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

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 sixth graders and 22 EMTs mock cardiac arrest scenarios evaluated on time and technique 6 th graders EMTs Time from arrival to defib. (Range) 90 seconds 69 to 111 seconds 67 seconds 50 to 87 seconds

Results The 6 th 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 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 cost- effectiveness of AED use AEDs will be available for use in home SkymallSkymall Catalog has AEDs for sale Skymall

On July 27, 2005 in Richmond, KY

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 highly effective