Hostname: page-component-7dd5485656-bt4hw Total loading time: 0 Render date: 2025-10-31T14:51:38.016Z Has data issue: false hasContentIssue false
  • English
  • Français

The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations

Published online by Cambridge University Press:  21 August 2012

Nathan Allen Stokes ,
Andrea Scapigliati ,
Antoine R. Trammell  and
David C. Parish
Nathan Allen Stokes*
Affiliation:
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia USA
Andrea Scapigliati
Affiliation:
Institute of Anesthesiology and Intensive Care, Department of Cardiovascular Medicine, Catholic University School of Medicine, Rome, Italy
Antoine R. Trammell
Affiliation:
Division of General Medicine, Emory University School of Medicine, Atlanta, Georgia USA
David C. Parish
Affiliation:
Internal Medicine, Mercer University School of Medicine, Macon, Georgia USA
*
Correspondence: Nathan Allen Stokes, MD, NREMT-P Department of Emergency Medicine Emory University School of Medicine 49 Jesse Hill Jr Dr SE Atlanta, GA 30303 USA E-mail nstokes@emory.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

The automated external defibrillator (AED) is a tool that contributes to survival with mixed outcomes. This review assesses the effectiveness of the AED, consistencies and variations among studies, and how varying outcomes can be resolved.

Methods

A worksheet for the International Liaison Committee on Resuscitation (ILCOR) 2010 science review focused on hospital survival in AED programs was the foundation of the articles reviewed. Articles identified in the search covering a broader range of topics were added. All articles were read by at least two authors; consensus discussions resolved differences.

Results

AED use developed sequentially. Use of AEDs by emergency medical technicians (EMTs) compared to manual defibrillators showed equal or superior survival. AED use was extended to trained responders likely to be near victims, such as fire/rescue, police, airline attendants, and casino security guards, with improvement in all venues but not all programs. Broad public access initiatives demonstrated increased survival despite low rates of AED use. Home AED programs have not improved survival; in-hospital trials have had mixed results. Successful programs have placed devices in high-risk sites, maintained the AEDs, recruited a team with a duty to respond, and conducted ongoing assessment of the program.

Conclusion

The AED can affect survival among patients with sudden ventricular fibrillation (VF). Components of AED programs that affect outcome include the operator, location, the emergency response system, ongoing maintenance and evaluation. Comparing outcomes is complicated by variations in definitions of populations and variables. The effect of AEDs on individuals can be dramatic, but the effect on populations is limited.

StokesNA , ScapigliatiA , TrammellAR , ParishDC . The Effect of the AED and AED Programs on Survival of Individuals, Groups and Populations. Prehosp Disaster Med.2012;27(5):1–6.

Keywords

cardiopulmonary resuscitationdefibrillatorsemergency medical servicesout-of-hospital cardiac arrest

Information

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 27 , Issue 5 , October 2012 , pp. 419 - 424
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Bocka JJ. Automated external defibrillation. http://emedicine.medscape.com/article/780533-overview. Accessed October 14, 2010.Google Scholar
2. Beck, CS, Pritchard, WH, Feil, HS. Ventricular fibrillation of long duration abolished by electric shock. JAMA. 1947;135(15):985.CrossRefGoogle ScholarPubMed
3. Zoll, PM, Linenthal, AJ, Gibson, W, Paul, MH, Norman, LR. Termination of ventricular fibrillation in man by externally applied electric countershock. N Engl J Med. 1956;254(16):727-732.CrossRefGoogle Scholar
4. Kouwenhoven, WB, Milnor, WR, Knickerbocker, GG, Chesnut, WR. Closed chest defibrillation of the heart. Surgery. 1957;42(3):550-561.Google ScholarPubMed
5. Pantridge, JF, Geddes, JS. A mobile intensive-care unit in the management of myocardial infarction. Lancet. 1967;2(7510):271-273.CrossRefGoogle ScholarPubMed
6. Rose, LB, Press, E. Cardiac defibrillation by ambulance attendants. JAMA. 1972;219(1):63-68.CrossRefGoogle ScholarPubMed
7. Kassanoff, I, Whaley, W, Walter, WH 3rd, et al. Stadium coronary care. A concept in emergency health care delivery. JAMA. 1972;221(4):397-399.CrossRefGoogle Scholar
8. Diack, AW, Welborn, WS, Rullman, RG, Walter, CW, Wayne, MA. An automatic cardiac resuscitator for emergency treatment of cardiac arrest. Med Instrum. 1979;13(2):78-83.Google ScholarPubMed
9. Heber, M. Out-of-hospital resuscitation using the “heart-aid”, an automated external defibrillator-pacemaker. Int J Cardiol. 1983;3(4):456-458.CrossRefGoogle Scholar
10. National Academy of Sciences - National Research Council: Standards guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA. 1986;255(21):2905-2989.CrossRefGoogle Scholar
11. Parish, DC, Trammell, AR, Scapigliati, A. Worksheet for evidence-based review of science for emergency cardiac care [EIT-015]. Circulation. 2010;122(16 Suppl 2):1-16. http://circ.ahajournals.org/site/C2010/EIT-015.pdf. Accessed November 30, 2010.Google Scholar
12. Mancini, ME, Soar, J, Bhanji, F, et al. Part 12: Education, implementation, and teams: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122(16 Suppl 2):S539-S581. http://circ.ahajournals.org/cgi/content/full/122/16_suppl_2/S539. Accessed November 30, 2010.CrossRefGoogle ScholarPubMed
13. Stults, KR, Brown, DD, Kerber, RE. Efficacy of an automated external defibrillator in the management of out-of-hospital cardiac arrest: validation of the diagnostic algorithm and initial clinical experience in a rural environment. Circulation. 1986;73(4):701-709.CrossRefGoogle Scholar
14. Jakobsson, J, Rehnqvist, N, Nyqvist, O. Clinical experience with three different defibrillators for resuscitation of out of hospital cardiac arrest. Resuscitation. 1990;19(2):167-173.CrossRefGoogle ScholarPubMed
15. Cummins, RO, Eisenberg, M, Bergner, L, Murray, JA. Sensitivity, accuracy, and safety of an automatic external defibrillator. Lancet. 1984;2(8398):318-320.CrossRefGoogle ScholarPubMed
16. Schneider, T, Martens, PR, Paschen, H, et al. Multicenter, randomized, controlled trial of 150-J biphasic shocks compared with 200- to 360-J monophasic shocks in the resuscitation of out-of-hospital cardiac arrest victims. Optimized Response to Cardiac Arrest (ORCA) Investigators. Circulation. 2000;102(15):1780-1787.CrossRefGoogle ScholarPubMed
17. American Heart Association. 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: Comparison chart of key changes. http://www.americanheart.org/downloadable/heart/1132781451610Comparison%20Chart%202005%20guidelines%20FINAL.pdf. Accessed November 29, 2010.Google Scholar
18. Jost, D, Degrange, H, Verret, C, et al. DEFI 2005: a randomized controlled trial of the effect of automated external defibrillator cardiopulmonary resuscitation protocol on outcome from out-of-hospital cardiac arrest. Circulation. 2010;121(14):1614-1622.CrossRefGoogle ScholarPubMed
19. Weisfeldt, ML, Sitlani, CM, Ornato, JP, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. 2010;55(16):1713-1720.CrossRefGoogle ScholarPubMed
20. Hallstrom, AP, Ornato, JP, Weisfeldt, M, et al. Public-access defibrillation and survival after out-of-hospital cardiac arrest. N Engl J Med. 2004;351(7):637-646.Google ScholarPubMed
21. Peberdy, MA, Ottingham, LV, Groh, WJ, et al. Adverse events associated with lay emergency response programs: the public access defibrillation trial experience. Resuscitation. 2006;70(1):59-65.CrossRefGoogle ScholarPubMed
22. Zafari, AM, Zarter, SK, Heggen, V, et al. A program encouraging early defibrillation results in improved in-hospital resuscitation efficacy. J Am Coll Cardiol. 2004;44(4):846-852.CrossRefGoogle ScholarPubMed
23. Hanefeld, C, Lichte, C, Mentges-Schroter, I, Sirtl, C, Mugge, A. Hospital-wide first-responder automated external defibrillator programme: 1 year experience. Resuscitation. 2005;66(2):167-170.CrossRefGoogle Scholar
24. Forcina, MS, Farhat, AY, O'Neil, WW, Haines, DE. Cardiac arrest survival after implementation of automated external defibrillator technology in the in-hospital setting. Crit Care Med. 2009;37(4):1229-1236.CrossRefGoogle ScholarPubMed
25. Smith, RJ, Hickey, BB, Santamaria, JD. Automated external defibrillators and survival after in-hospital cardiac arrest: early experience at an Australian teaching hospital. Crit Care Resusc. 2009;11(4):261-265.Google ScholarPubMed
26. Chan, PS, Krumholz, HM, Spertus, JA, et al. Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA. 2010;304(1):2129-2136.CrossRefGoogle ScholarPubMed
27. Chan, PS, Jain, R, Nallmothu, BK, Berg, RA, Sasson, C. Rapid response teams: a systematic review and meta-analysis. Arch Intern Med. 2010;170(1):18-26.CrossRefGoogle ScholarPubMed
28. Eisenberg, MS, Bergner, L, Hallstrom, A. Out-of-hospital cardiac arrest: improved survival with paramedic services. Lancet. 1980;1(8172):812-815.CrossRefGoogle ScholarPubMed
29. Eisenberg, MS, Copass, MK, Hallstrom, AP, et al. Treatment of out-of-hospital cardiac arrests with rapid defibrillation by emergency medical technicians. N Engl J Med. 1980;302(25):1379-1383.CrossRefGoogle ScholarPubMed
30. Vukov, LF, White, RD, Bachman, JW, O'Brien, PC. New perspectives on rural EMT defibrillation. Ann Emerg Med. 1988;17(4):318-321.CrossRefGoogle ScholarPubMed
31. Haynes, BE, Mendoza, A, McNeil, M, Schroeder, J, Smiley, DR. A statewide early defibrillation initiative including laypersons and outcome reporting. JAMA. 1991;266(4):545-547.CrossRefGoogle ScholarPubMed
32. White, RD, Asplin, BR, Bugliosi, TF, Hankins, DG. High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med. 1996;28(5):480-485.CrossRefGoogle ScholarPubMed
33. Stiell, IG, Wells, GA, Field, BJ, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS study phase II. Ontario Prehospital Advanced Life Support. JAMA.. 1999;281(13):1175-1181.CrossRefGoogle ScholarPubMed
34. Capucci, A, Aschieri, D, Piepoli, MF, Bardy, GH, Iconomu, E, Arvedi, M. Tripling survival from sudden cardiac arrest via early defibrillation without traditional education in cardiopulmonary resuscitation. Circulation. 2002;106(9):1065-1070.CrossRefGoogle ScholarPubMed
35. Cappato, R, Curnis, A, Marzollo, P, et al. Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS). Eur Heart J. 2006;27(5):553-561.CrossRefGoogle ScholarPubMed
36. Kajino, K, Iwami, T, Berg, RA, et al. Comparison of neurological outcomes following witnessed out-of-hospital ventricular fibrillation defibrillated with either biphasic or monophasic automated external defibrillators. Emerg Med J. 2009;26(7):492-496.CrossRefGoogle ScholarPubMed
37. Eisenberg, MS, Moore, J, Cummins, RO, et al. Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation. Am J Cardiol. 1989;63(7):443-446.CrossRefGoogle ScholarPubMed
38. Bardy, GH, Lee, KL, Mark, DB, et al. Home use of automated external defibrillators for sudden cardiac arrest. N Engl J Med. 2008;358(17):1793-1804.CrossRefGoogle ScholarPubMed
39. O'Rourke, MF, Donaldson, E, Geddes, JS. An airline cardiac arrest program. Circulation. 1997;96(9):2849-2853.CrossRefGoogle ScholarPubMed
40. Page, RL, Joglar, JA, Kowal, RC, et al. Use of automated external defibrillators by a U.S. airline. N Engl J Med. 2000;343(17):1210-1216.CrossRefGoogle Scholar
41. Caffrey, SL, Willoughby, PJ, Pepe, PE, Becker, LB. Public use of automated external defibrillators. N Engl J Med. 2002;347(16):1242-1247.CrossRefGoogle ScholarPubMed
42. Valenzuela, TD, Roe, DJ, Nichol, G, Clark, LL, Spaite, DW, Hardman, RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. NEngl J Med. 2000;343(17):1206-1209.CrossRefGoogle ScholarPubMed
43. Drezner, JA, Rao, AL, Heistand, J, Bloomingdale, MK, Harmon, KG. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation. 2009;120(6):518-525.CrossRefGoogle ScholarPubMed
44. Colquhoun, MC, Chamberlain, DA, Newcombe, RG, et al. A national scheme for public access defibrillation in England and Wales: early results. Resuscitation. 2008;78(3):275-280.CrossRefGoogle ScholarPubMed
45. Culley, LL, Rea, TD, Murray, JA, et al. Public access defibrillation in out-of-hospital cardiac arrest: a community-based study. Circulation. 2004;109(15):1859-1863.CrossRefGoogle ScholarPubMed
46. Fleischhackl, R, Roessler, B, Domanovits, H, et al. Results from Austria's nationwide public access defibrillation (ANPAD) programme collected over 2 years. Resuscitation. 2008;77(2):195-200.CrossRefGoogle ScholarPubMed
47. Davies, CS, Colquhoun, M, Graham, S, Evans, T, Chamberlain, D. Defibrillator Advisory Committee. Defibrillators in public places: the introduction of a national scheme for public access defibrillation in England. Resuscitation. 2002;52(1):13-21.CrossRefGoogle ScholarPubMed
48. Whitfield, R, Colquhoun, M, Chamberlain, D, Newcombe, R, Davies, CS, Boyle, R. The Department of Health national defibrillator programme: analysis of downloads from 250 deployments of public access defibrillators. Resuscitation. 2005;64:269-277.CrossRefGoogle ScholarPubMed
49. Kuisma, M, Castren, M, Nurminen, K. Public access defibrillation in Helsinki--costs and potential benefits from a community-based pilot study. Resuscitation. 2003;56(2):149-152.CrossRefGoogle ScholarPubMed
50. Sakai, T, Iwami, T, Kitamura, T, et al. Effectiveness of the new ‘mobile AED map’ to find and retrieve an AED: a randomised controlled trial. Resuscitation. 2011;82(1):69-73.CrossRefGoogle ScholarPubMed
51. Scholten, AC, van Manen, JG, van der Worp, WE, Ijzerman, MJ, Doggen, CJ. Early cardiopulmonary resuscitation and use of automated external defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service. Resuscitation. 2011;82:1273-1278.CrossRefGoogle ScholarPubMed
52. Stokes, A. Reconciling fractured communications data. A response to the IOM report. EMS Mag. 2007;36(5):46-53, 55.Google Scholar
53. McNally, B, Stokes, A, Crouch, A, Kellermann, AL, CARES Surveillance Group. CARES: Cardiac Arrest Registry to Enhance Survival. Ann Emerg Med. 2009;54(5):674-683. e2.CrossRefGoogle Scholar
54. Dickey, W, Adgey, AA. Mortality within hospital after resuscitation from ventricular fibrillation outside hospital. Br Heart J. 1992;67(4):334-338.CrossRefGoogle ScholarPubMed
55. Jacoby, JL, Cesta, M, Heller, MB, Salen, P, Reed, J. Synchronized emergency department cardioversion of atrial dysrhythmias saves time, money and resources. J Emerg Med. 2005;28(1):27-30.CrossRefGoogle ScholarPubMed
56. Kitamura, T, Iwami, T, Kawamura, T, et al. Nationwide public-access defibrillation in Japan. N Engl J Med. 2010;362(11):994-1004.CrossRefGoogle ScholarPubMed
57. Pell, JP, Walker, A, Cobbe, SM. Cost-effectiveness of automated external defibrillators in public places: Con. Curr Opin Cardiol. 2007;22(1):5-10.CrossRefGoogle ScholarPubMed
58. Folke, F, Lippert, FK, Nielsen, SL, et al. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations. Circulation. 2009;120(6):510-517.CrossRefGoogle Scholar
59. Atkins, DL. Realistic expectations for public access defibrillation programs. Curr Opin Crit Care. 2010;16(3):191-195.CrossRefGoogle ScholarPubMed
60. Gold, LS, Eisenberg, M. Cost-effectiveness of automated external defibrillators in public places: Pro. Curr Opin Cardiol. 2007;22(1):1-4.CrossRefGoogle ScholarPubMed
61. Groh, WJ, Birnbaum, A, Barry, A, et al. Characteristics of volunteers responding to emergencies in the public access defibrillation trial. Resuscitation. 2007;72(2):193-199.CrossRefGoogle ScholarPubMed
62. Stokes, A, McNally, B. How good is that data? EMS Mag. 2007;36(7):77-81.Google ScholarPubMed