Training and educational paperHigh acceptance of a home AED programme by survivors of sudden cardiac arrest and their families☆
Introduction
Sudden cardiac arrest is still one of the leading causes of death in the western world.1, 2 Many of these cardiac arrests are due to ventricular fibrillation. The need of sufficient prompt resuscitation is evident. Unfortunately, often too much time elapses before sufficient basic life support commences. That is (1) because most lay-persons don’t know how to perform basic life support correctly, and (2) because professional help needs time to arrive at the scene.3
Within 2 min of arrest, two-thirds of patients have electrocardiographic evidence of ventricular fibrillation or tachycardia,4 but the probability of a rhythm being amenable to defibrillation declines over time.5 Therefore, bystander interventions must be considered together with efforts to minimise ambulance response times.6, 7 In recent years, there has been reasonable progress in the development of automated external defibrillators (AEDs). These AEDs analyse the heart rhythm and if there is a shockable rhythm they recommend a shock. Additionally laypeople get instructions of how to perform CPR and can easily handle these AEDs.8 Many different efforts have been made to promote the public access defibrillation initiative.9, 10 An early study from Seattle showed that equipping first-responder units with AEDs decreased the time to defibrillation to 5 min and increased rates of survival as compared with first-responder CPR alone. Similarly, AEDs deployed in well-defined niche locations such as airplanes, airports, and casinos provided further proof of the concept.11
The concept of AEDs at home, though attractive at first glance, remains still unproven. In addition to the cost implications, community-based strategies could not be used and first-responders would be limited to the people available in each home.12, 13, 14, 15, 16, 17 Previous studies have shown that the risk for a re-arrest for cardiac arrest survivors is about 25–50% within the first year.18, 19, 20 Although there are strategies available for the prevention of a second cardiac arrest for those patients, according to current guidelines only a certain percentage are to be treated with implantable cardioverter defibrillator implantation, heart transplantation or ablation. In addition, despite the obvious benefits of CPR training for families of patients likely to become victims of recurrent cardiac arrest, neither general practitioners nor hospital physicians usually encourage relatives/friends/neighbours to take appropriate courses. One reason for this practice is the concern about the psychological effects of such training on both cardiac patients and their families.17, 21, 22
For a decade now, our Department of Emergency Medicine has organised a special annual event for cardiac arrest survivors and their families. The annual get-together is held at a unique institution, a wine tavern nesting in the vineyards surrounding the city. In our attempts to get to know as many facets of life after resuscitation as possible, we have managed to involve an appreciable number of cardiac arrest survivors and their families in specific projects. For the most part, the projects are related to CPR training, including the use of an AED by the family22 (Figure 1).
Therefore, the aim of this study was to survey the situation in families of cardiac arrest survivors provided with an AED for their home with concurrent training and yearly refresher courses about their attitudes towards cardiopulmonary resuscitation training and the use of an AED. Their life-supporting first-aid knowledge, reaction towards and willingness to have an AED in their home and use it in case of an emergency was evaluated.
Section snippets
Methods
Since the beginning of our project in spring 1999, life supporting first aid training and AEDs were provided at families’ homes by trained medical students to survivors selected from a cardiac arrest registry. Structured interviews were made before, immediately after training and 1 year later with both patients and their relatives/friends/neighbours. The study procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki
Results
From August 1991 until October 2004, 2137 cardiac arrest patients were admitted to the emergency department and were included in the cardiac arrest registry. Of those 1252 (59%) had their cardiac arrest outside the hospital with a cardiac aetiology in 908 (73%) cases. The arrest was witnessed in 905 (72%) cases and in those the first recorded ECG rhythm was ventricular fibrillation in 640 (70%) patients.
Discussion
Life supporting first aid training and distribution of AEDs to former cardiac arrest survivors at their homes is feasible and highly appreciated by all participants. Physician instructors, undergraduates of our medical school and our patients very much welcomed this diversion from their daily routine. No major problems occurred from teaching our medical students until to the final training sessions with the patients at their homes. Patients had the feeling that the “medical system” still takes
Acknowledgments
We would like to thank Wolfdieter Scheinecker, Philip Eisenburger, Reinhard Malzer, Alfred Kaff, Christoph Redelsteiner, Gertrude Meixner, Peter Lillie, Michael Tikal, Helmut Peschel and the numerous students for their help.
Funding: Austrian National Bank Anniversary Foundation, Björn Steiger Foundation Germany, Lions Club Vienna, Medical Scientific Foundation by the Mayor of Vienna, Ministry of Science and Traffic, Austria for EC program, Philips Medical Systems and The Laerdal Foundation for
References (40)
- et al.
Resuscitation in Europe: a tale of five European regions
Resuscitation
(1999) - et al.
Differing operational outcomes with six commercially available automated external defibrillators
Resuscitation
(2004) - et al.
Frequency of sudden cardiac death and profiles of risk
Am J Cardiol
(1997) - et al.
Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation
Am J Cardiol
(1989) - et al.
Barriers and facilitators to the prescription of automated external defibrillators for home use in patients with heart disease: a survey of cardiologists
Heart Lung
(2001) - et al.
Impact of in-home defibrillators on postmyocardial infarction patients and significant others: an interview study
Heart Lung
(2002) - et al.
One-year survival after prehospital cardiac arrest: The Utstein Style applied to a rural–suburban system
Am J Emerg Med
(1994) - et al.
CPR courses and semi-automatic defibrillators—life saving in cardiac arrest?
Resuscitation
(2004) - et al.
Hurrah—we are still alive! A different dimension in post-resuscitative care: the annual gathering of cardiac arrest survivors at a typical Viennese wine tavern
Resuscitation
(2002) - et al.
The need for wider dissemination of CPR skills: are schools the answer
Resuscitation
(1994)
Feasibility of life-supporting first-aid (LSFA) training as a mandatory subject in primary schools
Resuscitation
Attitudes towards CPR training and performance in family members of patients with heart disease
Resuscitation
Cardiopulmonary resuscitation training for family members of patients on cardiac rehabilitation programmes in Scotland
Resuscitation
CPR instruction by videotape: results of a community project
Ann Emerg Med
Layperson CPR: are we training the right people?
Ann Emerg Med
Community attitudes towards performing cardiopulmonary resuscitation in Western Australia
Resuscitation
Attitudes of trained Swedish lay rescuers toward CPR performance in an emergency. A survey of 1020 recently trained CPR rescuers
Resuscitation
Cardiopulmonary resuscitation skills retention in family members of cardiac patients
Am J Emerg Med
Public access defibrillation in Helsinki—costs and potential benefits from a community based pilot study
Resuscitation
Out-of-hospital cardiac arrest in the 1990's: a population-based study in the Maastricht area on incidence, characteristics and survival
J Am Coll Cardiol
Cited by (0)
- ☆
A Spanish translated version of the summary of this article appears as Appendix in the online version at 10.1016/j.resuscitation.2006.03.010.