Should AEDs go home?
February 1, 2002
Is it time to consider placing AEDs in the home? This was the subject of a panel discussion held January 30th at the National Press Club in Washington, DC. The discussion was sponsored by Philips Medical Systems, in cooperation with the American Red Cross and the National Center for Early Defibrillation, and moderated by Howard Torman, MD, former health and medical correspondent for CBS This Morning. Discussants included Gust Bardy, MD, Lance Becker, MD, Edward Racht, MD, Arthur Kellermann, MD, MPH; Richard Lazar, Esq., Chicago HeartSave Program Director, Sherry Caffrey, and survivor Lee Curtes of Milwaukee. Introductory remarks were made by Scott Conner, vice president of health, safety and community services at the American Red Cross, Mary Newman, executive director of NCED and Deborah DiSanzo, vice president and general manager for cardiac resuscitation at Philips.
Most panelists agreed that while there may be some merit in placing AEDs in homes of high-risk individuals, it is too early recommend an AED in every home. Some would define high-risk individuals as people who meet the criteria for having an implantable cardioverter defibrillator (ICD) but for some reason do not have one; others would define "high-risk" more broadly. Still others suggested consideration of widespread deployment in homes as a way to capture pre-symptomatic at-risk individuals.
Presenting the "pro" side, Dr. Becker stated that the only difference between the 50 percent who survive at Chicago O’Hare Airport where a public access defibrillation program is in place and the two percent who survive in the city of Chicago is that "a defibrillator was there and there was a person who knew how to use that defibrillator." Following this logic, and knowing that most cases of sudden cardiac arrest occur in the home and that public access defibrillation programs therefore can only reach a "fraction of the people," Becker asked whether it is a "slam-dunk" that there should be AED in every home in America. While he favored eliminating what he called the "prescription barrier," that is, the current FDA requirement for a prescription from a physician for AED purchase, Becker was reluctant to embrace AEDs as essential elements of home safety preparedness.
"I don’t think we’re ready for widespread dissemination and the reason is because we don’t yet have the vital data that we need to figure out how to effectively do it," said Becker. The reason the answers are elusive, he added, is that cardiac arrest research is "terribly under-funded."
Bardy, co-author of a study demonstrating the ease with which untrained six graders learned how to use AEDs, took a strong position in favor of home defibrillation. "Aside from the public health issues, aside from the resource allocation issues, aside from the lack of data, from a pure perspective of time…the only way out of (sudden cardiac arrest) is an electrical shock," he said. "Logically it makes sense to have an AED in the home." According to Bardy, "People who would be reasonable candidates, other than the worried well with disposable income, would be people that have some risk but not enough risk to merit an implantable defibrillator."
Lazar took the "pro" side a bit further, advocating elimination of not only the prescription barrier but also what he described as the barriers of training and medical oversight requirements. "What’s on the table today is who gets to buy (AEDs), under what circumstances, and who gets to decide. I think it’s time for individuals and businesses to decide."
Presenting the "con" side, Kellermann urged caution, reflecting the view he expressed in his 2000 editorial in the Journal of the American Medical Association. "There is absolutely no data to support home defibrillation. Not today, not at this time," he said. Kellermann cited concerns that AEDs in the home might divert attention and resources from prevention and EMS and he called for "doing the right thing in a measured way." For those who are ready to spend $3,500 on an AED for the home, Kellermann said: "My advice to you is this: take $2,500 of that money and join a health club and take the other thousand dollars and donate it to your local EMS squad. You’ll do more for your health and you’ll do more for your community."
While experts continue to debate, Curtes, who described himself as the "luckiest man in the world," has made a personal choice. He keeps an AED at home, in his car and at work, but not necessarily for his own safety. "I feel it’s important for me to give a life back," he said, "and some day I will get my chance."
To view the two-hour webcast, click here.
To read the USA Today article, click here.
To see the NCED position statement on home defibrillation, click here.