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Heart rhythm disorders and pacemakers
The Northern Ireland Public Access Defibrillation (NIPAD) study: effectiveness in urban and rural populations
  1. M J Moore1,
  2. A J Hamilton1,2,
  3. K J Cairns3,
  4. A Marshall3,
  5. B M Glover1,
  6. C J McCann1,
  7. J Jordan4,
  8. F Kee2,
  9. A A J Adgey1
  1. 1
    Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland
  2. 2
    Epidemiology and Public Health, Queen’s University Belfast, Northern Ireland
  3. 3
    Department of Applied Mathematics, Queen’s University, Belfast, Northern Ireland
  4. 4
    School of Nursing and Midwifery, Queen’s University, Belfast, Northern Ireland
  1. Professor A A J Adgey, Regional Medical Cardiology Centre, Grosvenor Road, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland; Jennifer.adgey{at}belfasttrust.hscni.net

Abstract

Objective: To assess the impact of mobile automated external defibrillators (AEDs) on out-of-hospital cardiac arrests (OHCAs) in urban and rural populations.

Design: Prospective before and after intervention, population study.

Setting: Urban and rural areas of 160 000 each.

Patients, interventions and main outcome measures: In 2004–6 the demographics of OHCAs were assessed. In 2005–6 AEDs were deployed (29 urban, 53 rural): 335 urban first responders (FRs) and 493 rural FRs were trained in AED use and dispatched to OHCAs. Call-to-response interval (CRI), resuscitation and survival-to-discharge rates for OHCA were compared.

Results: In 2004 there were 163 urban OHCAs and the emergency medical services (EMS) attended 158 (ventricular fibrillation (VF) 27/158 (17.1%)). In 2005–6 there were 226 OHCAs, EMS attended 216 (VF 30/216 (13.9%)). In 2005–6 FRs were paged to 128 OHCAs (56.6%), FRs attended 88/128 (68.8%): 18/128 (14.1%) reached before the EMS. The best combined FR/EMS mean (SD) CRI in 2005–6 (5 min 56 s (4)) was better than the EMS alone in 2004 (7 min (3); p = 0.002). Survival rate was 5.1% in 2004, 1.4% in 2005–6 (p = NS). In 2004 there were 131 rural OHCAs, EMS attended 121 (VF 19/121 (15.7%)). In 2005–6 there were 122 OHCAs, EMS attended 114 (VF 19/114 (16.7%)). In 2005–6 FRs were paged to 49 OHCAs, FRs attended 42/49 (85.7%): 23/49 (46.9%) reached before the EMS. The best combined FR/EMS mean (SD) CRI in 2005–6 (9 min 22 s (6)) was better than the EMS alone in 2004 (11 min 2 s (6); p = 0.018). Survival rate was 2.5% in 2004, 3.5% in 2005–6 (p = NS).

Conclusions: Despite improvement in CRI there was no impact on survival (witnessed arrest 32.8%, VF 15.6%).

Trial registration number: ISRCTN07286796.

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Footnotes

  • Funding: The Research and Development Office, Investing for Health Grant. The Royal Victoria Hospital Fellowship. The British Heart Foundation.

  • Competing interests: None.

  • Ethics approval: Ethics approval obtained from the local research ethics committee, Queen’s University, Belfast.

  • The NIPAD Study Steering Group comprised the investigators: Mr John Wright, Northern Ireland Ambulance Service; Inspector Yvonne Davidson, Police Service of Northern Ireland; Mr Peter Ferguson, research nurse, Queen’s University, Belfast; Mrs Davina Gray, research nurse, Queen’s University, Belfast; Ms Mary Black, N&W Belfast Health Action Zone; Ms Hiliary Johnston, Investing for Health, Northern Ireland; Mr Stephen Murray, Investing for Health, Northern Ireland; Ms Florence Hand, HSS Northern Board.

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