Identifying the Operational Bottleneck to Shock Delivery After Automated External Defibrillator Activation.

Authors

Tsuyoshi Nojima, Tetsuya Yumoto, Takafumi Obara, Kohei Tokioka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Published in

Resuscitation. Pages 111361. Oct 20, 2026. Epub Oct 20, 2026.

Abstract

Cardiac arrest registries record automated external defibrillator (AED) use and shock delivery but not post-activation operational timing. We aimed to identify the largest measurable bottleneck and an exploratory pad-application target for shock delivery within 60 seconds of AED power-on.
We retrospectively analyzed timestamps from remotely monitored Nihon Kohden AEDs between January 2018 and February 2026. After excluding inspection records, we grouped records into activation events and quantified intervals. Shock-timing and receiver operating characteristic (ROC) analyses were restricted to initially shock-advised events with recorded shock delivery.
We analyzed 8,115 activation events. Median times were 42 seconds (interquartile range [IQR], 30-56) from power-on to completion of pad application, nine seconds (IQR, 9-11) from pad application to the first analysis, and 52 seconds (IQR, 40-66) from power-on to the first analysis endpoint. The power-on-to-pad-application interval accounted for a median of 81% (IQR, 75-85) of the total power-on-to-first-analysis interval, increasing to 87% (IQR, 85-90) when first analysis occurred more than 60 seconds after power-on. Among 900 initially shock-advised events with recorded shock delivery, the median pad-application-to-shock interval was 15 seconds (IQR 13-17). Exploratory ROC analysis yielded a power-on to pad-application threshold of ≥ 51 seconds in relation to first recorded shock delivery occurring more than 60 seconds after AED power-on.
The interval from AED power-on to electronically detected completion of pad application, encompassing all intervening actions, was the largest measurable post-activation bottleneck. Completion within 50 seconds may serve as an exploratory process target for first recorded shock delivery within 60 seconds among initially shock-advised events.

PMID:
42901368
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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