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Automatic External Defibrillation articles  added 12/28/00

Skyaid comment: AEDs are useful, but frequently not cost effective to have in fixed locations. 
Also please note: more than 70% of sudden cardiac arrests occur in residences, not in public places.

Prehosp Emerg Care 1999 Jan-Mar;3(1):60-5

Institution of a police automated external defibrillation program: concepts and practice.
Davis EA, McCrorry J, Mosesso VN Jr
Department of Emergency Medicine, University of Rochester Medical Center, New York 14642, USA. edavis@ed.urmc.rochester.edu
The authors have successfully implemented automated external defibrillation (AED) training in police departments that function as first responders. The initial elements are to think the project through, and to develop clear policies and procedures for the police as they relate to dispatching so there is timeliness of notification, because response time is such a critical element. Roles for all of the participants must be clearly defined and understood by all parties for such aspects as scene management, scene responsibility of care, and transfer of care to the receiving facilities. Communication to the entire health care community that the police have an expanded role in defibrillation is desirable. A system to evaluate training, compliance with protocol, and efficacy must be developed and closely monitored. While this is a tremendous amount of work and a large time investment, the result can be a dramatic increase in patient survival.

Ann Emerg Med 1998 Feb;31(2):234-40
EMT defibrillation does not increase survival from sudden cardiac death in a two-tiered urban-suburban EMS system.
Sweeney TA, Runge JW, Gibbs MA, Raymond JM, Schafermeyer RW, Norton HJ, Boyle-Whitesel MJ
Department of Emergency Medicine, Medical Center of Delaware, Wilmington, USA. TSweeney@christianacare.org
OBJECTIVE: The use of automatic external defibrillators (AEDs) by EMS initial responders is widely advocated. Evidence supporting the use of AEDs is based largely on the experience of one metropolitan area, with effect on survival in many systems not yet proved. We conducted this study to determine whether the addition of AEDs to an EMS system with a response time of 4 minutes for first-responder emergency medical technicians (FREMTs) and 10 minutes for paramedics would affect survival from cardiac arrest. METHODS: This prospective, controlled, crossover study (AED versus no AED) of consecutive cardiac arrests managed by 24 FREMT fire companies took place from 1992 to 1995 in Charlotte, North Carolina, a city of 455,000. Patients were stratified using the Utstein criteria. The primary endpoint was survival to hospital discharge among patients with bystander-witnessed arrests of cardiac origin. RESULTS: Of the 627 patients, 243 were bystander-witnessed arrests of cardiac origin. Survival to hospital discharge was accomplished in 5 of 110 patients (4.6%; 95% confidence interval [CI] 0.6% to 8.4%) with AED compared with 7 of 133 (5.3%, 95% CI 1.5% to 9.1%) without AED (P = .8). Both groups were comparable with regard to age, gender, history of myocardial infarction, congestive heart failure or diabetes, arrest at home, bystander CPR, and whether or not ventricular fibrillation (VF) was the initial rhythm. For arrests of any cause, witnessed by bystanders or EMS personnel, with an initial rhythm of VF or ventricular tachycardia (VT), 5 of 77 (6.5%, 95% CI 1.0% to 12.0%) with AED survived compared with 8 of 105 patients (7.6%, 95% CI 2.5% to 12.7%) without AED (P = .8). Statistically significant differences were noted in race and EMS response times between the two groups, which did not affect survival. CONCLUSION: Addition of AEDs to this EMS system did not improve survival from sudden cardiac death. The data do not support routinely equipping initial responders with AEDs as an isolated enhancement, and raise further doubt about such expenditures in similar EMS systems without first optimizing bystander CPR and EMS dispatching.

Prehosp Emerg Care 1999 Oct-Dec;3(4):303-5

Public-access defibrillation: where do we place the AEDs?
Gratton M, Lindholm DJ, Campbell JP
University of Missouri-Kansas City School of Medicine and Department of Emergency Medicine, Truman Medical Center 64108, USA. mgratton@cctr.umkc.edu
BACKGROUND: Many prehospital cardiac arrests occur in public places. Even the best EMS systems have a finite response time. Therefore, it has been recommended that automated external defibrillators (AEDs) be placed in public areas for immediate access by trained members of the general public. OBJECTIVE: To determine the locations of multiple cardiac arrests in order to plan for placement of public-access AEDs. METHODS: Retrospective review of all primary cardiac arrests in calendar year 1997. Cardiac arrests in which resuscitation was not attempted (DOA), traumatic cases, pediatric cases, and those due to "other" causes were excluded. Location of the cardiac arrest was obtained from the ambulance run ticket. The EMS system is an urban, Midwestern, all-ALS, public-utility model system with fire department first responders that transports approximately 58,000 patients annually. RESULTS: There was scene response to 922 cardiac arrests. 377 DOAs and 219 nonprimary cardiac arrests were excluded. There were 326 primary cardiac arrests. Sixteen locations had more than one cardiac arrest: 11 locations had two cardiac arrests, four locations had three cardiac arrests, and one location had four cardiac arrests. The airport, an airline overhaul facility, a casino, and two hotels each had two cardiac arrests; the other locations of multiple cardiac arrests were in nursing homes. The professional sports stadiums had no cardiac arrests. CONCLUSIONS: Since very few locations had more than one cardiac arrest, it may be difficult to identify high-yield public places in which to place an AED. Nursing homes may want to consider AED availability.