A first city-wide early defibrillation project in a German city: 5-year results of the Bochum against sudden cardiac arrest study.
BACKGROUND
Immediate defibrillation is the decisive determinant of prognosis in patients suffering from cardiac/circulatory arrest caused by ventricular fibrillation (VF). Therefore, various national and international associations recommend that first responders use defibrillators as soon as possible and also recommend public access to early defibrillation programmes. Here we report the results of the first city-wide early defibrillation project in a large German urban area.


METHODS
There were 155 automated external defibrillators (AEDs) put into operation in the Bochum municipal area, and 6,294 people took part in cardiopulmonary resuscitation (CPR) and AED training. Free, accessible AEDs were installed in places with large volumes of people. Additionally, emergency forces were progressively equipped with AEDs.


RESULTS
Twelve AED administrations prior to the arrival of an emergency physician were recorded and analysed over a period of 5 years (08/2004-08/2009). Rhythm analysis via AED demonstrated VF in seven cases, non-malignant dysrhythmias in four cases and asystole in one case. Two of the seven patients with VF were successfully defibrillated and survived cardiac/circulatory arrest without any neurological sequelae. Eight of the 12 AED applications were performed by laymen. The mean time between switching the unit on and applying the electrodes to the patient was 39 seconds (SD +/-20 sec). On average, another 20 seconds elapsed before the AED recommendation of "shock delivery" was displayed, and a total of 96 seconds elapsed before shock administration (+/- 56 sec).


CONCLUSIONS
Consistent with other reports, our findings show that the organisation of a city-wide initiative by a project office combining public access and first-responder defibrillation programmes can be safe, feasible and successful. Our experiences confirm that strategic planning of AED placement is a prerequisite for successful, cost-effective resuscitation.
Hanefeld
Christoph
C
Emergency Medical System of the city of Bochum, Brandwacht 1, 44894 Bochum, Germany. christoph.hanefeld@rub.de
D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D047548:Defibrillators / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution; D004554:Electric Countershock / Q000592:standards; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D015397:Program Evaluation; D014505:Urban Population