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Paradigm shift: changing public access to all-access defibrillation
  1. Thomas Rea
  1. Department of Medicine, University of Washington, Seattle, WA 98195, USA
  1. Correspondence to Dr Thomas Rea, University of Washington, Seattle, WA 98195, USA; rea123{at}u.washington.edu

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Out-of-hospital cardiac arrest (OHCA) is a major cause of mortality in industrialised countries and an emerging public health challenge in developing countries as the burden of non-communicable chronic disease—specifically cardiovascular disease—increases. Although efforts aimed at risk stratification and prevention are key, OHCA is often the first clinical manifestation of heart disease, making prevention only part of a comprehensive solution.

As a consequence, there is a need for effective treatment in the form of resuscitation. What are the public health implications of improving survival from ventricular fibrillation OHCA? Current international estimates are that there are ~12 treated ventricular fibrillation arrests per hundred thousand persons of population.1 Extrapolated to North America, Europe and Australia, this incidence translates to nearly 150 000 such arrests each year. Estimates of incidence are less certain for Asia, Africa, Central and South America, but undoubtedly ventricular fibrillation OHCA collectively strikes hundreds of thousands of lives each year in these geographies as well.

Survival is variable across communities. Aggregate estimates for survival among mature, resourced emergency response systems range from 15% to 30% for ventricular fibrillation OHCA and yet there are examples of survival consistently exceeding 50% in particular systems or circumstances, indicating a real opportunity to advance survival and in turn improve public health if we could achieve consistent best practices across systems.1 Importantly, if resuscitation is successful and an OHCA victim survives to be discharged from the hospital, the survivor experiences on average an excellent prognosis that rivals age-matched counterpart without OHCA. Most survivors return home, resume work and enjoy a satisfactory quality of life.2 Hence, strategies that can increase survival following OHCA have important personal and societal benefits.

High-yield strategies to improve resuscitation should derive from our understanding of the pathophysiology of OHCA. Scientific investigation has provided for important discovery that has defined effective …

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