Public access defibrillation: a review.
چکیده
Sudden cardiac death remains a worldwide health problem. More than 1000 such deaths occur daily in the United States; most are secondary to ventricular fibrillation (VF). Unfortunately, only about 5% of victims survive. Sudden cardiac death is the most common “accidental” death in the US. A combined total of all airline, automobile, and drowning deaths would not equal the number of accidental or unexpected sudden cardiac deaths. The key issue in successfully treating sudden cardiac death is early defibrillation. “The sooner the better” is never more true than with defibrillation of VF. In various settings, if defibrillation is applied immediately or very early, such as in the cardiac catheterisation laboratory or at cardiac rehabilitation centres, a survival rate of 90% is possible and should be expected. For every minute of delay, however, the survival rate appears to decrease by approximately 10%. The importance of early defibrillation for successful resuscitation has prompted important statements on both sides of the Atlantic supporting first responder defibrillator use. The American Heart Association has stated, “it is essential to integrate the concept of early defibrillation into an eVective emergency cardiac care system”. To achieve this goal, the AHA endorses the position that “all emergency personnel should be trained and permitted to operate an appropriately maintained defibrillator, if their professional activities require that they respond to persons experiencing cardiac arrest”. The UK Department of Health Steering Group on ambulance performance standards has likewise proposed that: Emergency medical system response should occur within eight minutes of cardiac arrest through the use of rapid response vehicles, including motor bikes, and through first responder automated external defibrillation schemes. The first responders are anyone who has been selected and trained by an ambulance service to provide basic support and, in the event of a cardiac arrest, to use an automatic defibrillator. The natural extension to these statements has been to consider expanding the boundaries of first responders to include the lay public. Such concepts have made big headlines (fig 1), but are sometimes misunderstood. The public in public access defibrillation can be viewed on four levels. + The first tier would be first responders who provide emergency medical care as described by the American Heart Association and in the UK statements. These individuals can be easily taught to provide defibrillation with automatic external defibrillators + The second tier would be targeted responders such as police, security guards, and airline cabin crew. These individuals could be taught with relative ease the necessary skills to expand their duties to include first aid and public access defibrillation + The third tier would include family members with spouses, grandparents, or other family members at risk for sudden cardiac death. This type of programme has already been successfully implemented + The fourth tier would be the lay public themselves. Successful programmes have taught basic cardiopulmonary resuscitation skills to members of the lay public. Such individuals could also be taught to use automatic external defibrillators. The concept of public access defibrillation is based on deductive reasoning. Early defibrillation improves outcome from cardiac arrest due to VF. 13–15 The increased availability of automatic external defibrillators should result in earlier defibrillation, leading to better outcome from cardiac arrest. The concept seems sound, but has not been proved prospectively. Public access defibrillation is not a new idea. In 1986 the first defibrillator for public use became available (Life-Pack 100; PhysioControl, Redmond, Washington, USA). However, the concept failed to gain support for several reasons, particularly the lack of acceptance by physicians. Such devices were available through prescription, which was minimal