Top Things to Know: Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest

Published: March 21, 2022

  1. Out-of-hospital cardiac arrest is a global public health issue experienced by ≈3.8 million people annually. Only 8% to 12% survive to hospital discharge. Early defibrillation of shockable rhythms is associated with improved survival, but ensuring timely access to defibrillators has been a significant challenge.
  2. Public-access defibrillation is the use of AEDs by members of the public to facilitate CPR and early defibrillation before professional responders arrive. Unfortunately, public-access AEDs are used in less than 3% of OHCAs.
  3. This scientific statement was commissioned by the International Liaison Committee on Resuscitation with 3 objectives: (1) identify known barriers to public-access defibrillator use and early defibrillation, (2) discuss established and novel strategies to address those barriers, and (3) identify high-priority knowledge gaps for future research to address.
  4. Recognition of cardiac arrest is a critical first step toward successful retrieval and use of an AED. Innovative technology applications such as wearables (eg, clothing, watches), smart speakers, and machine learning could be used to minimize the occurrence of unwitnessed and untreated cardiac arrest.
  5. Coordinated, data-driven, regional strategies to optimize the locations of public access AEDs on the basis of cardiac arrest risk and site accessibility could improve accessibility of AEDs.
  6. AED registries can inform the public and emergency dispatchers on the location of public access AEDs to facilitate retrieval during an emergency. Registries may also contribute to improving AED readiness by informing AED owners and managers when batteries and pads need replacing.
  7. Effective signage to help bystanders locate an AED quickly is of key importance. Contemporary AED signs do not conform to a universal design, with significant variability in coloring, iconography, and other key features. A universal AED sign could improve recognition and effectiveness of the sign.
  8. Mobile device apps linked with local emergency dispatch services are being used in some communities to notify nearby bystanders of a cardiac arrest emergency and direct them to the nearest public access AED. This is an emerging strategy that could benefit from further implementation and study.
  9. Innovative delivery vectors for AEDs include: Bystanders directed by dispatchers to the nearest registered AED, first responders equipped with AEDs (firefighters, police, community responder programs), and unmanned aerial vehicles carrying AEDs.
  10. Approximately 80% of OHCA occur in residential settings. Innovative strategies to improve access to AEDs in homes could improve outcomes for many of these patients. Advances in AED technology allowing miniaturization and reduced cost may provide new opportunities to study the benefit of consumer grade AEDs in homes. Community responder programs, where neighbors equipped with AEDs respond to local OHCAs, could reduce delays to defibrillation in the home and deserve further investigation.


Dainty KN, Colquitt B, Bhanji F, Hunt EA, Jefkins T, Leary M, Ornato JP, Swor RA, Panchal A; on behalf of the Science Subcommittee of the American Heart Association Emergency Cardiovascular Care Committee. Understanding the importance of the lay responder experience in out-of-hospital cardiac arrest: a scientific statement from the American Heart Association [published online ahead of print March 21, 2022]. Circulation. doi: 10.1161/CIR.0000000000001054