Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation

doi:10.1016/0002-9149(89)90316-0

The American Journal of Cardiology

Volume 63, Issue 7, 15 February 1989, Pages 443-446

https://doi.org/10.1016/0002-9149(89)90316-0 Get rights and content

Abstract

This 57-month study evaluated the use of automatic external defibrillators (AEDs) in the homes of high risk cardiac patients (survivors of out-of-hospital ventricular fibrillation [VF]). The goal was to determine the utility of these devices by trained lay persons in actual cardiac arrest episodes. Ninety-seven survivors of out-of-hospital VF were enrolled in the study; 59 patients received AEDs, and 38 patients served as a control group. During the study period, 7 deaths occurred in the hospital without preceding out-of-hospital cardiac arrest or from noncardiac causes. There were 14 out-of-hospital cardiac arrests, 10 in the AED group and 4 in the control group. There was 1 long-term survivor in the control group. In the AED group, among the 10 cardiac arrests for which the device was available, it was used in 6. Only 2 patients were in VF; 1 was resuscitated with residual neurologic deficits and survived several months. This study observed a small potential for AEDs to save high risk patients.

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Cited by (82)

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Citation Excerpt :
The full text of this CoSTR is on the ILCOR website.270 The SysRev performed as part of the 2015 ILCOR review265,266 identified 32 studies relating to BLS training in likely rescuers (eg, family or caregivers) of high-risk OHCA groups.273–304 One study298 from the 2015 review was not relevant for the revised outcomes in this update and was not included in this updated review.
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A systematic review of basic life support training targeted to family members of high-risk cardiac patients
2016, Resuscitation
Targeting basic life support (BLS) training to bystanders who are most likely to witness an out of hospital cardiac arrest (OHCA) is an important public health intervention. We performed a systematic review examining the evidence of the effectiveness of providing BLS training to family members of high-risk cardiac patients.
A search of Ovid MEDLINE, CINAL, EMBASE, Informit, Cochrane Library, Web of Science, Scopus, ERIC and ProQuest Dissertations and Theses Global was conducted. We included all studies training adult family members of high-risk cardiac patients regardless of methods used for cardiopulmonary resuscitation (CPR) or BLS training. Two reviewers independently extracted data and evaluated the quality of evidence using GRADE (Grades of Recommendation, Assessment, Development and Evaluation).
We included 26 of the 1172 studies identified. The majority of studies were non-randomised controlled trials (n = 18), of very low to moderate quality. Currently, there is insufficient evidence to indicate a benefit of this intervention for patients; largely because of low numbers of OHCA events and high loss to follow-up. However, the majority of trained individuals were able to competently perform BLS skills, reported a willingness to use these skills and experienced lower anxiety.
Whilst there is no current evidence for improvement in patient outcomes from targeted BLS training for family members, this group are willing and capable to learn these skills. Future research may need to examine longer periods of follow-up using alternate methods (e.g. cardiac arrest registries), and examine the effectiveness of training in the modern era.
Part 8: Education, implementation, and teams. 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations
2015, Resuscitation
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Impacting sudden cardiac arrest in the home: A safety and effectiveness study of privately-owned AEDs
2013, Resuscitation
Citation Excerpt :
As early as 1984, studies were conducted with AEDs in the homes of SCA survivors to see if family members could be adequately trained to use the device effectively.7 In 1989, 59 patients at high risk were provided an AED; there were 10 arrests over a 57 month period, and the devices were used in 6 events.8 Only two patients were in VF, one died at the scene and one was resuscitated with residual neurologic deficits.
Sudden cardiac arrest (SCA) remains a major public health problem. The majority of SCA events occur in the home; however, scant data has been published regarding the effectiveness of privately owned AEDs.
The study, initiated in 2002 under prescription labeling, continued with over the counter availability in 2004 and was completed in 2009. Surveillance methods included annual surveys, follow-up phone calls, media reports, and use queries upon order of replacement pads. AED owners reporting emergency use of the device were contacted for an in-depth interview, and the ECG and event data in the device's internal memory were evaluated.
25 cases were identified in which an AED was used on a patient in SCA. Two uses were on children. The SCA was witnessed in 76% (19/25) of the cases. In 56% (14/25), the patient presented in VF and at least one shock was delivered. All 14 patients who were shocked had termination of VF; 6 (43%) required more than one shock due to refibrillation. Shock efficacy was 100% (25/25) for termination of VF for all delivered shocks. Of the patients with a witnessed arrest who were shocked, 67% (8/12) survived to hospital discharge. There were no circumstances of unsafe emergency use of the AED or harm to the patient, responder, or bystanders.
People who purchase an AED for their home, even without previous AED experience, are able to use the device successfully in both adults and children. The high survival rate observed in this study demonstrates that lay responders with privately owned AEDs can successfully and safely use the devices.
The significance of protein S-100B testing in cardiac arrest patients
2011, Clinical Biochemistry
Cardiac arrest often represents the first expression of an underlying cardiac disease. Despite advances in neurocritical care, the neurological assessment of cardiac arrest patients relies on clinical, instrumental and biochemical parameters. The clinical significance of S-100 calcium binding protein B (S-100B) has substantially increased throughout several areas of clinical neuroscience, but reliable evidences attest it can be used as a reliable and early predictor of poor physiological and cognitive neurological outcomes after cardiac arrest.
Part 12: Education, implementation, and teams: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations
2010, Resuscitation
Citation Excerpt :
One LOE 4 study402 was neutral. For home AED deployment, three studies (LOE 1197,403; LOE 2404) showed that home AED programs are safe and feasible but were unlikely to result in a significant increase in survival of out-of-hospital VF cardiac arrest. For on-site AEDs in public places, 11 studies (LOE 1197; LOE 2357; LOE 3224,361,362; LOE 4226,363–366,405) supported on-site AEDs.

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^☆: This study was supported in part by grant HS 04894 from the National Center for Health Services Research and Health Care Technology Assessment, Rockville, Maryland.

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Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation☆

Abstract

Ann Emerg Med

Lancet

Ann Emerg Med

Ann Emerg Med

Am J Cardiol