Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million.
OBJECTIVE
The purpose of this study was to assess the effectiveness of contemporary automatic external defibrillator (AED) use.


BACKGROUND
In the PAD (Public Access Defibrillation) trial, survival was doubled by focused training of lay volunteers to use an AED in high-risk public settings.


METHODS
We performed a population-based cohort study of persons with nontraumatic out-of-hospital cardiac arrest before emergency medical system (EMS) arrival at Resuscitation Outcomes Consortium (ROC) sites between December 2005 and May 2007. Multiple logistic regression was used to assess the independent association between AED application and survival to hospital discharge.


RESULTS
Of 13,769 out-of-hospital cardiac arrests, 4,403 (32.0%) received bystander cardiopulmonary resuscitation but had no AED applied before EMS arrival, and 289 (2.1%) had an AED applied before EMS arrival. The AED was applied by health care workers (32%), lay volunteers (35%), police (26%), or unknown (7%). Overall survival to hospital discharge was 7%. Survival was 9% (382 of 4,403) with bystander cardiopulmonary resuscitation but no AED, 24% (69 of 289) with AED application, and 38% (64 of 170) with AED shock delivered. In multivariable analyses adjusting for: 1) age and sex; 2) bystander cardiopulmonary resuscitation performed; 3) location of arrest (public or private); 4) EMS response interval; 5) arrest witnessed; 6) initial shockable or not shockable rhythm; and 7) study site, AED application was associated with greater likelihood of survival (odds ratio: 1.75; 95% confidence interval: 1.23 to 2.50; p < 0.002). Extrapolating this greater survival from the ROC EMS population base (21 million) to the population of the U.S. and Canada (330 million), AED application by bystanders seems to save 474 lives/year.


CONCLUSIONS
Application of an AED in communities is associated with nearly a doubling of survival after out-of-hospital cardiac arrest. These results reinforce the importance of strategically expanding community-based AED programs.
Weisfeldt
Myron L
ML
Johns Hopkins University, Baltimore, Maryland 21287, USA. mlw5@jhmi.edu
Sitlani
Colleen M
CM
Ornato
Joseph P
JP
Rea
Thomas
T
Aufderheide
Tom P
TP
Davis
Daniel
D
Dreyer
Jonathan
J
Hess
Erik P
EP
Jui
Jonathan
J
Maloney
Justin
J
Sopko
George
G
Powell
Judy
J
Nichol
Graham
G
Morrison
Laurie J
LJ
D000368:Aged; D001331:Automation; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation*; D047548:Defibrillators; D004554:Electric Countershock / Q000295:instrumentation*; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
BMJ. 2003 Jan 18;326(7381):162; author reply 162
12531856
N Engl J Med. 2002 Oct 17;347(16):1242-7
12393821
Resuscitation. 2008 Aug;78(2):161-9
18479802
Circulation. 2002 Aug 27;106(9):1058-64
12196329
Curr Opin Anaesthesiol. 2005 Apr;18(2):175-80
16534335
Acad Emerg Med. 2001 Apr;8(4):324-30
11282666
N Engl J Med. 2004 Aug 12;351(7):647-56
15306666
N Engl J Med. 2008 Apr 24;358(17):1793-804
18381485
Resuscitation. 2008 Oct;79(1):22-7
18687513
Circulation. 2004 Apr 20;109(15):1859-63
15023881
Resuscitation. 2007 Jul;74(1):52-62
17303309
Circulation. 2009 Aug 11;120(6):510-7
19635969
Resuscitation. 1998 Dec;39(3):145-51
10078803
Biometrics. 1984 Dec;40(4):961-71
6534418
Biometrics. 1986 Mar;42(1):121-30
3719049
Anaesthesist. 2006 Dec;55(12):1281-90
17021885
Ital Heart J. 2002 Dec;3(12):721-5
12611123
Resuscitation. 2008 Aug;78(2):186-95
18487004
Harefuah. 2006 May;145(5):375-9, 396
16805222
Am J Cardiol. 2004 Jan 15;93(2):131-5
14715335
Curr Opin Cardiol. 2007 Jan;22(1):5-10
17143038
BMJ. 2002 Sep 7;325(7363):515
12217989
Resuscitation. 2008 Sep;78(3):275-80
18562074
Resuscitation. 2004 Nov;63(2):167-74
15531068
N Engl J Med. 2000 Oct 26;343(17):1206-9
11071670
Ann Emerg Med. 2009 Feb;53(2):241-248
18450329
JAMA. 2006 Aug 9;296(6):655-60
16896108
N Engl J Med. 2004 Aug 12;351(7):637-46
15306665
N Engl J Med. 2000 Oct 26;343(17):1210-6
11071671
Circulation. 2003 Oct 21;108(16):1939-44
14530198
Resuscitation. 2003 Sep;58(3):297-308
12969608
JAMA. 2002 Dec 18;288(23):3008-13
12479765
Curr Opin Cardiol. 2007 Jan;22(1):1-4
17143037
JAMA. 2008 Sep 24;300(12):1423-31
18812533
Stat Methods Med Res. 1999 Mar;8(1):3-15
10347857
Resuscitation. 2008 Aug;78(2):179-85
18487005
Int J Nurs Stud. 2006 Nov;43(8):1057-62
16423355
Prehosp Emerg Care. 2005 Jul-Sep;9(3):339-43
16147487
Prehosp Emerg Care. 2007 Oct-Dec;11(4):369-82
17907019
N Engl J Med. 2003 Jun 26;348(26):2626-33
12826637