Current Research : Increasing the odds of survival

Two studies, published recently in The New England Journal of Medicine, lend additional support to the value of training and equipping nonmedical personnel with automated external defibrillators (AEDs).

The first, by Terence Valenzuela, MD, MPH, and colleagues, was a prospective study evaluating sudden cardiac arrest in casinos.1 Casino security guards were trained to use AEDs and devices were placed in locations designed to enable a three-minute interval from collapse to first shock. Of the victims in the treatable rhythm of ventricular fibrillation, 53% survived to hospital discharge. The survival rate was 74% for victims who received the first shock within three minutes of collapse.

The second study, by Richard Page, MD, and colleagues, evaluated the use of AEDs by flight attendants on American Airlines between June 1997 and July 1999. All flight attendants (24,000) were trained. AEDs were used on aircraft in 191 cases and at the terminal gate in nine cases, sometimes to monitor conscious patients. Of the 14 victims in documented ventricular fibrillation, 40% survived to hospital discharge with full neurologic recovery. No complications were associated with monitoring patients.2

These survival rates compare favorably with the average survival rate in most community settings (7%).3, 4

According to an editorial by Rose Marie Robertson, MD, of Vanderbilt University Medical Center, "Taken together, these studies provide strong evidence that trained personnel can intervene effectively when witnessed cardiac arrest is due to ventricular fibrillation."5

1 Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman R. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos, N Engl J Med 2000;343:1206-9.

2 Page RL, Joglar JA, Kowal RC, Zagrodzky JD, Nelson LL, Ramaswamy K, Barbera SJ, Hamdan MH, McKenas DK. Use of automated external defibrillators by a U.S. airline, N Engl J Med 2000;343:1210-16.

3 Callaway CW. Improving neurologic outcomes after out-of-hospital cardiac arrest. Prehospital Emergency Care 1997;1(1):45.

4 Becker LB. The epidemiology of sudden cardiac arrest (book chapter), Cardiac Arrest: The Science and Practice of Resuscitation Medicine (Paradis NA, Halperin HR, Nowak RM). Baltimore: Williams and Wilkins, 1996.

5 Robertson RM. Sudden death from cardiac arrest-improving the odds, N Engl J Med 2000;343:1259-60.

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