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Arrhythmias
Public access defibrillation: new developments for mass implementation
  1. Alessandro Capucci1,
  2. Daniela Aschieri2
  1. 1Cardiology Department, Università Politecnica delle Marche, Ancona, Italy
  2. 2Cardiology Department, Ospedale G da Saliceto, Piacenza, Italy
  1. Correspondence to Professor Alessandro Capucci, Clinica di Cardiologia, Ospedale Torrette- Via Conca 71 - Ancona, Italy; acapucci{at}univpm.it

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Rapid defibrillation is the best method for resuscitating victims after sudden cardiac arrest. Experimental and clinical studies have shown that electrical shocks applied within 30 s of ventricular fibrillation (VF) can produce a 98% rate of resuscitation. However, when the shock is delivered after 7 min of VF, the resuscitation rate falls to 27%. This has given rise to the ‘goal’ of early defibrillation in out-of-hospital cardiac arrest (OHCA).

Over the past 30 years or so, advances in technology have provided innovative opportunities in the area of automated external defibrillator (AED) technology. Defibrillation within 5 min is the only effective means of returning a heart in VF to its normal rhythm. The use of AEDs can help to achieve the objective of reducing mortality in OHCA.

In most cases it is all but impossible to predict who will have a sudden cardiac arrest, or where and when it will happen. What we do know is that each day more than 1000 Europeans suffer from sudden cardiac arrest, usually away from the hospital, and that the ambulance arrives too late. Of course, for some patients the chance of survival is down to luck. A patient is nine times more likely to survive if he/she is observed having the arrest. But even if witnessed, the chance of surviving mainly depends on immediate access to a defibrillator.

For almost two decades, Rochester and Seattle in the USA have reported consistent survival rates of 30–40% for witnessed VF—about three times the US and European average—utilising an organised two tiered system of early defibrillation and public access defibrillation (PAD).1 Comparatively, the survival rates from performing basic cardiopulmonary resuscitation (CPR) alone are reported at between 0–6%, a rate that has not improved since the 1950s.2 Although much money and effort have been spent by scientific communities in training …

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