Public Use of Automated External Defibrillators

Caffrey, Sherry L.; Willoughby, Paula J.; Pepe, Paul E.; Becker, Lance B.

doi:10.1056/nejmoa020932

Cited by 730 publications

(340 citation statements)

References 32 publications

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“…Advantages of this approach include the provision of “willing and trained bystanders” who are prepared and equipped with onsite AEDs to act in a cardiac arrest emergency. Successful targeted AED programs have been reported in busy airports, casinos, sports arenas, and railway stations 19, 20, 21, 29, 30. This Sao Paulo Metro targeted AED program achieved similar survival rates with intact neurological function as those observed with such programs in the United States, Europe, and Japan (Table 5).…”

Section: Discussionmentioning

confidence: 66%

“…Targeted AED programs for airports, casinos, railway stations, and sports venues in the United States, Europe, and Japan have shown similar positive results, but this is the first report of such a successful program in a large Latin American city 19, 20, 21, 29, 30…”

Section: Discussionmentioning

confidence: 88%

“…Transportation hubs, such as large international airports and busy railway stations, have been fertile ground for successful PAD programs 19, 20, 21…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 88%

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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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“…However, it is often difficult to shorten the time from the cardiac arrest to the defibrillation utilizing the emergency medical service. An automated external defibrillator (AED) allows bystander rescuers to defibrillate out‐of‐hospital ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) before the emergency medical service arrives 17, 18, 19, 20, 21, 22, 23, 24, 25. In fact, nationwide dissemination of publicly accessible AEDs in Japan resulted in an earlier administration of shocks by bystanders and has improved the rate of survival 26, 27.…”

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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“…In order to provide rapid access to defibrillation, PAD programs have been established to provide access to defibrillators in high‐use public areas. Studies show that PAD programs in railways, casinos, and airports in the United States, Europe, and Japan have improved survival in patients with OHCA 3, 4, 5, 6, 7. Despite this, a study showed that PAD was deployed successfully in less than 2% of OHCA, suggesting that there are still areas that can improve their access and deployment of PAD 8.…”

Section: Introductionmentioning

confidence: 99%