Improving survival from sudden cardiac arrest: the role of the automated external defibrillator.
BACKGROUND
Sudden cardiac death is a major public health problem in the United States, and improving survival after out-of-hospital cardiac arrest has been the subject of intense study. Early defibrillation has been shown to be critical to improving survival. Use of automated external defibrillators (AEDs) has become an important component of emergency medical systems, and recent advances in AED technology have allowed expansion of AED use to nontraditional first responders and the lay public.


OBJECTIVE
To examine advancements in AED technology, review the impact of AEDs on time to defibrillation and survival, and explore the future role of AEDs in the effort to improve survival following sudden cardiac arrest.


METHODS
MEDLINE was searched for articles from 1966 through December 2000 (Medical Subject Headings: electric countershock, heart arrest, resuscitation, emergency medical services; keywords: automatic external defibrillator, automated external defibrillator, public access defibrillation). Reference lists of relevant articles, news releases, and product information from manufacturers were also reviewed.


METHODS
Initial MEDLINE search produced 4816 articles, from which 101 articles were selected for referencing based on having been published in a peer-reviewed journal and on relevance to the subject of the manuscript as determined by all 5 authors.


METHODS
All studies were critically reviewed for relevance, accuracy, and quality of data and study design by all authors.


RESULTS
Recent advances in AED technology and design have resulted in marked simplification of AED operation, improvements in accuracy and effectiveness, and reductions in cost. Use of AEDs by first responders and laypersons has reduced time to defibrillation and improved survival from sudden cardiac arrest in several communities. Initial studies of the cost-effectiveness of AED use in comparison with other commonly used treatments are favorable.


CONCLUSIONS
The AED represents an efficient method of delivering defibrillation to persons experiencing out-of-hospital cardiac arrest and its use by both traditional and nontraditional first responders appears to be safe and effective. The rapidly expanding role of AEDs in traditional emergency medical systems is supported by the literature, and initial studies of public access to defibrillation offer hope that further improvements in survival after sudden cardiac death can be achieved.
New England Cardiac Arrhythmia Center, Division of Cardiology, New England Medical Center, 750 Washington St, Boston, MA 02111, USA. nestes@lifespan.org
J P
JP
Marenco
P J
PJ
Wang
M S
MS
Link
M K
MK
Homoud
N A
NA
Estes
D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004554:Electric Countershock / Q000191:economics / Q000295:instrumentation; D004632:Emergency Medical Services / Q000191:economics / Q000379:methods / Q000639:trends*; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017150:Public Sector; D012151:Resuscitation / Q000191:economics / Q000295:instrumentation* / Q000639:trends; D016019:Survival Analysis