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Senior Citizen Health & Medicine
One Life A Day Saved by Bystander Using Automated
External Defibrillator
CPR plus AED more than doubles survival of cardiac
arrest with just CPR
 Nov. 5, 2007 - Cardiopulmonary resuscitation (CPR)
combined with bystander use of an automated external defibrillator (AE
D) more than doubled the chances of surviving out-of-hospital cardiac
arrest compared with using CPR alone, researchers reported at the
American Heart Associations Scientific Sessions 2007.
Based on national statistics related to
out-of-hospital cardiac arrest, researchers estimated that bystander CPR
plus use of an AED in the United States and Canada saves 522 lives a
year, or more than one life per day.
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This is not a randomized, controlled study, but it
describes what is going on in the real world, where people at the scene
of a cardiac arrest are saving lives, said Myron L. Weisfeldt, M.D.,
chairman of medicine at Johns Hopkins University in Baltimore and lead
investigator of the study.
The findings came from a study involving 11 urban
and rural communities in the United States and Canada. The sites are
participants in the Resuscitations Outcomes Consortium (ROC), a network
of communities involved in studies of prehospital emergency care.
Weisfeldt reported findings from the latest ROC
research effort, a study that evaluated the impact of bystander-applied
AEDs on survival from out-of-hospital cardiac arrest.
Several years ago, the National Institutes of
Health-sponsored Public Access Defibrillation (PAD) trial showed that
training lay volunteers to perform CPR and use AEDs placed in public
buildings doubled the number of survivors from out-of-hospital arrest
compared with training bystanders to deliver CPR alone.
The new study did not train specific bystander to
respond, but included patients who had out-of-hospital cardiac arrests
between Dec. 1, 2005 and Nov. 30, 2006, and were evaluated by emergency
medical service (EMS) personnel.
A total of 10,663 EMS-treated patients were
included in the study. Bystanders administered CPR in 3,191 cases
(29.9 percent) and used an AED with CPR in 259 cases (2.4 percent).
Overall, 7 percent of the 10,663 patients survived to hospital
discharge. However, survival varied substantially according to the
type and timing of resuscitation attempted. Of patients who had
bystander CPR but no use of an AED, just 9 percent survived to hospital
discharge.
When bystanders provided CPR and attached an AED
and the device delivered a shock, survival increased to 36 percent
approximately four times that of CPR alone.
Some of this improvement was likely a result of
other favorable aspects of the arrest rather than AED use. Thus, in a
statistical analysis that accounted for factors such as location of the
arrest, EMS response time and bystander CPR attempts, AED application
still more than doubled the likelihood of survival to hospital discharge
after cardiac arrest.
The findings provide strong support for making AEDs
more widely available in communities, Weisfeldt said. The most
effective way to do that is for city governments to enact ordinances
mandating AEDs in certain public buildings, such as schools and sports
arenas, he said. An AED costs about $2,000 each, and materials and
labor for a cabinet and appropriate signs would probably increase the
cost.
When you compare that to the cost of other safety
measures required by law, such as seat belts in automobiles and
sprinkler systems to help control fires in buildings, my own conclusion
is that its not an enormous expense, he said. We do many things in
the name of public safety that are much more expensive than what a
community-based AED program would cost.
The American Heart Association promotes community
lay rescuer AED programs and urges training for potential rescuers in
CPR and the use of the AED, plus linking the programs to local EMS
systems. CPR training is important because early CPR is an integral
part of providing lifesaving aid to people suffering sudden cardiac
arrest. CPR helps circulate oxygen-rich blood to the brain and other
organs. After the AED is attached and delivers a shock, the typical AED
will prompt the operator to continue CPR for two minutes while the
device continues to analyze the victims heart rhythm.
This study reaffirms the importance of the chain
of survival, said American Heart Association spokersperson Mary Fran
Hazinski, R.N. Early recognition, early CPR and early defibrillation
by bystanders can produce survival as high as 36 percent for
out-of-hospital cardiac arrest. Prompt bystander action is the key to
this survival.
Co-authors are Colleen Griffith; Tom P. Aufderheide,
M.D.; Daniel P. Davis, M.D.; Jonathan Dreyer, M.D.; Erik P. Hess, M.D.;
Jonathan Jui, M.D.; Alexander MacQuarrie, Justin P. Maloney, M.D.;
Laurie J. Morrison, M.D., M.Sc.; Graham Nichol, M.D., M.P.H.; Joseph P.
Ornato, M.D.; Judy Powell; Thomas D. Rea, M.D.; and the ROC
investigators.
The study is supported by the National Heart, Lung,
and Blood Institute, Canadian Health and Defense Agencies and the
American Heart Association.
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