, Terry.

Professor Terry Brown: [00:21:07] Its return of spontaneous circulation.

So basically, if somebody has had an arrest, they�re not conscious not responding they're not breathing, but ROSC basically the heart starts beating without any CPR or defibrillation.

So, it's, they're there, they're on their, on their own so they, they've come back to life.

Early defibrillation is the key for the majority of cases. Sometimes it can be as a result of CPR, if it's good quality, CPR, you know, somebody could come back to life if they're doing good CPR.

So, we have gone scene. So that's basically before the ambulance service leaves the scene to go to hospital.

So, then we have ROSC on scene. And then the main outcomes that we are interested in and which is part of the ambulance quality indicators for NHS England, is whether a patient has achieved ROSC at hospital handover.

So, when the ambulance gets to A&E whether the patient has, has a ROSC or not,

Paul Swindell: [00:22:05] So you're saying that they might not have been able to resuscitate them at the scene, but they may have on the journey to hospital. I guess because E-CPR type equipment? Lucas machines, and even coming into play is in some countries is ECMO, it?

Professor Terry Brown: [00:22:21] So yeah, I'm performing CPR in a moving ambulance is very difficult, but there will be decisions made. So those, that achieve ROSC on scene, not all of them will have ROSC at hospital handover, and they, might rearrest in the ambulance and vice versa.

There might be some that are, they transport start to transport that hadn't achieved ROSC, but achieve ROSC in the ambulance on the way in. So we have ROSC at hospital handover, and then we have survival to discharge.

Paul Swindell: [00:22:49] I guess some, patients are, or from speaking with many in the group have multiple arrests. They have one and they're down. The ambulance gets to them, they resuscitate them. Then perhaps in the ambulance or later on they have multiple events, I guess this is all presented as one event. I take it.

Professor Terry Brown: [00:23:09] If it�s, on the same day. Wherever the original location is, if it's at home and they've resuscitated, put in the ambulance and rearrests again, that that is all counted as the same event. If they subsequently are discharged and then rearrests at a later date, then that's counted as a separate event.

Paul Swindell: [00:23:27] So, is this data only provided for certain parties or can anyone. See this information, can the members of the public, if they've got an interest, to see where they, they sort of fit into the picture. Because my arrest was in 2014 which is the first year that you did your, stats. But can other people see about their year.

Professor Terry Brown: [00:23:47] We have a website and on the website, what we have now is the annual EPI report, and we have an infographic, that shows all the sort of the incidents, bystander witness rates, bystander CPR rates. The variation between each ambulance service.

So, all the information that's provided on the, for the ambulance quality indicators, that information is on, on our website, and it's backed up by data from the registry.

So, the information that's on the website is for annual average. And then for the current year, we update it as every month data is submitted to the registry.

So, for 2019 we have data up to the end of November.

Paul Swindell: [00:24:33] Oh excellent.

Professor Terry Brown: [00:24:34] You click on the, ambulance service. and then it shows the, the figures for that. But with regards to individual patient information.

Paul Swindell: [00:24:42] I guess people can go to that if they really want to know the individual details of their case, they can go to the hospital, can�t they? Or the ambulance service.

Professor Terry Brown: [00:24:51] If they want, to, about individual cases in you go to the ambulance service, but anybody who wants to know whether they're on the registry or not, they can put in freedom information requests through the normal channels.

Your arrest was in, what did you say, 2014?

We can't confirm that now because, as part of our information governance, after two years, we have to delete all personal identifiable information from the registry. So yeah, so for 2014, although you probably are on the registry, we wouldn�t be able to confirm that, now.

Paul Swindell: [00:25:26] Okay.

Just to go back to what you said about your website, I've just Googled and I put in O H C A O and then space Warwick, and that brought up you as the first option, and I clicked on the first link, and as you say that, brings up your website with information about the project and the information for health professionals and information for public.

So, there's more info if you're lay-person. And then, there's some publications, and at the bottom of the menu, there's a link to your interactive map. And that's, very nice. infographic, as you mentioned, you�ve got all of the various regions highlighted in lovely colours.

And if I clicked on the East of England, which is my region, it then brings up a nice page with full stats, number of ROSCs, number of ROSCs within a particular subgroup, the number of survivals and the bystander CPR and the number of public accessible defibrillators that were used, which is, it's really interesting.

One thing that only goes back to 2015 there is that when the data was published in 2015 or we would mine be in that 2015 one or is 2014 not on here for some reason?

Professor Terry Brown: [00:26:45] Its not on there because of the completeness of the information. The registry has data back to 2014, but it was just the completeness of the registry. Not every ambulance service was submitting data in that year, so we didn't want to at that, to the interactive map.

So for completeness, we just thought oh well start at 2015 where, when everybody was sending us good quality information.

Paul Swindell: [00:27:10] Okay.

Well, I think if anyone's interested in looking at that, that data, it's a really nice infographic and there's lots of information on there. It's really worth having a little bit of a, delve into that if you want to have more. And I don't think I've got any more questions for you Terry.

So, I don't know if you've got anything else that you'd like to say.

Professor Terry Brown: [00:27:29] My interest is looking at public access defibrillation at the moment. And with the current project that I'm involved, is, is looking at where are the public access defibrillators in relation to a cardiac arrest and are they in the right place?

So, I�m doing a three-year study, looking at, the location of all defibrillators.

So, we're working closely with British Heart Foundation. who are developing their, Circuit database of all defibrillators in the country.

So, are they, are they located in the right place in relation to cardiac arrests?

If not, where should we put defibrillators in the future so that they are made of, are available to everybody that has a cardiac arrest?

So, for example, we had a medical student, a couple of years ago that looked at, cardiac arrest occurred in schools, and as a byproduct of that small project, found out that if, a defibrillator was put in every school in the West Midlands and made available, nearly 40% of all cardiac arrests could be treated with a defibrillator.

They were in within 300 meters of 40% of all cardiac arrests.

Paul Swindell: [00:28:45] That�s quite a staggering statistic really, isn�t it?

Professor Terry Brown: [00:28:48] Yeah, it is a big number considering that only 5% of cases are treated with a public access defibrillator.

So, we're looking at where to put defibrillators in the community, doing some mathematical modeling.

And then there's another little project, which is everybody's keen to be part of that's been funded by Resuscitation Council, is looking at the use of drones to deliver AEDs to cardiac arrests, where it's going to be, it's difficult for ambulances to get to. So, in rural communities or, where ambulances having, long traveling times.

So, this is another small project, that we're getting involved with.

Paul Swindell: [00:29:31] Over the last couple of years, I've seen various sort of newspaper reports about drone usage, typically in, Europe, I think possibly Belgium and the Netherlands,

Professor Terry Brown: [00:29:41] Sweden is the, is the big place as well.

Yeah. Yeah .

Paul Swindell: [00:29:45] Has anyone got them in actual use yet?

Professor Terry Brown: [00:29:48] I don't think they are at a moment.

The main problem with, using drones in the UK is getting, civil aviation authority authorization. To, fly the drones, out of line of sight.

Because at the moment, as far as I understand that regulation, you're only allowed to fly drones within 500 meters. So, you only see them. You have to be able to see the drone, whereas with, AED delivery, you're going to fly them remotely.

Paul Swindell: [00:30:17] I imagine the shenanigans that happened at the Gatwick airport or some other airport in the last year or two, that only complicates the scenario and the legal aspect, doesn't it?

Professor Terry Brown: [00:30:27] They are officially no fly zones, so you have to build into whatever model you use. You have to fly them around, no fly zones, to deliver them. So, if, you know if you can't fly over military air airbases or military training grounds or things like that.

So, there are certain areas you can't fly them.

Paul Swindell: [00:30:45] But in in certain places like cities and things like that, they could be, they could be quite useful.

Professor Terry Brown: [00:30:50] Well, there is, colleagues in Canada have done some feasibility studies. We're looking at delivering, AEDs, sort of, into high rise building and whether it�s feasible to do that.

Paul Swindell: [00:31:02] Yeah, because I believe the stats on survival from a cardiac arrest when you're above full three up pretty dire really aren't

Professor Terry Brown: [00:31:09] Yeah, it can be. Yeah.

Marcus, in Singapore that looked at modeling, you know, where do you put a defibrillator in a high-rise building? Is it on the ground floor or do you actually put one in, in the lift?

So yeah.

Paul Swindell: [00:31:22] That's true.

Professor Terry Brown: [00:31:23] Yep.

Paul Swindell: [00:31:23] One on every floor, every other floor. Ideally.

Professor Terry Brown: [00:31:26] If you can afford

Paul Swindell: [00:31:29] I don't know if you listened to my podcast recently with, Gary Montague of the Heart Hero AED, which is an, an American startup and their, their aim is to deliver a high quality, low cost device. I think they're aiming currently for under $700 for a device that's got GPS tracking.

It uses batteries that you can buy in the shop, links to the, emergency services in the States anyway, but they hope to have it so they can go to most, emergency services.

So, essentially, it's a domestic AED and they aim to get it down to as low cost as possible.

So, it may be in a few years� time if they've get the volume that they can actually get it in a high proportion of people's houses,

Professor Terry Brown: [00:32:19] Yep. Yep.

Paul Swindell: [00:32:20] Which is the perfect place for them really.

Professor Terry Brown: [00:32:24] Yeah.

Paul Swindell: [00:32:24] So, thank you very much, Terry, for your time today. It's been a.

Professor Terry Brown: [00:32:29] I just want to add another thing, and I must do this.

But just say that the registry is currently funded by the British Heart Foundation and the Resuscitation Council. We have funding for another three years. We are backed by the association of ambulance chief executives and the national association of ambulance chief medical officers.

And I�d just like to thank the work of all of my colleagues at Warwick

Paul Swindell: [00:33:00] Yeah I think it's worthwhile mentioning that because without, without their funds and their support, you wouldn't be able to do this. And, and in time, I'm sure it's going to see, or reap dividends in, in feeding back into the chain of survival so that more and more people to survive.

Professor Terry Brown: [00:33:18] Yup, hopefully.

Paul Swindell: [00:33:20] So it's been a really interesting, chat and, thank you very much for your time and, take care in this, strange times we're in, and I look forward to seeing more, more stats and information from you and your website.

Professor Terry Brown: [00:33:32] If anybody wants to get in touch with me, please don't hesitate.

Paul Swindell: [00:33:36] And your contact details presumably will be on the website?

Professor Terry Brown: [00:33:39] If you contact us through the website is the OHCAO resource email address that will be picked up by one of the team and passed on.

Paul Swindell: [00:33:47] I will put all the links into the show notes on the website and the podcast.

Professor Terry Brown: [00:33:53] Yup, Okay.

Paul Swindell: [00:33:55] So thanks very much Terry, and we'll speak again soon.

This concludes this episode of the life After Cardiac Arrest podcast, and I'd love to know what you think. And you can do that via Facebook, Twitter, Instagram, or the website, and you can find this by Googling Sudden Cardiac Arrest UK or the Life after cardiac arrest podcast.

If you have found value in this or other episodes, please help spread the word by leaving a review on your podcast provider such as Apple or wherever is convenient.

And don't forget, if you want to know more about life after cardiac arrest, check out our books, life after cardiac arrest on Amazon. Make sure you click subscribe.

And I'll speak to you next time.

If you enjoyed this podcast please do leave a positive review on Apple or other podcast providers as it helps us to spread the word.

Presented and edited by Paul Swindell.

Recorded March 2020. 

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