Elsevier

Resuscitation

Volume 81, Issue 8, August 2010, Pages 962-967
Resuscitation

Clinical paper
Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

https://doi.org/10.1016/j.resuscitation.2010.04.013Get rights and content

Abstract

Background

This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs.

Methods

For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac cause. Clinical, survival and cost data were collected from July 2005 until March 2008. Cost data were based on hospital transport, duration of admission in hospital wards, diagnostics and interventions. We divided the study population in three groups based on AED use: (1) onsite AED, (2) dispatched AED, (3) no AED. The endpoint was survival to discharge. P < 0.05 is indicated by *.

Results

Of the 2126 included patients, 136 were treated with an onsite AED, 365 with a dispatched AED and 1625 without AED. Overall (95% confidence interval [CI]) survival rate was 43% (35–51%), 16% (13–20%) and 14% (12–16%), respectively*. Per 100 survivors, the mean duration admitted at intensive care unit [ICU] were 267 (166–374), 495 (344–658), and 537 (450–609) days, respectively*; total duration of hospital admission was 2188 (1800–2594), 3132 (2573–3797), and 2765 (2519–3050) days, respectively*. Mean costs per survivor for hospital stay were €9233 (€7351–€11,280), €14,194 (€11,656–€17,254), and €13,693 (€12,226–€15,166), respectively*; total health care costs were €29,575 (€24,695–€34,183), €34,533 (€29,832–€39,487) and €31,772 (€29,217–€34,385), respectively. For both survivors and non-survivors, total costs per patient were €14,727 (€11,957–€18,324), €7703 (€6141–€9366) and €6580 (€5875–€7238), respectively*.

Conclusions

Onsite AED use was associated with higher survival rates. Surviving patients of the onsite AED group had lower total costs, mainly due to the shorter ICU stay.

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.

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