Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest

Ap, Hallstrom; Jp, Ornato; Weisfeldt, Myron L.; Travers, Andrew H.; Christenson, Jim; Ma, McBurnie; Zalenski, Robert J.; Lb, Becker; Eb, Schron; Proschan, Michael A.

doi:10.1056/nejmoa040566

Cited by 961 publications

(141 citation statements)

References 19 publications

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“…A cluster randomized controlled study showed that PAD deployment and training of lay volunteers in CPR and AED use significantly increased survival to discharge rates in comparison with volunteer CPR training only (23.4% vs 14.0%; relative risk=2.0) (Table 2). 7 A meta‐analysis of three studies (one assessing PAD use by lay volunteers7 and two assessing PAD use by fire fighters and police officers19, 20) assessed the effects of PAD use with CPR by nonhealthcare professionals and showed a significantly favorable association with survival to discharge compared with CPR alone (relative risk=1.39) 6. In contrast, home placement of PADs is not a promising strategy.…”

Section: Pad Programsmentioning

confidence: 99%

“…When arrest is suspected, dispatchers may instruct PAD use if available by emphasizing the diagnostic function, which can attenuate difficulties in identifying cardiac arrest 18. However, if facilitating PAD use by untrained lay people does not work, an additional planned response strategy may be considered in Japan, whereby volunteers are systematically trained 7. Further studies are needed to find effective measures to facilitate bystander CPR using PADs and to improve the accuracy of dispatcher recognition and instructions.…”

Section: Issues Concerning Pad That Needs To Be Addressedmentioning

confidence: 99%

“…The use of automated external defibrillators (AEDs) in pre‐hospital settings is a strategy to reduce the time interval until defibrillation 4. PAD use by bystanders or first responders can more effectively reduce this time interval and improve patient outcomes than the use of AED by emergency medical services (EMS) personnel 5, 6, 7, 8. However, controversy exists regarding the population impact of PAD deployment in communities, as only a small proportion of OHCA patients benefit from defibrillation 9…”

Section: Introductionmentioning

confidence: 99%

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Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Nakahara

Sakamoto

2017

J of Gen and Family Med

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Out‐of‐hospital cardiac arrest (OHCA) is a major health concern in Japan and other developed countries with aging populations. Improvements in OHCA outcomes require streamlining the chain of survival. Deployment of public‐access automated external defibrillators (PADs) and defibrillation by bystanders is one strategy that may streamline the chain by reducing the time to defibrillation in individuals with shockable rhythms. Although the effectiveness of PAD programs in increasing survival to discharge has been reported, there have been criticisms and concerns about the small population impact, cost‐effectiveness, and potential negative impact on those with nonshockable rhythms. This article reviews relevant literature regarding the effectiveness and concerns regarding PAD for OHCA.

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Section: Pad Programsmentioning

confidence: 99%

Section: Issues Concerning Pad That Needs To Be Addressedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Nakahara

Sakamoto

2017

J of Gen and Family Med

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“…Long‐term survival can increase as much as 2 to 3 times if a bystander/first responder also uses an automated external defibrillator (AED) before emergency medical service (EMS) arrival 2, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Many studies, including a prospective, randomized trial, have shown that public access defibrillation (PAD) programs improve the rate of survival among patients with an OHCA.…”

Section: Introductionmentioning

confidence: 99%

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Gianotto‐Oliveira

Gonzalez

Vianna

et al. 2015

JAHA

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BackgroundTargeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out‐of‐hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest.Methods and ResultsA prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001).ConclusionsImplementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long‐term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities.

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“…Early defibrillation improves the survival of victims of sudden cardiac arrest 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. However, it is often difficult to shorten the time from the cardiac arrest to the defibrillation utilizing the emergency medical service.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

Nishiyama

Negishi

et al. 2015

JAHA

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BackgroundAlthough automated external defibrillators (AEDs) have contributed to a better survival of out‐of‐hospital cardiac arrests, there have been reports of their malfunctioning. We investigated the diagnostic accuracy of commercially available AEDs using surface ECGs of ventricular fibrillation (VF), ventricular tachycardia (VT), and supraventricular tachycardia (SVT).Methods and ResultsECGs(VF 31, VT 48, SVT 97) were stored during electrophysiological studies and transmitted to 4 AEDs, the LifePak CR Plus (CR Plus), HeartStart FR3 (FR3), and CardioLife AED‐2150 (CL2150) and ‐9231 (CL9231), through the pad electrode cables. For VF, the CL2150 and CL9231 advised shocks in all cases, and the CR Plus and FR3 advised shocks in all but one VF case. For VTs faster than 180 bpm, the ratios for advising shocks were 79%, 36%, 89%, and 96% for the CR Plus, FR3, CL2150, and CL9231, respectively. The FR3 and CR Plus did not advise shocks for narrow QRS SVTs, whereas the CL9231 tended to treat high‐rate tachycardias faster than 180 bpm even with narrow QRS complexes. The characteristics of the shock advice for the FR3 differed from that for the CL9231 (kappa coefficient [κ]=0.479, P<0.001), and the CR Plus and CL2150 had characteristics somewhere between the 2 former AEDs (κ=0.818, P<0.001).ConclusionsCommercially available AEDs diagnosed VF almost always correctly. For VT and SVT diagnoses, a discrepancy was evident among the 4 investigated AEDs. The differences in the arrhythmia diagnosis algorithms for differentiating SVT from VT were thought to account for these differences.

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Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest

Abstract: Background

Cited by 961 publications

References 19 publications

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Effective deployment of public‐access automated external defibrillators to improve out‐of‐hospital cardiac arrest outcomes

Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America

Diagnostic Accuracy of Commercially Available Automated External Defibrillators

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