Background The rate of survival after out-of-hospital cardiacarrest is low. It is not known whether this rate will increaseif laypersons are trained to attempt defibrillation with theuse of automated external defibrillators (AEDs).
Methods We conducted a prospective, community-based, multicenterclinical trial in which we randomly assigned community units(e.g., shopping malls and apartment complexes) to a structuredand monitored emergency-response system involving lay volunteerstrained in cardiopulmonary resuscitation (CPR) alone or in CPRand the use of AEDs. The primary outcome was survival to hospitaldischarge.
Results More than 19,000 volunteer responders from 993 communityunits in 24 North American regions participated. The two studygroups had similar unit and volunteer characteristics. Patientswith treated out-of-hospital cardiac arrest in the two groupswere similar in age (mean, 69.8 years), proportion of men (67percent), rate of cardiac arrest in a public location (70 percent),and rate of witnessed cardiac arrest (72 percent). No inappropriateshocks were delivered. There were more survivors to hospitaldischarge in the units assigned to have volunteers trained inCPR plus the use of AEDs (30 survivors among 128 arrests) thanthere were in the units assigned to have volunteers trainedonly in CPR (15 among 107; P=0.03; relative risk, 2.0; 95 percentconfidence interval, 1.07 to 3.77); there were only 2 survivorsin residential complexes. Functional status at hospital dischargedid not differ between the two groups.
Conclusions Training and equipping volunteers to attempt earlydefibrillation within a structured response system can increasethe number of survivors to hospital discharge after out-of-hospitalcardiac arrest in public locations. Trained laypersons can useAEDs safely and effectively.
Source Information
Alfred Hallstrom, Ph.D. (University of Washington, Seattle), and Joseph P. Ornato, M.D. (Virginia Commonwealth University Medical Center, Richmond), assume responsibility for the content of this article.
Address reprint requests to the Public Access Defibrillation Clinical Trial Center, University of Washington, School of Public Health and Community Medicine, Department of Biostatistics, 1107 NE 45th St., Room 505, Seattle, WA 98105, or at padctc{at}u.washington.edu.
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