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Previous Volume 347:1242-1247 October 17, 2002 Number 16 Next

Abstract PDF PDA Full Text PowerPoint Slide Set Perspective by Weaver, W. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Automated external defibrillators save lives when they are used by designated personnel in certain public settings. We performed a two-year prospective study at three Chicago airports to assess whether random bystanders witnessing out-of-hospital cardiac arrests would retrieve and successfully use automated external defibrillators.

Methods Defibrillators were installed a brisk 60-to-90-second walk apart throughout passenger terminals at O'Hare, Midway, and Meigs Field airports, which together serve more than 100 million passengers per year. The use of defibrillators was promoted by public-service videos in waiting areas, pamphlets, and reports in the media. We assessed the time from notification of the dispatchers to defibrillation, survival rate at 72 hours and at one year among persons with cardiac arrest, their neurologic status, and the characteristics of rescuers.

Results Over a two-year period, 21 persons had nontraumatic cardiac arrest, 18 of whom had ventricular fibrillation. With two exceptions, defibrillator operators were good Samaritans, acting voluntarily. In the case of four patients with ventricular fibrillation, defibrillators were neither nearby nor used within five minutes, and none of these patients survived. Three others remained in fibrillation and eventually died, despite the rapid use of a defibrillator (within five minutes). Eleven patients with ventricular fibrillation were successfully resuscitated, including eight who regained consciousness before hospital admission. No shock was delivered in four cases of suspected cardiac arrest, and the device correctly indicated that the problem was not due to ventricular fibrillation. The rescuers of 6 of the 11 successfully resuscitated patients had no training or experience in the use of automated defibrillators, although 3 had medical degrees. Ten of the 18 patients with ventricular fibrillation were alive and neurologically intact at one year.

Conclusions Automated external defibrillators deployed in readily accessible, well-marked public areas in Chicago airports were used effectively to assist patients with cardiac arrest. In the cases of survivors, most of the users had no duty to act and no prior training in the use of these devices.

Recent developments in automated-external-defibrillator technology have provided a means of increasing the rate of prompt defibrillation after out-of-hospital cardiac arrest.¹⁵ After minimal training, nonmedical personnel (e.g., flight attendants and casino workers) are able to use defibrillators in the workplace, with lifesaving effects.^{16,17,18,19,20} Nonetheless, such programs have involved designated personnel whose job description includes assisting persons who have had sudden cardiac arrest. Data are still lacking on the success of programs in which automated external defibrillators have been installed in public places to be used by persons who have no specific training or duty to act.

Beginning in June 1999, the City of Chicago placed highly visible, readily accessible automated external defibrillators for public use at its municipal airports under the auspices of the Chicago HeartSave Program.²¹ We evaluated the success of the program.

Methods

Study Design

This two-year, prospective, observational study evaluated how often bystanders used automated defibrillators placed in high-traffic locations — airports — and determined the resulting survival rates. The study sites were the three Chicago airports: O'Hare (1,735,561 ft² of terminal space [161,240 m²] and 80 million passengers annually), Midway (259,408 ft² [24,100 m²] and 20 million passengers annually), and Meigs Field (7000 ft² [650 m²] and 77,000 passengers annually). The percentage of people with training in cardiopulmonary resuscitation who pass through these airports is not known. Since 1999, basic training in cardiopulmonary resuscitation and the use of automated external defibrillators has been provided to a total of 450 airport police, security personnel, and public-safety dispatchers. Similar training has been made available, on a voluntary basis, to other airport-based employees (i.e., personnel without a specific duty to act in a medical emergency) from both the public sector (e.g., customs and immigration agents and members of the airport commissioner's staff) and the private sector (e.g., restaurant vendors and custodial workers). During the study, approximately 3000 of 44,000 airport workers were trained. Other potential users of the defibrillators are flight attendants, who have been trained in the in-flight use of defibrillators.^17,20

Defibrillators

On June 1, 1999, 33 publicly accessible automated defibrillators were installed throughout the O'Hare terminals. By February 1, 2001, 9 more had been placed in public areas and 17 had been placed in areas that were not accessible to the public (e.g., maintenance and secured baggage areas). Initially, 7 defibrillators were installed at Midway (10 as of March 13, 2001) and 1 at Meigs.

Defibrillators were housed in glass-faced cabinets a brisk 60-to-90-second walk apart (Figure 1). Indicator signs similar to those for toilets and telephones were placed in highly visible positions, usually above concourse walkways, adjacent to the defibrillators. Warning signs cautioned against tampering with or inappropriate use of defibrillators. Cabinets were equipped with audible alarms, strobe lights, and dispatcher alerts (to indicate the site) that were activated when the cabinet door was unsealed. Police, security personnel, and emergency-medical-services personnel were then dispatched to the indicated location unless follow-up callers provided more exact information.

View larger version (26K): [in this window] [in a new window]   Figure 1. Map of O'Hare International Airport, Showing the Locations of Automated External Defibrillators in Public Areas and the Locations of 20 Patients with Witnessed Cardiac Arrest. To convert distances to meters, multiply by 0.3.

 
Three-minute public-service announcements were played every half hour on television monitors in waiting areas, indicating the availability of the automated defibrillators, explaining their purpose, and encouraging their use. Printed materials were made available to the public and distributed to the airlines in bulk. Three public training sessions on the use of automated external defibrillators and cardiopulmonary resuscitation were held at various locations in Chicago, and numerous local and national media reports promoted the program.

The Chicago HeartSave Program was approved by the Chicago municipal government as an adjunct to its emergency-medical-services system. The study was considered part of a routine evaluation of the initiative. Participation by the bystanders was entirely voluntary, and informed consent was neither sought nor obtained. The State of Illinois has good-Samaritan laws that protect those who voluntarily provide cardiopulmonary resuscitation to others against litigation.

The defibrillator used (Model E, ForeRunner, Heartstream) delivers a biphasic, truncated exponential defibrillatory wave form and about 150 joules with each shock.²² A single-channel, liquid-crystal electrocardiographic tracing is displayed across the surface of the defibrillator.

Collection of Data

When activated, digital data cards within the defibrillator record electrocardiographic data, rescuers' voices, machine prompts, thoracic-impedance values, the amount of energy delivered, and the time of all events; data from the cards are downloaded for analysis. Security officers also complete incident reports, which include contact information for the patients and those who assisted them, information on whether bystanders performed cardiopulmonary resuscitation, and information obtained from interviews with the persons who provided assistance. We abstracted data from the paramedics' records on patients' condition at the time of the arrival and departure of emergency-medical-services personnel and at the time they arrived at the hospital.

Although the actual time of the collapse could not be determined definitively, the time from the notification of dispatchers (e.g., as a result of opening the defibrillator-cabinet door or a telephone call) to the delivery of the first shock was documented with the use of automated clocks at dispatch centers and data cards from the defibrillators. Dispatch and data-card–computer clocks were synchronized prospectively and checked regularly to ensure accuracy.

A patient's neurologic status, assessed at the scene and at the hospital and reassessed one year later over the telephone by one of the investigators, was defined as good if the patient had a cerebral performance category score of 1 (normal) or 2 (minimal disability).^23,24 The time from the delivery of the first shock to the patient's initial return to consciousness, defined by a purposeful response to spoken commands, was documented, as was the number of shocks required for initial conversion or restoration of spontaneous pulses.

Complications were defined as defibrillator tampering, inappropriate delivery of shocks by the automated defibrillator, failure of the defibrillator to deliver a shock in response to ventricular fibrillation, malfunction of the audible and visual alarms or prompts of the defibrillator, inappropriate use of the defibrillator by rescuers, or injury of rescuers or other bystanders as a result of use of the defibrillator.

Results

Characteristics of the Patients

Between June 1, 1999, and May 31, 2001, an automated defibrillator installed as part of the HeartSave Program was used for 21 persons at O'Hare, 5 at Midway, and none at Meigs. Among these 26 patients, 4 did not have cardiac arrest: 2 persons had seizures, 1 had shortness of breath (the defibrillator was used as a diagnostic tool by an off-duty paramedic), and 1 person, in the custody of immigration officials, feigned a syncopal episode. The defibrillators functioned appropriately — no shock was administered — in the cases of all four patients. Four additional persons with ventricular fibrillation were defibrillated with equipment that was not supplied by the HeartSave Program: three collapsed near gate areas and were defibrillated by nearby flight attendants using defibrillators from airplanes, and a fourth initially underwent defibrillation by paramedics with their own equipment.

Of the 22 patients with cardiac arrest for whom an airport-terminal defibrillator was obtained, a 33-year-old man had an arrest after a long fall and a 60-year-old man was found dead on a transit-system train. Of the 21 patients with nontraumatic cardiac arrest, 2 were women (age, 78 and 81 years) and 19 were men (median age, 58 years; range, 44 to 86). Nineteen were travelers, one was an airport employee, and one was a visitor.

Excluding the patient with trauma and the man who was found dead on the train, there were 20 patients with witnessed cardiac arrest. Although pulseless, two patients presented with some organized electrocardiographic activity. The remaining 18 (90 percent) presented with ventricular fibrillation; this group comprised both women and 16 men. The characteristics of these 18 patients are provided in Table 1.

View this table: [in this window] [in a new window]   Table 1. Characteristics of 18 Patients with Ventricular Fibrillation Who Received Defibrillator Shocks from Automated External Defibrillators (AED) Installed at Chicago Airport Terminals between June 1, 1999, and May 31, 2001.

 
Outcome of Defibrillation

The automated defibrillator functioned correctly in all 18 patients with ventricular fibrillation, immediately determining the need for and delivering shocks. In all 18 patients, the defibrillators were retrieved and operated by travelers or airport employees before the arrival of the emergency-medical-services crews. In the cases of four of the seven patients who died, the defibrillator was not immediately accessible (e.g., two patients on airplanes) or was not accessed within five minutes after collapse. Three others remained in persistent ventricular fibrillation and eventually died despite rapid use of the defibrillators (within five minutes). Two of these patients received seven and nine defibrillator shocks, respectively, before the paramedics arrived.

Eleven of the patients with ventricular fibrillation regained spontaneous circulation and eventually regained consciousness. Four returned to consciousness before the paramedics arrived, two during transport, two in the emergency department, and another three after hospitalization. For 9 of these 11 patients, defibrillators were retrieved and used by bystanders within five minutes. The other two did not receive a shock for seven minutes, but they received immediate cardiopulmonary resuscitation. All 11 had good neurologic outcomes before discharge (with a cerebral performance category of 1), and 10 were alive at one year. One patient died of other sequelae weeks after cardiac arrest. The long-term survival rate with a good neurologic outcome among all 18 patients with ventricular fibrillation was 56 percent (regardless of the location of cardiac arrest), and it was 67 percent among the 12 patients who underwent defibrillation within five minutes.

Characteristics of the Rescuers and Complications of Defibrillation

With two exceptions, the operators of the defibrillators were good Samaritans (airline passengers or airport employees) who had no duty to act, and all used the defibrillators voluntarily and correctly (Table 1). In 6 of the 11 cases in which patients were successfully resuscitated and regained consciousness, the defibrillator users had neither operated an automated external defibrillator previously nor been trained in its use, although three were physicians. No complications occurred. One of the 53 defibrillators was stolen during the two-year period.

Discussion

The results of this study demonstrate the lifesaving potential of public access to defibrillation.¹⁵ Most of the patients with ventricular fibrillation in the study were resuscitated within minutes by good Samaritans who had immediate access to an automated defibrillator. The overall one-year survival rate with a good neurologic outcome regardless of location was 56 percent. In contrast, survival rates are estimated to be less than 5 percent with the use of conventional, "rapid-response" emergency medical services.¹² Traditionally, most resuscitated patients are still comatose on hospital admission, and typically, more than half never regain consciousness.^25,26 Our results reflect a substantial change in that traditional clinical course.

Given the expected lifetime of the defibrillators installed by the HeartSave Program (a minimum of about 10 years), the cost of the program at the three Chicago airports, including the devices, cabinets, alarm systems, and quality-assurance measures, averages about $35,000 a year. On the basis of our results, this figure translates to a cost of about $3,000 per patient and about $7,000 per life saved. Our finding that the majority of patients who underwent successful defibrillation were conscious before reaching the hospital also has implications for the immediate use of medical resources (such as the need for mechanical ventilation and treatment in the intensive care unit) and for long-term cost effectiveness.²⁷ Nevertheless, further economic analyses are needed to confirm these potential cost savings.

Despite the central role of the automated defibrillator, the performance of cardiopulmonary resuscitation by bystanders may also have contributed to the good outcomes in this study.^7,9,10,28,29 All survivors received cardiopulmonary resuscitation, and one received cardiopulmonary resuscitation for 10 minutes between episodes of ventricular fibrillation before eventually being resuscitated. Even under optimal conditions, some time elapses before the first shock can be delivered. In one case, two HeartSave personnel who were standing next to an automated defibrillator witnessed the collapse. Still, it took at least two minutes for these experts to ready the patient and the equipment. These considerations and the role of basic cardiopulmonary resuscitation must be kept in mind when program designers are calculating predicted response intervals.¹⁵

In the cases of four of the seven patients for whom defibrillation was unsuccessful, the arrest occurred far from the main terminal and ticket-counter areas, and the response was thus delayed. Previous work has made clear the inverse association between the time needed to respond and survival. Of the patients who collapsed in a terminal for whom a defibrillator was retrieved and used within five minutes, 75 percent were resuscitated and rapidly regained consciousness.

Three patients remained in fibrillation despite a rapid response. All three had diabetes and were described as obese in medical records. Other data have suggested that obesity and diabetes may decrease the success of external defibrillation.^30,31 We did not systematically collect data on these clinical features, and thus we cannot address their frequency among patients who underwent successful defibrillation.

The program we studied has some unique advantages.³² Although most cardiac arrests occur at home (70 to 80 percent),^7,32 airports may be the public places with the highest concentration of cardiac arrests.²¹ O'Hare is used by many thousands of persons daily, including many health professionals and other persons who are likely to know how to perform cardiopulmonary resuscitation and who thus may feel more comfortable acting in such situations. Three of the seven rescuers without training or experience in the use of an automated external defibrillator had medical degrees. Thus, it is not known whether these results can be generalized to other public places that may be less frequented by health professionals.

Previous studies have demonstrated that targeted nonmedical personnel can be trained as part of their job descriptions to use automated external defibrillators in public venues, including casinos¹⁶ and airplanes.¹⁷ Our findings showed that bystanders will voluntarily aid persons with cardiac arrest and can do so successfully, even without prior training in the use of defibrillators. The survival rates were similar to (or exceeded) those in prior studies.^16,17 Although many rescuers were airport employees (i.e., custodians, customs or immigration officials, or wheelchair assistants), the majority had taken cardiopulmonary-resuscitation courses voluntarily and had no specific duty to act.

Studies demonstrate that even sixth-grade children can use automated external defibrillators without prior instruction.³³ In our study, 6 of the 11 successfully resuscitated patients were resuscitated by persons who had neither previously operated an automated defibrillator nor been specifically trained in its use. Although three had medical degrees and another was a health professional, this attribute does not imply that such persons have a duty to act or are comfortable using an unfamiliar device.

Although training in cardiopulmonary resuscitation and the use of automated external defibrillators is strongly encouraged for everyone, our findings suggest that the lack of such training should not constrain attempts to use a defibrillator in emergencies. Given the safety of these devices and our results, reasonable public health strategies would be to promulgate good-Samaritan laws; encourage the development of less expensive, more user-friendly automated defibrillators for public deployment in appropriate locations; and undertake aggressive public-education campaigns that promote the idea that anyone is capable of immediate action in such situations.^{15,33,34,35,36,37}

Ms. Caffrey reports having received consulting and lecture fees from Phillips Medical System. Dr. Becker reports having received honorariums and research support from Phillips Medical Systems and research support from Laerdal.

We are indebted to Chicago Mayor Richard M. Daley, Maggie Daley, and the City Council of Chicago, to the Department of Aviation and its commissioner, Thomas Walker, and to the Chicago Fire Department and its commissioner, James Joyce, for their support; to Mark Linse, E.M.T.-P., Lourdes Rodrigues, E.M.T.-B., Ellen Demertisidis, E.M.T.-B., Robert Gundlach, E.M.T.-P., former commissioner of aviation Mary Rose Lony, and former first deputy fire commissioner Cortez Trotter for their assistance with the development and implementation of the project and quality assurance; to Sandy Kowerko for assistance with the figures; and to Carol W. Smith for assistance in the preparation of the manuscript.

Source Information

From the City of Chicago Department of Aviation, Chicago (S.L.C.); the Chicago Fire Department, Chicago (P.J.W.); the Departments of Surgery and Medicine and the School of Public Health, University of Texas Southwestern Medical Center, Dallas (P.E.P.); and the Division of Emergency Medicine, University of Chicago, Chicago (L.B.B.).

Presented in part at the annual meeting of the American Heart Association, New Orleans, November 15, 2000.

Address reprint requests to Ms. Caffrey at the Department of Aviation, O'Hare International Airport, P.O. Box 66142, Chicago, IL 60666, or at sherord{at}aol.com.

References

1. Rosamond WD, Chambless LE, Folsom AR, et al. Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med 1998;339:861-867. [Free Full Text]
2. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden cardiac death in the United States, 1989 to 1998. Circulation 2001;104:2158-2163. [Free Full Text]
3. State-specific mortality from sudden cardiac death -- United States, 1999. MMWR Morb Mortal Wkly Rep 2002;51:123-126. [Medline]
4. 2002 Heart and stroke statistical update. Dallas: American Heart Association, 2002.
5. Becker LB. The epidemiology of sudden death. In: Paradis NA, Halperin HR, Nowak RM, eds. Cardiac arrest: the science and practice of resuscitation medicine. Baltimore: Williams & Wilkins, 1996:28-47.
6. Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001;345:1473-1482. [Free Full Text]
7. Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the "chain of survival" concept: a statement for health professionals from the Advanced Cardiac Care Committee, American Heart Association. Circulation 1991;83:832-847. 
8. Hossack KF, Hartwig R. Cardiac arrest associated with supervised cardiac rehabilitation. J Card Rehabil 1982;2:402-8.
9. White RD, Hankins DG, Bugliosi TF. Seven years' experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation 1998;39:145-151. [CrossRef][ISI][Medline]
10. Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114-119. [CrossRef][ISI][Medline]
11. Larsen MP, Eisenberg MS, Cummins EO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652-1658. [CrossRef][ISI][Medline]
12. Becker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area -- where are the survivors? Ann Emerg Med 1991;20:355-361. [CrossRef][ISI][Medline]
13. Lombardi G, Gallagher J, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 1994;271:678-683. [Abstract]
14. Becker LB, Pepe PE. Ensuring the effectiveness of community-wide emergency cardiac care. Ann Emerg Med 1993;22:354-365. [CrossRef][Medline]
15. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. 4. The automated external defibrillator: key link in the chain of survival. Circulation 2000;102:Suppl I:I-60. 
16. Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000;343:1206-1209. [Free Full Text]
17. Page RL, Joglar JA, Kowal RC, et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med 2000;343:1210-1216. [Free Full Text]
18. Wassertheil J, Keane G, Fisher N, Leditschke JF. Cardiac arrest outcomes at the Melbourne Cricket Ground and Shrine of Remembrance using a tiered response strategy -- a forerunner to public access defibrillation. Resuscitation 2000;44:97-104. [Medline]
19. MacDonald RD, Mottley JL, Weinstein C. Impact of prompt defibrillation on cardiac arrest at a major international airport. Prehosp Emerg Care 2002;6:1-5. [Medline]
20. O'Rourke MF, Donaldson EE, Geddes JS. An airline cardiac arrest program. Circulation 1997;96:2849-2853. [Free Full Text]
21. Becker L, Eisenberg M, Fahrenbruch C, Cobb LA. Public locations of cardiac arrest: implications for public access defibrillation. Circulation 1998;97:2106-2109. [Free Full Text]
22. White RD, Hankins DG, Atkinson EJ. Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest. Resuscitation 2001;49:9-14. [CrossRef][Medline]
23. Cummins RO, Chamberlain D, Hazinski MF, et al. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital "Utstein-style." Acad Emerg Med 1997;4:603-627. [ISI][Medline]
24. Safar P. Cerebral resuscitation after cardiac arrest: summaries and suggestions. Am J Emerg Med 1983;1:198-214. [Medline]
25. Greene HL. Sudden arrhythmic cardiac death -- mechanisms, resuscitation and classification: the Seattle perspective. Am J Cardiol 1990;65:4B-12B. [Medline]
26. Bonnin MJ, Pepe PE, Kimball KT, Clark PS Jr. Distinct criteria for termination of resuscitation in the out-of-hospital setting. JAMA 1993;270:1457-1462. [Abstract]
27. Nichol G, Hallstrom AP, Ornato JP, et al. Potential cost-effectiveness of public access defibrillation in the United States. Circulation 1998;97:1315-1320. [Free Full Text]
28. Gallagher EJ, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 1995;274:1922-1925. [Abstract]
29. Cobb LA, Fahrenbruch CE, Walsh TR, et al. Influence of cardiopulmonary resuscitation prior to defibrillation in patients with out-of-hospital ventricular fibrillation. JAMA 1999;281:1182-1188. [Free Full Text]
30. Kerber RE, Grayzel J, Hoyt R, Marcus M, Kennedy J. Transthoracic resistance in human defibrillation: influence of body weight, chest size, serial shocks, paddle size and paddle contact pressure. Circulation 1981;63:676-682. [Free Full Text]
31. Hallstrom AP, Cobb LA, Yu BH. Influence of comorbidity on the outcome of patients treated for out-of-hospital ventricular fibrillation. Circulation 1996;93:2019-2022. [Free Full Text]
32. Litwin PE, Eisenberg MS, Hallstrom AP, Cummins RO. The location of collapse and its effect on survival from cardiac arrest. Ann Emerg Med 1987;16:787-791. [CrossRef][ISI][Medline]
33. Gundry JW, Comess KA, DeRook FA, Jorgenson D, Bardy GH. Comparison of naive sixth-grade children with trained professionals in the use of an automated external defibrillator. Circulation 1999;100:1703-1707. [Free Full Text]
34. Domanovits H, Meron G, Sterz F, et al. Successful automatic external defibrillator operation by people trained only in basic life support in a simulated cardiac arrest situation. Resuscitation 1998;39:47-50. [CrossRef][ISI][Medline]
35. Eisenberg MS. Is it time for over-the-counter defibrillators? JAMA 2000;284:1435-1438. [Free Full Text]
36. SoRelle R. States set to pass laws limiting liability for lay users of automated external defibrillators. Circulation 1999;99:2606-2607. [Free Full Text]
37. Good Samaritan Civil Immunity for Use of Automated External Defibrillator, tit. 42, 8331.2, Pa. consolidated statutes (1998).

Abstract PDF PDA Full Text PowerPoint Slide Set Perspective by Weaver, W. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

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• Cooper, J. A., Cooper, J. D., Cooper, J. M. (2006). Cardiopulmonary Resuscitation: History, Current Practice, and Future Direction. Circulation 114: 2839-2849 [Full Text]  
• Muller, D., Agrawal, R., Arntz, H.-R. (2006). How Sudden Is Sudden Cardiac Death?. Circulation 114: 1146-1150 [Abstract] [Full Text]  
• Developed in Collaboration With the European Heart, , Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., Priori, S. G., Quinones, M. A., Roden, D. M., Silka, M. J., Tracy, C., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Antman, E. M., Anderson, J. L., Hunt, S. A., Halperin, J. L., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 48: 1064-1108 [Full Text]  
• Developed in Collaboration With the European Heart, , Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., Priori, S. G., Quinones, M. A., Roden, D. M., Silka, M. J., Tracy, C., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Antman, E. M., Anderson, J. L., Hunt, S. A., Halperin, J. L., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B., Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L. (2006). ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol 48: e247-e346 [Full Text]  
• Zipes, D. P., Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., Priori, S. G., Quinones, M. A., Roden, D. M., Silka, M. J., Tracy, C., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L., ACC/AHA (Practice Guidelines) Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Antman, E. M., Anderson, J. L., Hunt, S. A., Halperin, J. L., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2006). ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death--executive summary: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society.. Eur Heart J 27: 2099-2140 [Full Text]  
• Writing Committee Members, , Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., Priori, S. G., Quinones, M. A., Roden, D. M., Silka, M. J., Tracy, C., ESC Committee for Practice Guidelines, , Priori, S. G., Blanc, J.-J., Budaj, A., Camm, A. J., Dean, V., Deckers, J. W., Despres, C., Dickstein, K., Lekakis, J., McGregor, K., Metra, M., Morais, J., Osterspey, A., Tamargo, J. L., Zamorano, J. L., ACC/AHA Task Force Members, , Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Antman, E. M., Anderson, J. L., Hunt, S. A., Halperin, J. L., Nishimura, R., Ornato, J. P., Page, R. L., Riegel, B. (2006). ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8: 746-837 [Full Text]  
• Estes, N. A. M. III (2006). Automated external defibrillators--device reliability and clinical benefits.. JAMA 296: 700-702 [Full Text]  
• Estes, N. A. M. III, Weinberg, P., England, H. (2006). Benefits vs the Harms of Automated External Defibrillator Use--Reply. JAMA 295: 2850-2850 [Full Text]  
• Ong, M. E. H., Ornato, J. P., Edwards, D. P., Dhindsa, H. S., Best, A. M., Ines, C. S., Hickey, S., Clark, B., Williams, D. C., Powell, R. G., Overton, J. L., Peberdy, M. A. (2006). Use of an automated, load-distributing band chest compression device for out-of-hospital cardiac arrest resuscitation.. JAMA 295: 2629-2637 [Abstract] [Full Text]  
• Tang, W., Snyder, D., Wang, J., Huang, L., Chang, Y.-T., Sun, S., Weil, M. H. (2006). One-Shock Versus Three-Shock Defibrillation Protocol Significantly Improves Outcome in a Porcine Model of Prolonged Ventricular Fibrillation Cardiac Arrest. Circulation 113: 2683-2689 [Abstract] [Full Text]  
• Vincent, J.-L., Fink, M. P., Marini, J. J., Pinsky, M. R., Sibbald, W. J., Singer, M., Suter, P. M., Cook, D., Pepe, P. E., Evans, T. (2006). Intensive care and emergency medicine: progress over the past 25 years.. Chest 129: 1061-1067 [Abstract] [Full Text]  
• Aufderheide, T., Hazinski, M. F., Nichol, G., Steffens, S. S., Buroker, A., McCune, R., Stapleton, E., Nadkarni, V., Potts, J., Ramirez, R. R., Eigel, B., Epstein, A., Sayre, M., Halperin, H., Cummins, R. O. (2006). Community Lay Rescuer Automated External Defibrillation Programs: Key State Legislative Components and Implementation Strategies: A Summary of a Decade of Experience for Healthcare Providers, Policymakers, Legislators, Employers, and Community Leaders From the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy. Circulation 113: 1260-1270 [Abstract] [Full Text]  
• Cappato, R., Curnis, A., Marzollo, P., Mascioli, G., Bordonali, T., Beretti, S., Scalfi, F., Bontempi, L., Carolei, A., Bardy, G., De Ambroggi, L., Cas, L. D. (2006). Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS). Eur Heart J 27: 553-561 [Abstract] [Full Text]  
• Israel, C. W., Hohnloser, S. H. (2006). Automated external defibrillation in emergency medical systems: what has been achieved and where to go?. Eur Heart J 27: 508-509 [Full Text]  
• England, H., Weinberg, P. S., Estes, N. A. M. III (2006). The Automated External Defibrillator: Clinical Benefits and Legal Liability. JAMA 295: 687-690 [Full Text]  
• (2005). Part 1: Introduction. Circulation 112: IV-1-IV-5 [Full Text]  
• (2005). Part 3: Overview of CPR. Circulation 112: IV-12-IV-18 [Full Text]  
• (2005). Part 4: Adult Basic Life Support. Circulation 112: IV-19-IV-34 [Full Text]  
• (2005). Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing. Circulation 112: IV-35-IV-46 [Full Text]  
• Hazinski, M. F., Nadkarni, V. M., Hickey, R. W., O'Connor, R., Becker, L. B., Zaritsky, A. (2005). Major Changes in the 2005 AHA Guidelines for CPR and ECC: Reaching the Tipping Point for Change. Circulation 112: IV-206-IV-211 [Full Text]  
• O'Rourke, M F (2005). Reality of out of hospital cardiac arrest. Heart 91: 1505-1506 [Abstract] [Full Text]  
• (2005). Part 1: Introduction. Circulation 112: III-1-III-4 [Full Text]  
• (2005). Part 3: Defibrillation. Circulation 112: III-17-III-24 [Full Text]  
• Hazinski, M. F., Nolan, J. P., Becker, L. B., Steen, P. A. (2005). Controversial Topics From the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 112: III-133-III-136 [Full Text]  
• Davies, C S, Colquhoun, M C, Boyle, R, Chamberlain, D A (2005). A national programme for on-site defibrillation by lay people in selected high risk areas: initial results. Heart 91: 1299-1302 [Abstract] [Full Text]  
• Valenzuela, T. D., Kern, K. B., Clark, L. L., Berg, R. A., Berg, M. D., Berg, D. D., Hilwig, R. W., Otto, C. W., Newburn, D., Ewy, G. A. (2005). Interruptions of Chest Compressions During Emergency Medical Systems Resuscitation. Circulation 112: 1259-1265 [Abstract] [Full Text]  
• Yannopoulos, D., Nadkarni, V. M., McKnite, S. H., Rao, A., Kruger, K., Metzger, A., Benditt, D. G., Lurie, K. G. (2005). Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest. Circulation 112: 803-811 [Abstract] [Full Text]  
• Hazinski, M. F., Idris, A. H., Kerber, R. E., Epstein, A., Atkins, D., Tang, W., Lurie, K. (2005). Lay Rescuer Automated External Defibrillator ("Public Access Defibrillation") Programs: Lessons Learned From an International Multicenter Trial: Advisory Statement From the American Heart Association Emergency Cardiovascular Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Council on Clinical Cardiology. Circulation 111: 3336-3340 [Abstract] [Full Text]  
• Ewy, G. A. (2005). Cardiocerebral Resuscitation: The New Cardiopulmonary Resuscitation. Circulation 111: 2134-2142 [Full Text]  
• Myerburg, R. J., Estes, N.A. M. III, Fontaine, J. M., Link, M. S., Zipes, D. P. (2005). Task Force 10: Automated external defibrillators. J Am Coll Cardiol 45: 1369-1371 [Full Text]  
• Bell, D. D., Brindley, P. G., Forrest, D., Muslim, O. A., Zygun, D. (2005). Management following resuscitation from cardiac arrest: recommendations from the 2003 Rocky Mountain Critical Care Conference: [Conduite a tenir apres la reanimation post-arret cardiaque : recommendations de la conference du Rocky Mountain Critical Care 2003]. Canadian J. Anesthesia 52: 309-322 [Abstract] [Full Text]  
• Williamson, L J, Larsen, P D, Tzeng, Y C, Galletly, D C (2005). Effect of automatic external defibrillator audio prompts on cardiopulmonary resuscitation performance. Emerg. Med. J. 22: 140-143 [Abstract] [Full Text]  
• Zafari, A. M., Zarter, S. K., Heggen, V., Wilson, P., Taylor, R. A., Reddy, K., Backscheider, A. G., Dudley, S. C. Jr (2004). A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol 44: 846-852 [Abstract] [Full Text]  
• The Public Access Defibrillation Trial Investigato, (2004). Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest. NEJM 351: 637-646 [Abstract] [Full Text]  
• Culley, L. L., Rea, T. D., Murray, J. A., Welles, B., Fahrenbruch, C. E., Olsufka, M., Eisenberg, M. S., Copass, M. K. (2004). Public Access Defibrillation in Out-of-Hospital Cardiac Arrest: A Community-Based Study. Circulation 109: 1859-1863 [Abstract] [Full Text]  
• Prystowsky, E. N. (2004). Primary Prevention of Sudden Cardiac Death: The Time of Your Life. Circulation 109: 1073-1075 [Full Text]  
• Priori, S. G., Bossaert, L. L., Chamberlain, D. A., Napolitano, C., Arntz, H. R., Koster, R. W., Monsieurs, K. G., Capucci, A., Wellens, H. J. (2004). ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe. Eur Heart J 25: 437-445 [Full Text]  
• Pepe, P. E, Caffrey-Villari, S. (2004). Automated defibrillators. BMJ 328: E270-E271 [Full Text]  
• Hazinski, M. F., Markenson, D., Neish, S., Gerardi, M., Hootman, J., Nichol, G., Taras, H., Hickey, R., O'Connor, R., Potts, J., van der Jagt, E., Berger, S., Schexnayder, S., Garson, A. Jr, Doherty, A., Smith, S., Writing Group, (2004). Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: The Medical Emergency Response Plan for Schools: A Statement for Healthcare Providers, Policymakers, School Administrators, and Community Leaders. Circulation 109: 278-291 [Full Text]  
• Hazinski, M. F., Markenson, D., Neish, S., Gerardi, M., Hootman, J., Nichol, G., Taras, H., Hickey, R., O'Connor, R., Potts, J., van der Jagt, E., Berger, S., Schexnayder, S., Garson, A. Jr, Doherty, A., Smith, S. (2004). Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: The Medical Emergency Response Plan for Schools. A Statement for Healthcare Providers, Policymakers, School Administrators, and Community Leaders. Pediatrics 113: 155-168 [Full Text]  
• Pell, J P (2003). The debate on public place defibrillators: charged but shockingly ill informed. Heart 89: 1375-1376 [Abstract] [Full Text]  
• Rea, T. D., Crouthamel, M., Eisenberg, M. S., Becker, L. J., Lima, A. R. (2003). Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest. Circulation 108: 1196-1201 [Abstract] [Full Text]  
• Nichol, G., Valenzuela, T., Roe, D., Clark, L., Huszti, E., Wells, G.A. (2003). Cost Effectiveness of Defibrillation by Targeted Responders in Public Settings. Circulation 108: 697-703 [Abstract] [Full Text]  
• Cram, P., Fendrick, A. M., Vijan, S., Groeneveld, P. W., Caffrey-Villari, S., Pepe, P. E. (2003). Public Use of Automated External Defibrillators. NEJM 348: 755-756 [Full Text]  
• Weil, M. H., Tang, W., Bisera, J. (2003). Cardiopulmonary Resuscitation: One Size Does Not Fit All. Circulation 107: 794-794 [Full Text]  
• Weisfeldt, M. L., Becker, L. B. (2002). Resuscitation After Cardiac Arrest: A 3-Phase Time-Sensitive Model. JAMA 288: 3035-3038 [Full Text]  
• (2002). Use of AEDs by Bystanders. JWatch Emergency Med. 2002: 9-9 [Full Text]  
• (2002). Effective Lay Use of AEDs. Journal Watch Cardiology 2002: 1-1 [Full Text]  
• (2002). Minerva. BMJ 325: 978-978 [Full Text]