Can Public Access Defibrillators Can Public Access Defibrillators Save Lives?Save Lives?

Jessica BotnerJessica Botner

March 24, 2006March 24, 2006

Advisor: Dr. GrimesAdvisor: Dr. Grimes

Background of Cardiac ArrestBackground of Cardiac Arrest

Cardiac arrest is the sudden loss of heart Cardiac arrest is the sudden loss of heart functionfunction

There is no oxygenated blood flowing to the There is no oxygenated blood flowing to the brain and vital organsbrain and vital organs

Most cardiac arrest is caused by ventricular Most cardiac arrest is caused by ventricular fibrillation and ventricular tachycaridafibrillation and ventricular tachycarida

http://www.austinheartbeat.com/images

Cardiac Arrest TreatmentCardiac Arrest Treatment

Must be able to recognize the signs and Must be able to recognize the signs and symptomssymptoms

Follow the American Heart Association’s Follow the American Heart Association’s “Chain of Survival”“Chain of Survival”– Early AccessEarly Access– Early CPREarly CPR– Early DefibrillationEarly Defibrillation– Early Advanced CareEarly Advanced Care

Chain of SurvivalChain of Survival

Early DefibrillationEarly Defibrillation– Considered the Gold Standard of treatment for Considered the Gold Standard of treatment for

cardiac arrestcardiac arrest– A process of using an electrical current to alter the A process of using an electrical current to alter the

activity of the heart back to a life-sustaining rhythm activity of the heart back to a life-sustaining rhythm from pulseless v-tach or v-fibfrom pulseless v-tach or v-fib

– Time is of the essence!! (Brain death occurs in 4-6 Time is of the essence!! (Brain death occurs in 4-6 minutes)minutes)

– Can be done with a manual defibrillator or an Can be done with a manual defibrillator or an automated defibrillatorautomated defibrillator

Automated External DefibrillatorsAutomated External Defibrillators

As mentioned before defibrillation is the As mentioned before defibrillation is the gold standard treatment of cardiac arrestgold standard treatment of cardiac arrest

Automated External Defibrillators (AEDs) Automated External Defibrillators (AEDs) are designed to be effective and easy to are designed to be effective and easy to use so that treatment can be provided use so that treatment can be provided quickly to cardiac arrest victimsquickly to cardiac arrest victims

Can be used by untrained peopleCan be used by untrained people

cost-effectivecost-effective

How to use an AEDHow to use an AED

Most AEDs have verbal Most AEDs have verbal instructions to follow, instructions to follow, making their use simplemaking their use simple

Basic rules that apply to Basic rules that apply to most are:most are:– Turn on powerTurn on power– Attach electrodes to Attach electrodes to

machine and patient’s machine and patient’s chest (using pictures)chest (using pictures)

– Follow instructions from Follow instructions from AEDAED

EMTs vs. sixth gradersEMTs vs. sixth graders

Study conducted by Gundry in 1999Study conducted by Gundry in 1999

15 sixth graders and 22 EMTs 15 sixth graders and 22 EMTs

mock cardiac arrest scenarios evaluated on time mock cardiac arrest scenarios evaluated on time and techniqueand technique

66thth graders graders EMTsEMTs

Time from arrival to defib.Time from arrival to defib.

(Range)(Range)

90 seconds90 seconds

69 to 111 seconds69 to 111 seconds

67 seconds67 seconds

50 to 87 seconds50 to 87 seconds

ResultsResults

The 6The 6thth graders had only slightly slower graders had only slightly slower times than trained professionalstimes than trained professionals

No statistical significanceNo statistical significance

Suggests that widespread AED use could Suggests that widespread AED use could be effective with only minimal trainingbe effective with only minimal training

The PAD TrialThe PAD Trial

15 month trail in 24 North American regions15 month trail in 24 North American regionsfocus was to determine if public AED availability focus was to determine if public AED availability would be effective in out-of-hospital cardiac would be effective in out-of-hospital cardiac arrest in large urban areasarrest in large urban areascompared cardiac arrest response by laypersons compared cardiac arrest response by laypersons trained in CPR only and laypersons trained in trained in CPR only and laypersons trained in both CPR and AED use both CPR and AED use determination of success for this study is based determination of success for this study is based on how many cardiac arrest victims live to be on how many cardiac arrest victims live to be discharged from the hospital. discharged from the hospital.

PAD Trial statisticsPAD 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 TrialResults of PAD Trial

AED use is safe and effective when used in AED use is safe and effective when used in areas likely to have a witnessed cardiac arrest areas likely to have a witnessed cardiac arrest event event AEDs can be safely and effectively used by AEDs can be safely and effectively used by trained laypersons and can increase survival of trained laypersons and can increase survival of out-of-hospital cardiac arrest, especially when out-of-hospital cardiac arrest, especially when EMS response times are slow EMS response times are slow encourages wider-spread use of AEDs for encourages wider-spread use of AEDs for increased survival in out-of-hospital cardiac increased survival in out-of-hospital cardiac arrest arrest

Additional StudiesAdditional Studies

Piacenzia Progetto Vita (PPV) studyPiacenzia Progetto Vita (PPV) study– EMS, physician, and lay responder dispatched at the same timeEMS, physician, and lay responder dispatched at the same time– During the 22 month study 354 cardiac arrests occurred During the 22 month study 354 cardiac arrests occurred – Lay volunteers were the first to render care in 40 percent of Lay volunteers were the first to render care in 40 percent of

cases, whereas EMS were the first in 60 percent. cases, whereas EMS were the first in 60 percent. – The rate of survival from cardiac arrest to hospital discharge The rate of survival from cardiac arrest to hospital discharge

tripled, going from 3.3 percent up to 10.5 percent tripled, going from 3.3 percent up to 10.5 percent – the number of patients that had no serious neurological the number of patients that had no serious neurological

problems increased by four times, going from 3 percent to 12.3 problems increased by four times, going from 3 percent to 12.3 percent percent

Additional Studies Cont’dAdditional Studies Cont’d

Seattle/ King County, Washington StudySeattle/ King County, Washington Study475 AEDs were placed in different settings to be 475 AEDs were placed in different settings to be available to the volunteers available to the volunteers only 50 cases of cardiac arrest were treated only 50 cases of cardiac arrest were treated initially by the volunteers with public access initially by the volunteers with public access defibrillators before EMS arrival defibrillators before EMS arrival Out of the 50 arrests treated, 76 percent Out of the 50 arrests treated, 76 percent survived until hospital admission and 50 percent survived until hospital admission and 50 percent survived until hospital discharge. survived until hospital discharge. AEDs had a small impact in out-of-hospital AEDs had a small impact in out-of-hospital cardiac arrest in this study, but may improve cardiac arrest in this study, but may improve survival from cardiac arrest survival from cardiac arrest

On the Horizon…On the Horizon…

There are many ongoing studies of public There are many ongoing studies of public AED useAED use

Studies are being conducted to determine Studies are being conducted to determine the most effective placement and the cost-the most effective placement and the cost-effectiveness of AED useeffectiveness of AED use

AEDs will be available for use in homeAEDs will be available for use in home

SkymallSkymall Catalog has AEDs for sale Catalog has AEDs for sale

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.

On July 27, 2005 in Richmond, KY

ConclusionConclusion

Public access defibrillation is highly Public access defibrillation is highly endorsed by the American Heart endorsed by the American Heart AssociationAssociation

It has been shown to decrease mortality It has been shown to decrease mortality and/or neurological deficits of victims of and/or neurological deficits of victims of out-of-hospital cardiac arrest. out-of-hospital cardiac arrest.

Uncomplicated useUncomplicated use

highly effective 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-of-Hospital 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.