Automatic external defibrillation: Evaluations of its role in the home and in emergency medical services

doi:10.1016/S0196-0644(84)80441-2

Annals of Emergency Medicine

Volume 13, Issue 9, Part 2, September 1984, Pages 798-801

https://doi.org/10.1016/S0196-0644(84)80441-2 Get rights and content

Many recent efforts to improve emergency medical services (EMS) and increase survival rates are simply efforts to get defibrillation to patients as rapidly as possible. In the 1960s physicians traveled in mobile coronary care units to bring the defibrillator to cardiac arrest patients. Later, paramedics, rather than physicians, were used. During the late 1970s the concept of early out-of-hospital defibrillation expanded as emergency medical technicians (EMTs) learned to defibrillate. Researchers in several settings confirmed the effectiveness of early defibrillation by EMTs. The automatic detection of ventricular fibrillation (VF) creates new opportunities for the early defibrillation concept. This includes both automatic implantable defibrillators and automatic external defibrillators (AED). The King County, Washington, EMS is conducting two projects to evaluate AEDs. One is a randomized, controlled crossover study in which EMTs use either an AED or a standard manual defibrillator. Outcome measurements include time to countershock, conversion rates, and survival rates. In the second project family members of patients who have survived out-of-hospital VF randomly receive an AED and cardiopulmonary resuscitation (CPR) instruction, or CPR instruction alone. This study was designed to determine whether family members can be trained adequately to use the device effectively. Psychological tests measure the effect of learning about, living with, and using such technology. These studies may help define the role of AEDs in the future management of out-of-hospital VF.

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Cited by (54)

Impacting sudden cardiac arrest in the home: A safety and effectiveness study of privately-owned AEDs
2013, Resuscitation
Citation Excerpt :
However, studies have shown that approximately 80% of SCAs occur in the home, and the survival rate is lower in the home than in public places.5,6 As early as 1984, studies were conducted with AEDs in the homes of SCA survivors to see if family members could be adequately trained to use the device effectively.7 In 1989, 59 patients at high risk were provided an AED; there were 10 arrests over a 57 month period, and the devices were used in 6 events.8
Sudden cardiac arrest (SCA) remains a major public health problem. The majority of SCA events occur in the home; however, scant data has been published regarding the effectiveness of privately owned AEDs.
The study, initiated in 2002 under prescription labeling, continued with over the counter availability in 2004 and was completed in 2009. Surveillance methods included annual surveys, follow-up phone calls, media reports, and use queries upon order of replacement pads. AED owners reporting emergency use of the device were contacted for an in-depth interview, and the ECG and event data in the device's internal memory were evaluated.
25 cases were identified in which an AED was used on a patient in SCA. Two uses were on children. The SCA was witnessed in 76% (19/25) of the cases. In 56% (14/25), the patient presented in VF and at least one shock was delivered. All 14 patients who were shocked had termination of VF; 6 (43%) required more than one shock due to refibrillation. Shock efficacy was 100% (25/25) for termination of VF for all delivered shocks. Of the patients with a witnessed arrest who were shocked, 67% (8/12) survived to hospital discharge. There were no circumstances of unsafe emergency use of the AED or harm to the patient, responder, or bystanders.
People who purchase an AED for their home, even without previous AED experience, are able to use the device successfully in both adults and children. The high survival rate observed in this study demonstrates that lay responders with privately owned AEDs can successfully and safely use the devices.
Automatic External Defibrillation Around the World: The Time has Come
2008, Journal of Emergency Medicine
Public use of automatic defibrillators: A bolt from the blue
2002, Lancet
Automated external defibrillation as part BLS: Implications for education and practice
2002, Resuscitation
The latest Adult Basic Life Support (BLS) guidelines support the inclusion of the use of the automated external defibrillator (AED), as part of basic life support (BLS). Emphasis on the provision of early defibrillation as part of BLS acknowledges the importance of this manoeuvre in the successful termination of ventricular fibrillation. The ramifications of such changes for both first responders and organisations implementing the guidelines should not be underestimated. Issues relating to resourcing, content and duration of training and retraining, auditing and evaluation require further exploration. To consider these issues now seems particularly pertinent, given the recent launch of the UK Government's paper on public health, ‘Saving Lives—Our Healthier Nation’ which seeks to deploy AEDs in busy public places for use by trained members of the lay public. Additionally, defibrillation has been identified as one of the key competencies that all trained nurses and other health care providers should be able to undertake. This paper will consider the background to the current guideline changes, analyse the wider implications of translating the recommendations into practice, and offer possible solutions to address the issues raised. Whilst the analysis is particularly pertinent to the United Kingdom, many of the issues raised have international importance.
As últimas recomendações de Suporte Básico de Vida em Adultos (SBVA) favorecem a utilização do desfibrilhador automático externo (DAE) como parte do suporte básico de vida (SBV). A ênfase na desfibrilhação precoce como parte do SBV reconhece a importância desta manobra na interrupção com sucesso da fibrilhação ventricular. As implicações de tais alterações nos socorristas e nas organizações que implementam as recomendações, não devem ser menosprezadas. Os assuntos relacionados com os recursos, com o conteúdo e duração da formação e recertificação, da avaliação e da auditoria ainda precisam de ser explorados. A consideração destes assuntos é agora particularmente pertinente dado a recente publicação do documento do Governo Britânico sobre saúde pública “Saving Lives — Our Healthier Nation”, que procura disponibilizar DAE em locais públicos o que gerou movimentos para a sua utilização por leigos treinados. Além disso a desfibrilhação foi identificada como uma das competências fundamentais que todas as enfermeiras e outros profissionais de saúde devem ser capazes de executar. Neste artigo considera-se o contexto em que surgiram as alterações ás recomendações, analisam-se as principais implicações na transposição das recomendações para a prática e propõem-se soluções possı́veis para as questões levantadas. Sendo a análise particularmente pertinente para o Reino Unido, muitos dos assuntos levantados têm importância internacional.
Las últimas guı́as de Soporte Vital Básico del Adulto (BLS) apoyan la inclusión del uso del desfibrilador automático externo (AED), como parte del soporte vital básico (BLS). El énfasis puesto en la provisión de desfibrilación temprana como parte del BLS reconoce la importancia de la maniobra en la finalización exitosa de la fibrilación ventricular. No deben subestimarse las ramificaciones de tales cambios tanto para testigo reanimador como para las organizaciones que implementan las guı́as. Los asuntos relacionados a aportar recursos, contenidos y duración del entrenamiento y reentrenamiento, auditorı́a y evaluación requieren ulterior exploración. Hoy parece especialmente pertinente considerar estos asuntos, dado el reciente lanzamiento del artı́culo del Gobierno del Reino Unido en salud pública, ‘Salvando Vidas—Nuestra Nación Mas Sana’ que busca desplegar AEDs en lugares públicos concurridos para ser usados por legos entrenados miembros de la comunidad. Adicionalmente, la desfibrilación ha sido identificada como uno de los temas clave que deberı́an estar en condiciones de emprender todas las enfermeras y otros proveedores de cuidados de salud. Este artı́culo considera el antecedente de los cambios en las guı́as actuales, analiza las profundas implicancias de traducir a la práctica las recomendaciones, y ofrecer posibles soluciones para fundamentar los asuntos planteados. Mientras este análisis es particularmente pertinente al Reino Unido, muchos de los asuntos tratados tienen importancia internacional.
Impact of in-home defibrillators on postmyocardial infarction patients and their significant others: An interview study
2002, Heart and Lung: Journal of Acute and Critical Care
Objective: To investigate the impact of automated external defibrillator (AED) placement in the homes of postmyocardial infarction (MI) patients and their significant others. Design: This qualitative study used a semistructured interview to examine a nonrandomized convenience sample recruited from a larger study of home AEDs. Setting and Participants: Patients (and their significant others) were recruited from an ongoing study of AED use in the home. Seventeen interviews with 15 patients (14 men, 1 woman) and 16 significant others (1 man, 15 women) aged 39 to 80 years were performed in patients' homes. Methods: Verbatim transcripts of audiotaped interviews were reviewed, and responses were categorized. Other data were obtained from hospital chart abstraction. Results: The majority of subjects noted only positive effects of the presence of home AEDs (eg, giving them feelings of security and control). There was no evidence that AED presence in the home caused excessive anxiety or stress either in patients or their significant others, nor were they perceived to cause relationship stress. On average, patients and their significant others estimated a 38% and 43% (respectively) risk of cardiac arrest and a 92% and 87% likelihood of a successful resuscitation with the use of the AED. Subjects' perceived risk of cardiac arrest were subjectively related to their estimate of current health status, size of infarction, and symptoms during their MI. Subjects also related their estimates of risk to their likelihood of traveling with their AED and whether they would consider purchasing one. Significant others had high confidence in their ability to properly use the AED. Conclusions: AEDs were valued highly by subjects and enhanced their perceived control over their heart disease. This was especially true for subjects who believed that their risk of cardiac arrest was high. The possible effects of providing education regarding expert estimates of the likelihood of cardiac arrest and of a successful resuscitation at the time of AED placement are discussed. (Heart Lung® 2002;31:173-85.)
Part 4: The automated external defibrillator: Key link in the chain of survival
2000, Resuscitation
Citation Excerpt :
Clinical evaluation confirmed the safety and efficacy of this AED in termination of out-of-hospital VF arrest[72,76,77]. Home trials were conducted and reported, but the concept of home defibrillation for patients at high risk was not yet ready for acceptance [15,16,78–81]. In the last few years there has been a significant increase in the use of AEDs in early defibrillation programs in a variety of settings, including EMS systems, police departments, casinos, airport terminals, and commercial aircraft, among others [12,13,17,18,20–24,82–84].

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: Supported in part by grants from the National Center for Health Services Research (HS-04894) and the Cardiac Resuscitator Corporation, Wilsonville, Oregon.

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Automatic external defibrillation: Evaluations of its role in the home and in emergency medical services

Lancet

Lancet

Lancet

Int J Cardiol

Journal of the American College of Cardiology

Sudden cardiac death I: A decade's experience with out-of-hospital resuscitation

Mod Concepts Cardiovasc Dis

Out-of-hospital cardiac arrest: A review of major studies and a proposed uniform reporting system

Am J Public Health

Ventricular fibrillation in a medically supervised cardiac exercise program

JAMA

Cardiac arrest associated with supervised cardiac rehabilitation

Journal of Cardiac Rehabilitation

Treatment of out-of-hospital cardiac arrest with rapid defibrillation by emergency medical technicians

N Engl J Med