Background Automated external defibrillators save lives whenthey are used by designated personnel in certain public settings.We performed a two-year prospective study at three Chicago airportsto assess whether random bystanders witnessing out-of-hospitalcardiac arrests would retrieve and successfully use automatedexternal defibrillators.
Methods Defibrillators were installed a brisk 60-to-90-secondwalk apart throughout passenger terminals at O'Hare, Midway,and Meigs Field airports, which together serve more than 100million passengers per year. The use of defibrillators was promotedby public-service videos in waiting areas, pamphlets, and reportsin the media. We assessed the time from notification of thedispatchers to defibrillation, survival rate at 72 hours andat one year among persons with cardiac arrest, their neurologicstatus, and the characteristics of rescuers.
Results Over a two-year period, 21 persons had nontraumaticcardiac arrest, 18 of whom had ventricular fibrillation. Withtwo exceptions, defibrillator operators were good Samaritans,acting voluntarily. In the case of four patients with ventricularfibrillation, defibrillators were neither nearby nor used withinfive minutes, and none of these patients survived. Three othersremained in fibrillation and eventually died, despite the rapiduse of a defibrillator (within five minutes). Eleven patientswith 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 notdue to ventricular fibrillation. The rescuers of 6 of the 11successfully resuscitated patients had no training or experiencein the use of automated defibrillators, although 3 had medicaldegrees. Ten of the 18 patients with ventricular fibrillationwere alive and neurologically intact at one year.
Conclusions Automated external defibrillators deployed in readilyaccessible, well-marked public areas in Chicago airports wereused effectively to assist patients with cardiac arrest. Inthe cases of survivors, most of the users had no duty to actand no prior training in the use of these devices.
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.
Bardy, G. H., Lee, K. L., Mark, D. B., Poole, J. E., Toff, W. D., Tonkin, A. M., Smith, W., Dorian, P., Packer, D. L., White, R. D., Longstreth, W.T. Jr., Anderson, J., Johnson, G., Bischoff, E., Yallop, J. J., McNulty, S., Ray, L. D., Clapp-Channing, N. E., Rosenberg, Y., Schron, E. B., the HAT Investigators,
(2008). Home Use of Automated External Defibrillators for Sudden Cardiac Arrest. NEJM
358: 1793-1804
[Abstract][Full Text]
Chretien, Y. R., Coylewright, M., Chabbouh, S., Ghiglione, S., Mignon, A., Ali, B., Dudley, S. C. Jr., Zafari, A. M., Bassan, M., Chan, P. S., Nichol, G., Nallamothu, B. K., Saxon, L. A.
(2008). Time to Defibrillation after In-Hospital Cardiac Arrest. NEJM
358: 1631-1634
[Full Text]
Cairns, K J, Hamilton, A J, Marshall, A H, Moore, M J, Adgey, A A J, Kee, F
(2008). The obstacles to maximising the impact of public access defibrillation: an assessment of the dispatch mechanism for out-of-hospital cardiac arrest. Heart
94: 349-353
[Abstract][Full Text]
Abella, B. S., Aufderheide, T. P., Eigel, B., Hickey, R. W., Longstreth, W.T. Jr, Nadkarni, V., Nichol, G., Sayre, M. R., Sommargren, C. E., Hazinski, M. F.
(2008). Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary Resuscitation: A Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitation. Circulation
117: 704-709
[Full Text]
Saxon, L. A.
(2008). Survival after Tachyarrhythmic Arrest -- What Are We Waiting For?. NEJM
358: 77-79
[Full Text]
Ibrahim, W. H
(2007). Recent advances and controversies in adult cardiopulmonary resuscitation. Postgrad. Med. J.
83: 649-654
[Abstract][Full Text]
Ali, B., Zafari, A. M.
(2007). Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines. ANN INTERN MED
147: 171-179
[Abstract][Full Text]
Rothmier, J. D, Drezner, J. A, Harmon, K. G, LeBrun, C.
(2007). Automated external defibrillators in Washington State high schools * COMMENTARY. Br. J. Sports. Med.
41: 301-305
[Abstract][Full Text]
Kandray, D. P., Pieren, J. A., Benner, R. W.
(2007). Attitudes of Ohio Dentists and Dental Hygienists on the Use of Automated External Defibrillators. J Dent Educ
71: 480-486
[Abstract][Full Text]
Garot, P., Lefevre, T., Eltchaninoff, H., Morice, M.-C., Tamion, F., Abry, B., Lesault, P.-F., Le Tarnec, J.-Y., Pouges, C., Margenet, A., Monchi, M., Laurent, I., Dumas, P., Garot, J., Louvard, Y.
(2007). Six-Month Outcome of Emergency Percutaneous Coronary Intervention in Resuscitated Patients After Cardiac Arrest Complicating ST-Elevation Myocardial Infarction. Circulation
115: 1354-1362
[Abstract][Full Text]
Yannopoulos, D., Aufderheide, T.
(2007). Acute management of sudden cardiac death in adults based upon the new CPR guidelines. Europace
9: 2-9
[Abstract][Full Text]
Lehrich, R. W., Pun, P. H., Tanenbaum, N. D., Smith, S. R., Middleton, J. P.
(2007). Automated External Defibrillators and Survival from Cardiac Arrest in the Outpatient Hemodialysis Clinic. J. Am. Soc. Nephrol.
18: 312-320
[Abstract][Full Text]
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]