title: Cardiac arrest survival after implementation of automated external defibrillator technology in the in-hospital setting.
abstract: BACKGROUND
  Survival from ventricular tachycardia (VT) or ventricular fibrillation (VF) arrest is inversely related to delay to defibrillation. The automated external defibrillator (AED) has improved survival after out-of-hospital VT/VF arrest by decreasing time to defibrillation. The purpose of this study was to determine whether survival to discharge after in-hospital cardiac arrest caused by VT/VF could be improved via an institution-wide change from a standard monophasic defibrillator to a biphasic defibrillator with AED capability.
  
  
  RESULTS
  After extensive staff education, all standard defibrillators were replaced by AEDs at a single institution. Outcomes were analyzed for 1 year before the change and 1 year after the change using a prospective database. In patients whose initial rhythm was VT/VF, AEDs were not associated with improvement in time to first shock (median 1 minute for both cohorts, p = 0.79) or survival to discharge (31% vs. 29%, p = 0.8) compared with standard defibrillators. In patients whose initial rhythm was asystole or pulseless electrical activity, AEDs were associated with a significant decrease in survival (15%) compared with standard defibrillators (23%, p = 0.04). The overall AED cohort showed no difference in survival to discharge compared with the standard cohort (18% vs. 23%, p = 0.09).
  
  
  CONCLUSIONS
  Replacement of standard monophasic defibrillators with biphasic AEDs was associated with unchanged survival after in-hospital VT/VF arrest and decreased survival after in-hospital asystole or pulseless electrical activity arrest.
authors.affiliation: Department of Cardiovascular Medicine, Royal Oak, Michigan, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Forcina
authors.forename: Ali Y
authors.initials: AY
authors.lastname: Farhat
authors.forename: William W
authors.initials: WW
authors.lastname: O'Neil
authors.forename: David E
authors.initials: DE
authors.lastname: Haines