Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System Evaluation in the Resuscitation Outcomes Consortium Population of 21 Million

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:55

Article

Weisfeldt, Myron L.¹  Sitlani, Colleen M.²  Ornato, Joseph P.³  Rea, Thomas²  Aufderheide, Tom P.⁴  Davis, Daniel⁵  Dreyer, Jonathan⁶  Hess, Erik P.⁷  Jui, Jonathan⁸  Maloney, Justin⁹  Sopko, George¹⁰  Powell, Judy²  Nichol, Graham²  Morrison, Laurie J.¹¹ 

[1] Johns Hopkins Univ, Baltimore, MD 21287 USA

[2] Univ Washington, Seattle, WA 98195 USA

[3] Virginia Commonwealth Univ, Richmond, VA USA

[4] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[5] Univ Calif San Diego, San Diego, CA 92103 USA

[6] Univ Western Ontario, London, ON, Canada

[7] Mayo Clin, Rochester, MN USA

[8] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[9] Univ Ottawa, Ottawa, ON, Canada

[10] NHLBI, NIH, Bethesda, MD 20892 USA

[11] Univ Toronto, Toronto, ON, Canada

关键词: automatic external defibrillator;    cardiac arrest;    cardiopulmonary resuscitation;    defibrillation;    resuscitation;   

DOI  :  10.1016/j.jacc.2009.11.077

来源: Elsevier

【 摘 要 】

Objectives The purpose of this study was to assess the effectiveness of contemporary automatic external defibrillator (AED) use. Background In the PAD (Public Access Defibrillation) trial, survival was doubled by focused training of lay volunteers to use an AED in high-risk public settings. Methods We performed a population-based cohort study of persons with nontraumatic out-of-hospital cardiac arrest before emergency medical system (EMS) arrival at Resuscitation Outcomes Consortium (ROC) sites between December 2005 and May 2007. Multiple logistic regression was used to assess the independent association between AED application and survival to hospital discharge. Results Of 13,769 out-of-hospital cardiac arrests, 4,403 (32.0%) received bystander cardiopulmonary resuscitation but had no AED applied before EMS arrival, and 289 (2.1%) had an AED applied before EMS arrival. The AED was applied by health care workers (32%), lay volunteers (35%), police (26%), or unknown (7%). Overall survival to hospital discharge was 7%. Survival was 9% (382 of 4,403) with bystander cardiopulmonary resuscitation but no AED, 24% (69 of 289) with AED application, and 38% (64 of 170) with AED shock delivered. In multivariable analyses adjusting for: 1) age and sex; 2) bystander cardiopulmonary resuscitation performed; 3) location of arrest (public or private); 4) EMS response interval; 5) arrest witnessed; 6) initial shockable or not shockable rhythm; and 7) study site, AED application was associated with greater likelihood of survival (odds ratio: 1.75; 95% confidence interval: 1.23 to 2.50; p < 0.002). Extrapolating this greater survival from the ROC EMS population base (21 million) to the population of the U. S. and Canada (330 million), AED application by bystanders seems to save 474 lives/year. Conclusions Application of an AED in communities is associated with nearly a doubling of survival after out-of-hospital cardiac arrest. These results reinforce the importance of strategically expanding community-based AED programs. (J Am Coll Cardiol 2010;55:1713-20) (C) 2010 by the American College of Cardiology Foundation

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