Impact of Onsite or Dispatched Automated External Defibrillator Use on Survival After Out-of-Hospital Cardiac Arrest

Study Questions:

Does the use of automated external defibrillators (AEDs) shorten the time to first shock and improve survival in patients with out-of-hospital cardiac arrest (OHCA)?

Methods:

The subjects of this Dutch study were 2,833 consecutive patients (mean age 65 years) with OHCA in 2006-2009. In some cases, an AED that either was onsite or brought to the scene by a first responder was available for use. Neurologically-intact survival to hospital discharge was analyzed according to whether an onsite AED was used, a dispatched AED was used, or no AED was used during resuscitation.

Results:

An onsite AED was used in 4.5% of OHCAs. Patients treated with an onsite AED received their first shock a median of 6 minutes earlier than patients treated with a standard defibrillator and had a significantly higher neurologically-intact survival rate (50% vs. 14%). A dispatched AED was used in 17% of OHCAs and was associated with the first shock being delivered a median of 2.5 minutes earlier than when a standard defibrillator was used. Neurologically-intact survival did not differ significantly between patients in whom a dispatched AED was used (17%) and those in whom an AED was not used (14%).

Conclusions:

The authors concluded that onsite AEDs significantly improve survival in patients with OHCA, whereas dispatched AEDs are of limited value.

Perspective:

The results highlight the critical importance of early intervention in patients with OHCA. AEDs have much more impact on outcomes when available for immediate onsite use by bystanders than when brought to the scene by first responders.

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Early Intervention (Education), Defibrillators, Out-of-Hospital Cardiac Arrest, Survival Rate, Sunbathing, Cardiopulmonary Resuscitation, Skin Pigmentation, Heart Arrest


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