Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System
Key result
Pre-EMS AED use linked to ~75% higher hospital survival vs. bystander CPR alone.
- OR 1.75
- 95% CI 1.23-2.50
- P<0.002
- n=13,769
Why the study?
Does automatic external defibrillator (AED) application before EMS arrival improve survival to hospital discharge in persons with out-of-hospital cardiac arrest?
Population
13,769 persons with nontraumatic out-of-hospital cardiac arrest before emergency medical system arrival at…
Comparison
Automatic external defibrillator applied before… vs Bystander cardiopulmonary resuscitation but no…
Design
Cohort
Follow-up
to hospital discharge
Authors
Discussion
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Member takes
Implication
Application of an AED before EMS arrival in out-of-hospital cardiac arrest is associated with nearly a doubling of survival to hospital discharge.
Key Points
- Assess the effectiveness of automatic external defibrillator application by bystanders prior to emergency medical system arrival in out-of-hospital cardiac arrest.
- Conducted a population-based cohort study of 13,769 nontraumatic out-of-hospital cardiac arrests across Resuscitation Outcomes Consortium sites between December 2005 and May 2007.
- Used multiple logistic regression to assess the association between pre-EMS automatic external defibrillator application and survival to hospital discharge, adjusting for patient demographics, bystander CPR, arrest location, EMS response interval, witnessed status, rhythm shockability, and study site.
- An automated external defibrillator was applied before EMS arrival in 2.1% (289/13,769) of arrests, resulting in a 24% (69/289) survival rate to discharge (38% [64/170] when a shock was delivered) compared with 9% (382/4,403) with bystander CPR alone and 7% overall.
- Pre-EMS defibrillator application was independently associated with higher survival to hospital discharge compared with no application (OR: 1.75; 95% CI: 1.23 to 2.50; p < 0.002).
Study Design
Type
Cohort (n=13,769)
Multicenter
Yes
Structured PICO
Does automatic external defibrillator (AED) application before EMS arrival improve survival to hospital discharge in persons with out-of-hospital cardiac arrest?
P
Population
13,769 persons with nontraumatic out-of-hospital cardiac arrest before EMS arrival.
E
Exposure
Automatic external defibrillator (AED) applied before EMS arrival
C
Comparator
Bystander cardiopulmonary resuscitation but no AED applied before EMS arrival
O
Outcome
Survival to hospital dischargehard clinical
Main Result
Odds Ratio: 1.75 (95% CI 1.23–2.5)
Absolute Event Rate: 24% vs 9%
p-value: p=<0.002
Application of an AED before EMS arrival in out-of-hospital cardiac arrest is associated with nearly a doubling of survival to hospital discharge.
Cite This Study
Weisfeldt et al. (2010) conducted a cohort in nontraumatic out-of-hospital cardiac arrest (n=13,769). Automatic external defibrillator (AED) application vs. Bystander cardiopulmonary resuscitation but no AED was evaluated on survival to hospital discharge (OR 1.75, 95% CI 1.23-2.50, p=<0.002). Application of an AED before EMS arrival was associated with greater survival to hospital discharge compared to bystander CPR alone (OR 1.75; 95% CI 1.23-2.50; p<0.002).