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Automated External Defibrillators Are Safe and Effective Outside the Hospital

Because survival after out-of-hospital cardiac arrest depends greatly on time to defibrillation, the American Heart Association advocates the use of automated external defibrillators (AEDs) by nonmedical personnel. In these 2 studies, investigators report data on the use of AEDs in 2 unique clinical situations, in casinos and on a U.S. airline.

In the first study, 148 people suffered cardiac arrest in casinos in Nevada and Mississippi; AEDs were used on 105 who had ventricular fibrillation (VF) documented as the initial rhythm. Fifty-six of the 105 (53 percent) were resuscitated successfully and survived to hospital discharge. Among the 90 people whose collapses were witnessed, the average time to first shock was 4.4 minutes. Survival rates were 74 percent among those who received a first defibrillation within 3 minutes and 49 percent among those who received one after more than 3 minutes.

The second study was sponsored by a U.S. airline that placed AEDs on all flights and trained attendants in AED use. AEDs were used on 200 people during a 2-year period. Of the 200, 99 experienced loss of consciousness. Fourteen of the 99 had documented VF; device sensitivity was 100 percent (14/14). Of the 14, 13 received recommended shock; in all 13, VF was terminated with the first shock. No shock was recommended for people without VF (although 2 people with presumed VF did receive shock). Forty percent of those who received shock (6/15) survived to hospital discharge.

Comment: The results of these 2 studies confirm the feasibility of AED use by trained nonmedical personnel, demonstrate the remarkable safety and efficacy of AEDs, and suggest that further deployment of AEDs in public places is warranted. However, enthusiasm for AEDs must be tempered by the unfortunate fact that 80 percent of cardiac arrests do not occur in public places. Furthermore, these 2 studies were conducted in unique situations (in casinos and on airplanes). Whether similar results can be obtained in athletic facilities, train stations, and other public areas remains to be seen. Finally, cost-effectiveness studies will need to be performed to justify the expense associated with widespread deployment of AEDs and with training of nonmedical personnel.

— H Calkins

Published in Journal Watch Cardiology January 5, 2001

Citation(s):

Valenzuela TD et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000 Oct 26 343 1206-1209.

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Page RL et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med 2000 Oct 26 343 1210-1216.

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• Medline abstract (Free)