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Volume 343:1206-1209 October 26, 2000 Number 17 Next

	Full Text PDF Editorial by Robertson, R. M. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest.

Methods We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital.

Results Automated external defibrillators were used in 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients (53 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (±SD) of 3.5±2.9 minutes from collapse to attachment of the defibrillator, 4.4±2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8± 4.3 minutes from collapse to the arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes.

Conclusions Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.

Source Information

From the Department of Emergency Medicine, College of Medicine (T.D.V., L.L.C., D.W.S.), and the Division of Epidemiology and Biostatistics, College of Public Health (D.J.R.), University of Arizona, Tucson; the Clinical Epidemiology Unit, Ottawa Civic Hospital, University of Ontario, Ottawa, Ont., Canada (G.N.); and the Clark County Fire Department, Las Vegas (R.G.H.).

Address reprint requests to Dr. Valenzuela at the Department of Emergency Medicine, 1501 N. Campbell Ave., P.O.B. 245057, Tucson, AZ 85724-5057, or at terry.aemrc.arizona.edu.

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