Impact of prompt defibrillation on cardiac arrest at a major international airport.
OBJECTIVE
To describe the impact of a rapidly deployable, automated external defibrillator (AED)-equipped first-responder service at Boston's Logan International Airport on the rate of survival to hospital discharge after cardiac arrest.


METHODS
A prospective observational outcome study was undertaken for cardiac arrests taking place on the airport grounds from January 1, 1995, to December 31, 1999. Patients were included if they were unresponsive, they had no palpable pulse and no spontaneous respirations, an AED was turned on, and the cardiac arrest took place on airport grounds. Airport fire rescue and emergency medical services (EMS) personnel submitted resuscitation records and AED memory modules for each cardiac arrest. Each author independently reviewed all cardiac arrest reports and code summaries to ensure accuracy and data integrity. Relevant dispatch and response times were determined from airport fire rescue and EMS dispatch records. Patient outcome was determined from hospital patient records. Descriptive statistics were calculated.


RESULTS
The airport fire rescue crew responded to 53 cardiac arrests. Of those, 38 met inclusion criteria. In 36 of 38 cases (94.7%), the airport fire rescue crew was first to apply the defibrillator, and the first to deliver a shock in 28 of 32 cases (87.5%) where a shock was delivered. The median response time for the airport fire rescue crew was 2 minutes, with a mode of 1 minute. The EMS response times were 5:29 (95% CI 4:37-6:19) for basic life support crews and 8:07 (95% CI 7:17-8:57) for advanced life support crews. All patients who survived to hospital admission (n = 15) and hospital discharge (n = 8) received their first shock by the airport fire rescue crew. Eight patients (21.1%) survived to hospital discharge. In five of the eight survivors to hospital discharge, defibrillation by the airport crew alone achieved a return of spontaneous circulation.


CONCLUSIONS
A rapidly deployable first-responder service permits early defibrillation minutes before arrival of EMS personnel. This rapid response positively impacts the return of spontaneous circulation and survival to hospital discharge after cardiac arrest.
MacDonald
Russell D
RD
Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts, USA. rmacdonald@gov.mb.ca
Mottley
J Lawrence
JL
Weinstein
Carl
C
D000368:Aged; D001359:Aviation; D004554:Electric Countershock / Q000379:methods; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology