Defibrillation by general practitioners.
OBJECTIVE
To investigate the mode of cardiac arrest in patients with acute myocardial infarction attended by general practitioners, and the effectiveness of early defibrillation.


METHODS
Retrospective observational study.


METHODS
British general practice.


METHODS
General practitioners equipped with defibrillators by the British Heart Foundation.


METHODS
Cardiac rhythm when first monitored, response to defibrillation assessed by survival to reach hospital alive and survival to hospital discharge.


METHODS
Defibrillation and standard cardiopulmonary resuscitation in patients with cardiac arrest complicating acute myocardial infarction attended by British general practitioners.


RESULTS
When a doctor equipped with a defibrillator witnessed an arrest or was able to initiate resuscitation within 4 min of the patient collapsing, 90% of patients were found to have developed a rhythm likely to respond to a defibrillatory shock. Defibrillation under these circumstances was very successful with more than 70% of patients subsequently admitted to hospital alive and approximately 60% surviving to be discharged alive. When the doctor commenced resuscitation later, fewer patients were found to have rhythms likely to be responsive to a DC shock. A greater proportion was in asystole and resuscitation was less frequently successful under these circumstances. When the arrest occurred in the doctor's surgery, 85% of patients were admitted to hospital alive and three quarters survived to hospital discharge.


CONCLUSIONS
All those who provide the initial care for this vulnerable group of patients should be equipped with defibrillators. The more widespread deployment of defibrillators in the community may be a successful strategy for reducing unnecessary deaths from coronary heart disease.
Colquhoun
M C
MC
Court Road Surgery, Malvern, Worcestershire WR14 3BL, UK. colquhoun@bishopsfrome.u-net.com
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D004554:Electric Countershock; D005194:Family Practice; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D013222:State Medicine; D013997:Time Factors; D006113:United Kingdom