Clinical paperSurvival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator☆
Section snippets
Background
The automated external defibrillator (AED) provides the possibility to decrease the interval from collapse to attempted defibrillation by enabling persons outside the traditional emergency medical services (EMS) response system who are typically not trained in rhythm recognition to deliver lifesaving therapy. Various approaches have incorporated the AED in an effort to improve survival from out-of-hospital cardiac arrest. The AED can be deployed onsite at a (high risk) location where public are
Study area and AED usage
The Amsterdam Resuscitation Studies (ARREST) research group maintains a prospective database of all resuscitation efforts in the Dutch province North Holland, covering approximately 2671 km2 and a population of 2.4 million people. In case of a medical emergency, the Dutch dial the national emergency number, where an operator connects the call to a regional ambulance dispatch centre. If a cardiac arrest is suspected, the dispatcher sends out two ambulances of a single tier. Also, the dispatcher
Inclusion
A total of 2356 consecutive patients with an OHCA of cardiac cause were resuscitated during the 32-month study period. Subsequent hospital admission could not be traced in 6 patients and 15 foreign patients were transferred to a hospital in their home country and were excluded. The 173 patients whose collapse had been witnessed by ambulance personnel and the 31 patients in whom AED use was unknown were excluded as well. In total, 2126 patients were included in this analysis. Table 2 shows
Discussion
This study measured the healthcare costs to hospital discharge of resuscitated patients and related these costs to the use of an onsite AED, dispatched AED, or EMS care without AED use. Patients treated with an onsite AED showed two to three times higher survival rates than those treated with a dispatched AED or without an AED. For surviving patients, onsite AED use was associated with lower in-hospital nursing-day costs, partially attributed to fewer admission days in the ICU. There was no
Conclusion
Onsite AED use was associated with a two- to three-fold increase of hospital survival. Surviving patients of the onsite AED group had the lowest total costs, mainly due to the shorter duration of admission. There was no significant difference in costs or survival between dispatched AED use and no AED use. Dispatched AEDs are likely to improve survival and lower health care costs per survivor only if response times are decreased significantly.
Funding sources
This study was supported by a grant from the Netherlands Heart Foundation, Den Haag, the Netherlands (grant number 2006-B179) and a grant from Physio Control Inc.
Conflict of interest statement
None.
Acknowledgements
We greatly appreciate Michiel Hulleman, Esther Landman and Renate van der Meer for their contribution to the data collection, data entry and patient follow up. We are greatly indebted to the dispatch centres, ambulance paramedics and first responders of Amsterdam en Omstreken, Kennemerland and Noord-Holland Noord and Meditaxi for their indispensable cooperation and support.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.04.013.