Do public access defibrillation (PAD) programmes lead to an increase of patients surviving to discharge from hospital following out of hospital cardiac arrest?--a literature review.
OBJECTIVE
To ascertain the evidence for effectiveness of Public Access Defibrillation Programmes using any level of first responder.


METHODS
Structured searches were made of Medline, Cinahl, Embase, and 'All EBM reviews' (CDSR, ACP Journal Club, DARE, CCTR). No limits were set on the searches in terms of date, publication type or language. Limited hand searches were carried out and colleagues approached for potential papers.


METHODS
All 491 results were 'hand searched' for suitability. Potential papers for inclusion were further reviewed by access to abstracts or full text if necessary. The final papers for review were assessed using a recognised checklist.


RESULTS
Of a total of 491 results from all databases removal of repeats and papers that did not answer the question led to 22 papers being further reviewed. Of these 19 were excluded and a final three were assessed and reviewed. Of the three papers two were randomised controlled trials (one with cross over design) and one was a non-randomised controlled cross over trial. Two of the papers assessed the use of level one responders and one level two responders. Odds ratios for the trials using level one responders were 1.3 and 1.6. The relative risk (of survival) for the trial using level two responders was 2.0. However all three trials had wide confidence intervals.


CONCLUSIONS
The use of level one responders probably carries a slight benefit for patients in OOHCA. The use of level two responders may lead to a greater benefit but only for a small section of the population suffering OOHCA. Emphasis must also be placed on the improvement of ambulance response times and bystander CPR rates.
Clare
Carl
C
Cardiorespiratory Nursing, Royal Brompton and Harefield NHS Trust, Imperial College, UK. c.clare@imperial.ac.uk
D016001:Confidence Intervals; D018592:Cross-Over Studies; D047548:Defibrillators / Q000706:statistics & numerical data; D004554:Electric Countershock / Q000295:instrumentation / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005392:First Aid / Q000295:instrumentation / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome