A national scheme for public access defibrillation in England and Wales: early results.
BACKGROUND
Automated external defibrillators (AEDs) operated by lay persons are used in the UK in a National Defibrillator Programme promoting public access defibrillation (PAD).


METHODS
Two strategies are used: (1) Static AEDs installed permanently in busy public places operated by those working nearby. (2) Mobile AEDs operated by community first responders (CFRs) who travel to the casualty.


RESULTS
One thousand five hundred and thirty resuscitation attempts. With static AEDs, return of spontaneous circulation (ROSC) was achieved in 170/437 (39%) patients, hospital discharge in 113/437 (26%). With mobile AEDs, ROSC was achieved in 110/1093 (10%), hospital discharge in 32 (2.9%) (P<0.001 for both variables). More shocks were administered with static AEDS 347/437 (79%) than mobile AEDs 388/1093 (35.5%) P<0.001. Highly significant advantages existed for witnessed arrests, administration of shocks, bystander CPR before arrival of AED and short delays to start CPR and attach AED. These factors were more common with static AEDs. For CFRs, patients at home did less well than those at other locations for ROSC (P<0.001) and survival (P=.006). Patients at home were older, more arrests were unwitnessed, fewer shocks were given, delays to start CPR and attach electrodes were longer.


CONCLUSIONS
PAD is a highly effective strategy for patients with sudden cardiac arrest due to ventricular fibrillation who arrest in public places where AEDs are installed. Community responders who travel with an AED are less effective, but offer some prospect of resuscitation for many patients who would otherwise receive no treatment. Both strategies merit continuing development.
Department of Primary Care and Public Health, (Medical Statistics), School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, United Kingdom. mcc@mcolquhoun.plus.com
M C
MC
Colquhoun
D A
DA
Chamberlain
R G
RG
Newcombe
R
R
Harris
S
S
Harris
K
K
Peel
C S
CS
Davies
R
R
Boyle
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D047548:Defibrillators / Q000706:statistics & numerical data* / Q000600:supply & distribution; D004739:England / Q000453:epidemiology; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D015397:Program Evaluation; D015980:Public Health Practice; D015996:Survival Rate; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology