Pushing the Envelope to Save More Lives
by Paul M. Paris, MD

From Pantridge to Smith, Jones and You

In 1967 in Belfast, Northern Ireland, Dr. Frank Pantridge became the first to show that victims of sudden cardiac death could be successfully resuscitated outside of the hospital environment. He did so by initiating a unique program that sent an ambulance staffed with a resuscitation team to the scene of those suffering chest pain. An AC defibrillator, powered by two 12-volt car batteries using a converted static inverter, weighed 150 pounds and was mounted in the ambulance. The first ten patients suffering cardiac arrest while in this experimental vehicle were all successfully resuscitated. As the project continued and greater numbers were available for study, the Belfast investigators took note that the time it took from onset of cardiac arrest to first defibrillation attempt was the single most significant factor in determining a successful resuscitation.

The innovative Belfast program was the catalyst for the development of ALS systems throughout the United States. But despite this legacy, over the past three decades EMS systems have struggled to optimize sudden cardiac arrest survival rates. The national average remains well below ten percent and in many large cities below two percent. The advent of automatic defibrillators provided a potential solution. The new technology allowed defibrillation to be performed by a wide variety of individuals with diverse backgrounds and training. First EMT-Ps, then firefighters and now police have all have shown they can improve sudden cardiac death survival rates using well-designed systems. More recently, improved survival rates on airlines and in casinos demonstrate that other categories of non-traditional responders can be effective. All the successful programs reconfirm Pantridge’s original observation: time to defibrillation is the single most important factor in improving save rates.

What’s next? Since the majority of cardiac arrests occur in the home, the obvious new frontier is home defibrillation. As defibrillators become smaller, less expensive and become even easier to use, the once futuristic idea of having defibrillators as common as fire extinguishers is no longer idle fancy.

The initial programs in home defibrillation actually began more than 15 years ago. In 1985 Mickey Eisenberg, MD, PhD, renowned researcher from the University of Washington, wrote an editorial "Automatic External Defibrillation: Bringing It Home." 1 In this editorial and a subsequent one published in 2000, he raised many insightful questions. He concluded his 1985 editorial by asking "Will this sort of defibrillation be in the hands of everyone, or will only a few wield its power?" Small, easy-to-use automatic defibrillators will soon rival the cost of home computers. And just as it becomes increasingly rare to find a household without a computer, eventually it may be equally difficult to find one a household that does not consider a defibrillator a basic first-aid tool - no less important than a smoke detector or fire extinguisher.

We know with certainty that defibrillators save lives when properly applied soon after the onset of ventricular fibrillation. There are still important academic questions to be answered with evidence-based research: What is the cost-benefit ratio compared to other health interventions? How do we optimize training, education, and continuing education? What locations and methods of deployment bring the greatest benefits at the lowest cost?

But with or without additional research, market forces and media attention are already prompting adoption of this new, exciting technology. Individuals can buy a defibrillators online through CVS.com and they will soon become available for easy purchase at other internet sources and even at your local WalMart. Commercial messages espousing their value are starting to appear in targeted markets and will begin to proliferate, particularly as the emergence of less expensive units make personal defibrillators an affordable option. It’s conceivable that many individuals will own their own defibrillator before these medical devices become routinely available at shopping malls, restaurants, churches, physician’s offices, health clubs, golf courses and other potentially high-risk locations. While academic issues are debated, the next frontier is clear. What started from the ideas of Pantridge will soon be adopted by the Smiths, the Joneses - and perhaps you.

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