New Horizons of Drones

Panacea for fatal arrhythmias, delays in defibrillation and pandemic

Dogac Niyazi OZUCELIK

Dogac Niyazi OZUCELIK

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Dogac Niyazi OZUCELIK received his emergency medicine specialisation from Dokuz Eylul University Faculty of Medicine, Department of Emergency Medicine between 1997-2001 and docentship from Hacettepe University Faculty of Medicine. He is especially involved in disaster management, preparedness, ambulance systems, trauma systems and resuscitation



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Canan Akman received her emergency medicine specialisation from Hacettepe University Faculty of Medicine, Department of Emergency Medicine between 2006-2011. She continues to work as an associate professor at Çanakkale Onsekiz Mart University Faculty of Medicine, Department of Emergency Medicine.



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Ozgur Karcioglu has graduated from his residency in Emergency Medicine (1998). He has attended the “International Emergency Medicine” Fellowship in PSU (2005). He is the department chair of EM, Taksim Education Hospital. Five editorships and three original books were published by InTechOpen and Bentham Science, respectively.

Every minute is critical for a successful intervention in trauma and cardiac emergencies such as life-threatening arrhythmias and airway compromise. Utilisation of drones paves the way to improve health care, especially in underserved areas. These new technological aids will enable us to transport AEDs to the patient with OHCA to save lives.

Time is critical in cardiac emergencies

Time is among the most crucial aspects of health care. Many authors emphasise the “golden hour” as the critical time window for successful intervention in trauma. It is even more stringent in cardiac emergencies such as life-threatening arrhythmias and airway compromise. Nowadays it can be contemplated that innovative measures to save lives will be an upheaval for our world.

Unmanned aerial vehicles (a.k.a. drones), appear to revolutionise prehospital medicine enabling advanced health care delivery to those in austere environments and difficult regions.

Lethal arrhythmias and subsequent sudden cardiac arrest (CA) in adults cause the death of millions of people every year all over the world. Patients with coronary artery disease and decompensated heart failure constitute approximately 80 per cent of CA cases. In 70 per cent  of patients with CA, the first recorded rhythm is ventricular fibrillation (VF). This is followed by pulseless electrical activity (PEA), bradyarrhythmias, asystole, and ventricular tachycardia (VT). Survival rates, including hospital discharge, of cases with VF are between 7.7 per cent  and 40 per cent , with a median value of 22 per cent  (Nichol, 2008). If all CA cases are taken into account, this median rate declines to 8.4 per cent . This shows that cases with VF have a better prognosis if expedient defibrillation can be accomplished.

Restoration of adequate cardiac function provides return of spontaneous circulation (ROSC). On the other hand, restoration of neurological function predicts successful resuscitation.

The most important and effective treatment in CA cases is early, appropriate, effective compression and defibrillation. This approach, defined as 'high-quality CPR', is more valuable than any medication. If we count all the positive factors:

  • Witnessed arrest
  • Performing CPR in the field
  • Minimal interruption to compressions
  • Early/immediate defibrillation
  • AED use
  • Administering hypothermia to comatose patients
  • Avoiding hyperventilation

“Quality CPR” is a prerequisite for successful resuscitation. The technical components of this are;

  • 100-120 compressions per minute
  • 10 breaths per minute (avoiding hyperventilation)
  • Pressure depth of 5 to 6 cm
  • Chest compression fraction of 80 per cent  or more
  • Full chest recoil

The global availability of healthcare resources based on drones stems from a need for a collaboration of a wide range of civilian and military medical forces to develop this contemporary technology for wider accessibility (Braun19). Recent years witnessed emergence of de novo strategies for defibrillation easily accessible to thepublic, including volunteer bystander and responder programs and AED-delivery by drones (Folke23). Some researchers employed simulation-based programs to train laypersons on the operation of AEDs delivered by drones in rural and difficult regions (Gino23).

Fischer et al. designed a study with 10 paramedic personnel and 19 laypersons to face with a manikin as victims of OHCA within a field test in a difficult geography in Europe. Following a mock-call, the AEDs were brought via drones and utilised in 29 case scenarios without severe untoward events. Mean delivery times of the drones was 5.2 minutes. The paramedics applied the first shock after a mean of 12:1 ± 2:0 min and hands-off times were 50 ± 22 seconds. They postulated that the delivery and utilisation of AEDs with semi-autonomously flying vehicles (drones) in difficult regions appears to be practical (Fischer23).

How are drugs given?

The basis of drug administration within the scope of ACLS is IV administration. IO application is the first choice when necessary but not successful in 3 consecutive attempts or within 90 seconds of IV application. In cases where this is not possible, endotracheal tube (ETT) is an alternative. In this application, it is given in 2-2.5 times dose and diluted to 10 mL with saline. Then, lungs are ventilated with a bag-valve-mask (BVM) to allow it to pass through the alveolocapillary membrane to the capillaries. In IV administration, drugs are mostly infused from the arm or leg, the extremity is raised as much as possible or flushed with 20 mL IV saline.

In a recent study, authors examined the association of time to treatment (drug or placebo) with survival to hospital discharge and neurologic outcome (Rahimi23). The survival rate of patients to discharge was found to be reduced as lag time to administration of the drugs is protracted, in amiodarone (OR, 0.9; per min), lidocaine (OR, 0.9). Amiodarone resulted in more favourable survival at all times of drug administration (OR, 1.32; 95 per cent  CI, 1.0-1.6). It can be considered that new advances such as drones would facilitate shorter delays in drug administration and in turn, increase the rate of survival and favourable outcomes following cardiac emergencies.

Pandemics and drones

The COVID-19 pandemic spread has represented new opportunities for the drones to be beneficial in healthcare. To be more specific, in regions with difficulties to get access to developed institutions, these devices provided life-saving aids for severe and critical  patients. For example, the use of drones for transportation of diagnostic samples resulted in significant shortening of the travel time taken for samples in West Africa (Sylverken 19). This opportunity can augment the potential of coping with the pandemic and other diseases affecting the globe. There have also been important advances in regard to expedite emergency blood delivery to recipients in need of these products (Ling19). Emergent need for transfusion of blood and by-products, an US–based firm, Zipline launched a drone delivery procedure in Rwanda. In 2018, Zipline initiated a more advanced genre of delivery drone, which was faster than before. It is reported to be the fastest available commercial delivery drone. Zipline proved a higher success in its processes including the time between taking the call (order) and launching the delivery was radically diminished from 10 minutes to 1 minute. These new vehicles can now fly for almost 160 kms with up to 2 kilograms.

Matternet, another company, has successfully operated 1800 flights over Swiss cities and delivered 850 blood and pathology specimens in Swiss cities by 2019 (DDMF). Another drone-based delivery service named Flirtey from Nevada collaborates with ambulance and medical providers to deliver medications to clinics in rural areas. Flirtey has also partnered with Domino’s Pizza and 7-Eleven to deliver food, drinks, and other consumer products. The delivery took only 3 minutes, whereas vehicle delivery took 90 minutes.

Therefore, we can postulate that utilisation of drones paves the way to improve health care, especially in remote and underserved areas. These new technological aids will enable medical professionals to transport AEDs correctly to the exact location of the patient with OHCA to save lives.

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