"Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation.

Abstract

Objective-To determine the outcome of out of hospital defibrillation in Scotland during the year after the introduction of automated external defibrinlators in October 1988.Design-Retrospective analysis of ambulance service reports and hospital records.Setting-Scottish Ambulance Service and acute receiving hospitals throughout Scotland. Main outcome measures-Delay from cardiac arrest to first defibrillator shock; vital state on arrival at hospital accident and emergency department; survival to hospital discharge.Results-During the study period 268 defibrillators were purchased by public subscription and 96% of the 2000 ambulance crew underwent an eight hour training programme in cardiopulmonary resuscitation and defibrillation. A total of 1111 cardiac arrests were recorded, and defibriliation was indicated and undertaken in 602 (54%) patients, mean age 63 (range 14-92) years. A spontaneous pulse was present on arrival at hospital in 180 (30%) of the defibrillated patients, and 75 (12-5%) were subsequently discharged alive. As expected, the likelihood of survival was inversely related to the delay from the onset of cardiac arrest to the time of the first schock and was greater in the case of witnessed arrest. If ventricular fibrillation occurred after the arrival of the ambulance, survival to discharge was 33%.Conclusions-An effective scheme for out of hospital defibrillation can be introduced rapidly, and with limited training implications and costs, by the use of automated external defibriliators in ambulances.

Assessment of In-Hospital Cardiopulmonary Resuscitation Using Utstein Template in a University Hospital

“…Since electrical defibrillation is the single most important therapy for the treatment of such patients, the effect of successful defibrillation on our present results is understandable. To be successful, defibrillation must be done promptly: the chances of successful recovery decrease 5-10% for each minute the patient remains in VF (Cummins et al 1989;Hargarten et al 1990;Cobbe et al 1991). In our study, immediate defibrillation of patients who suffered VF/VT cardiac arrest resulted in higher immediate survival and survival to hospital discharge.…”

Training lay-people to use automatic external defibrillators: Are all of their needs being met?

“…Consequently, some ten years after it had been developed, it was acknowledged that the AED offered a possible solution to this problem. Some ambulance services had already decided that it would be advantageous to use 24 them as this would also save the time and expense of training crews to manually defibrillate (Cobbe, Redmond, Watson et al, 1991;Walters, D'Auria and Glucksman, 1990). …”

“…‗The generosity of the Scottish public allowed the target to be achieved with remarkable speed' (Cobbe et al, 1991(Cobbe et al, , p.1520 In this way, the public had "discovered" AEDs and as this occurred there were some who developed a more active approach to these devices. One of the first aid organisations began training its members to use them and they were also placed in vehicles to be used by police officers (Ross et al, 2001;Walters et al, 1994).…”

Enhancing the Power of Record Linkage Involving Low Quality Personal Identifiers: Use of the Best Link Principle and Cause of Death Prior Likelihoods

“…The objective was to equip all 407 ambulances and operational support vehicles in Scotland with defibrillators and cover training and maintenance costs. This was achieved through both the fundraising and the donation of 22 defibrillators by the Scottish Home and Health Department (1). Follow-up of the Heartstart project is funded by the British Heart Foundation.…”