Transcript Can Public Defibrillators Save Lives?

Can Public Access Defibrillators
Save Lives?
Jessica Botner
March 24, 2006
Advisor: Dr. Grimes
Background of Cardiac Arrest
Cardiac arrest is the sudden loss of heart
function
There is no oxygenated blood flowing to the
brain and vital organs
Most cardiac arrest is caused by ventricular
fibrillation and ventricular tachycarida
http://www.austinheartbeat.com/images
Cardiac Arrest Treatment
Must be able to recognize the signs and
symptoms
Follow the American Heart Association’s
“Chain of Survival”
– Early Access
– Early CPR
– Early Defibrillation
– Early Advanced Care
Chain of Survival
Early Defibrillation
– Considered the Gold Standard of treatment for
cardiac arrest
– A process of using an electrical current to alter the
activity of the heart back to a life-sustaining rhythm
from pulseless v-tach or v-fib
– Time is of the essence!! (Brain death occurs in 4-6
minutes)
– Can be done with a manual defibrillator or an
automated defibrillator
Automated External Defibrillators
As mentioned before defibrillation is the
gold standard treatment of cardiac arrest
Automated External Defibrillators (AEDs)
are designed to be effective and easy to
use so that treatment can be provided
quickly to cardiac arrest victims
Can be used by untrained people
cost-effective
How to use an AED
Most AEDs have verbal
instructions to follow,
making their use simple
Basic rules that apply to
most are:
– Turn on power
– Attach electrodes to
machine and patient’s
chest (using pictures)
– Follow instructions from
AED
EMTs vs. sixth graders
Study conducted by Gundry in 1999
15 sixth graders and 22 EMTs
mock cardiac arrest scenarios evaluated on time
and technique
Time from arrival to defib.
(Range)
6th graders
EMTs
90 seconds
69 to 111 seconds
67 seconds
50 to 87 seconds
Results
The 6th graders had only slightly slower
times than trained professionals
No statistical significance
Suggests that widespread AED use could
be effective with only minimal training
The PAD Trial
15 month trail in 24 North American regions
focus was to determine if public AED availability
would be effective in out-of-hospital cardiac
arrest in large urban areas
compared cardiac arrest response by
laypersons trained in CPR only and laypersons
trained in both CPR and AED use
determination of success for this study is based
on how many cardiac arrest victims live to be
discharged from the hospital.
PAD Trial statistics
Hallstrom A, et al, Public-Access Defibrillation and
Survival after Out-of-Hospital
Cardiac Arrest. The New England Journal of
Medicine, 2004, 351:7: 644
Hallstrom A, et al, Public-Access Defibrillation and Survival after
Out-of-Hospital
Cardiac Arrest. The New England Journal of Medicine, 2004, 351:7:
645
Results of PAD Trial
AED use is safe and effective when used in
areas likely to have a witnessed cardiac arrest
event
AEDs can be safely and effectively used by
trained laypersons and can increase survival of
out-of-hospital cardiac arrest, especially when
EMS response times are slow
encourages wider-spread use of AEDs for
increased survival in out-of-hospital cardiac
arrest
Additional Studies
Piacenzia Progetto Vita (PPV) study
– EMS, physician, and lay responder dispatched at the same time
– During the 22 month study 354 cardiac arrests occurred
– Lay volunteers were the first to render care in 40 percent of
cases, whereas EMS were the first in 60 percent.
– The rate of survival from cardiac arrest to hospital discharge
tripled, going from 3.3 percent up to 10.5 percent
– the number of patients that had no serious neurological
problems increased by four times, going from 3 percent to 12.3
percent
Additional Studies Cont’d
Seattle/ King County, Washington Study
475 AEDs were placed in different settings to be
available to the volunteers
only 50 cases of cardiac arrest were treated
initially by the volunteers with public access
defibrillators before EMS arrival
Out of the 50 arrests treated, 76 percent
survived until hospital admission and 50 percent
survived until hospital discharge.
AEDs had a small impact in out-of-hospital
cardiac arrest in this study, but may improve
survival from cardiac arrest
On the Horizon…
There are many ongoing studies of public
AED use
Studies are being conducted to determine
the most effective placement and the costeffectiveness of AED use
AEDs will be available for use in home
Skymall Catalog has AEDs for sale
On July 27, 2005 in Richmond, KY
Campus police honored for saving man's life
By: Megan Jones/News editor
Campus Police Officer Nate Johnson and Public Safety Dispatcher
Linda Hall were recognized at the first Student Government
Association Student Senate meeting Tuesday evening for saving an
incoming freshman's father from dying of cardiac arrest during
summer orientation.
On July 27, Hall received a call for medical assistance at the
Student Services Building and notified units to respond.
Jerry Fischer, of Lexington, collapsed while taking a break
between orientation sessions in the morning.
"We were registering our daughter for freshmen (orientation)," said
Julie Fischer, wife of Jerry Fischer. "He fell down, and I thought
he tripped, but we turned him over and he wasn't breathing."
Media Credit: Megan Jones/Progress
SGA President, Kyle Moon, presented
campus police officer Nate Johnson
with a certificate of recognition for
saving a man´s life.
Conclusion
Public access defibrillation is highly
endorsed by the American Heart
Association
It has been shown to decrease mortality
and/or neurological deficits of victims of
out-of-hospital cardiac arrest.
Uncomplicated use
highly effective
References
1. American Heart Associationa. Cardiac Arrest. 2005. Available at
http://www.americanheart.org/presenter:jhtml?identifier=4481. Accessed November 12, 2005.
2. American Heart Associationb. Cardiopulmonary Resuscitation (CPR). 2005. Available at
http://www.americanheart.org/presenter:jhtml?identifier=4479. Accessed November 12, 2005.
3. American Heart Associationc. Defibrillation. 2005. Available at
http://www.americanheart.org/presenter:jhtml?identifier=4540. Accessed November 12, 2005.
4. 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 Resucitation. Circulation.2002; 1065-1070.
5. Culley LL, Rea TD, Murray JA, Welles B, Fhrenbruch CE, Olsufka M, et al. Public Access Defibrillation in Out-ofHospital Cardiac Arrest A Community-Based Study. Circulation. 2004
6. eMedicine Consumer Health. Automated external defibrillator (AED). Available at
http://www.emedicinehealth.com/articles/10873-4.asp. Accessed November 7, 2005.
7. Gundry JW, Comess KA, DeRook FA, Jorgenson D, Bardy GH. Comparison of naïve sixth-grade children with trained
professional in the use of an automated external defibrillator. Circulation. 1999; 100: 1703-7.
8. Hallstrom A, Ornato JP, Weisfeldt M, Travers A, Christenson J, McBurnie MA, et al. Public-Access Defibrillation and
Survival afer out-of-hospital Cardiac Arrest. N Engl J Med. 2004; 351(7): 637-46.
9. Hamby RI, Mittal S, Stein KM. Using an AED. April 7, 2005. Available at
http://heart.healthcentersonline.com/cardiacarrest/aed3.cfm. Accessed November 9, 2005.
10. Hazinski MF, Idris AH, Kerber RE, Epstein A, Atkins D, Tang W, Lurie K. Lay Rescuer Automated External
Defibrillator (“Public Access Defibrillation”) Programs. Circulation. 2005; 111: 3336-3340.
11. Myerburg RJ, Velez M, Fenster J, Rosenberg DG, Castellanos. Community-Based Responses to Impending or Actual
Cardiac Arrest and Advances in Post-Cardiac Arrest Care. J Interv Card Electrophysiol. 2003; 9: 189-202.
12. Ornato JP, McBurnie MA, Nichol G, Salive M, Weisfeldt M, Riegel B, et al. The Public Access Defibrillation (PAD)
Trial study design and rationale. Resuscitation. 2003; 56: 135-147.
13. Powell J, Van Ottingham L, Schron E. Public Defibrillation Increased Survival From A Structured Response System. J
Cardiovasc Nurs. 2004; 19(6): 384-9.
14. Richardson LD, Gunels MD, Groh WJ, Peberdy MA, Pennington S, Wilets I, et al. Implementation of Community-Based
Public Access Defibrillation in the PAD Trial. Acad Emerg Med. 2005; 12(8): 688-697.