Public Access Defibrillation Trial - PAD
The goal of the trial was to determine whether laypersons trained to perform cardiopulmonary resuscitation (CPR), to call 911, and to use automated external defibrillators (AEDs) could increase survival for patients experiencing an out-of-hospital cardiac arrest compared to laypersons trained only to call 911 and perform CPR.
Training of laypersons to perform CPR and to use AEDs will be associated with an increase in survival for patients experiencing an out-of-hospital cardiac arrest compared to laypersons trained only to perform CPR.
Mean Follow Up: Hospital discharge
Mean Patient Age: mean age 70 years
Units: ≥250 persons age ≥50 years onsite ≥16 hours/day or a history of ≥1 witnessed out-of-hospital cardiac arrest, identified pool of eligible on-site volunteers, and clearly defined geographic boundaries
Patients: Age ≥8 years with confirmed treatable out-of-hospital cardiac arrest of cardiac etiology
Units: Existing or prior public access defibrillation program, very fast response rate for defibrillation, or trained medical personnel
Number of patients surviving through hospital discharge
Community units (n=993) at 21 US and three Canadian sites were randomized to receive volunteer training in CPR only or CPR with defibrillation capability (CPR+AED). Volunteers underwent initial training and 1-2 follow-up trainings during the study. Study units included shopping areas (24%), recreation (24%), multi-unit residential units (15%), entertainment complexes (9%), community centers (7%), office complexes (7%), and other public facilities (14%).
There were >19,000 volunteer rescuers participating in the trial. The number of out-of-hospital cardiac arrests treated with CPR+AED was higher than in the CPR-only group (128 with CPR+AED vs. 107 CPR only), with the differences occurring in the public rather than residential units.
There were no differences in adverse events between treatment arms (0.2% with CPR only vs. 0.3% with CPR+AED), and there were no inappropriate shocks delivered by the lay-trained personnel. There were fewer survivors in the CPR-only group versus the CPR+AED group (15 with CPR only vs. 30 with CPR+AED, p=0.03, relative risk 2.0, 95% CI 1.07-3.77), with the difference driven by survivors in the public units (14 with CPR only vs. 29 with CPR+AED), rather than the residential units (1 each).
Training laypersons to perform CPR+AED was associated with an increase in survival for patients experiencing an out-of-hospital cardiac arrest compared to training laypersons only to perform CPR. The benefit was driven by improvements in survival in public locations, rather than multi-unit residential facilities.
The upcoming HAT trial will evaluate use of CPR+ICD in the home setting, where more than 75% of cardiac arrests occur. The present study looked only at arrests occurring in public facilities or multi-unit residential facilities.
The Public Access Defibrillation Trial Investigators. Public-Access Defibrillation and Survival after Out-of-Hospital Cardiac Arrest. N Engl J Med 2004;351:637-46.
Presented by Dr. Joseph P. Ornato at the November 2003 American Heart Association Annual Scientific Sessions, Orlando, FL.
Keywords: Risk, Defibrillators, Follow-Up Studies, Out-of-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation, Recreation
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