Automatic external defibrillators: clinical issues for cardiology.

THE 1985 National Conference on Standards and Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, recently held in Dallas, re- viewed and endorsed the concept of early defibrillation performed by emergency medical technicians (EMTs).This concept has also received support from the Ad- vanced Coronary Treatment Foundation' and the American College of Emergency Physicians.' Unlike many elements of prehospital care for cardiac arrest patients, these endorsements were based on a solid foundation of controlled clinical trials.3-'.In these tri- als, however, initial responders operated only manual defibrillators that require operator interpretation of the rhythms.Automatic and semiautomatic external defibrillators have recently been developed.These devices should help first responders and EMTs out of hospital, and relatives and friends in the home, achieve early defi- brillation of individuals at high risk for sudden cardiac death.Although the concept of defibrillation by EMTs received endorsement in Dallas, no firm decision was reached on whether EMT defibrillation programs should use automatic, semiautomatic, or manually op- erated defibrillators.In addition, no decisive com- ments were made on the use of automatic and semiau- tomatic defibrillators by first responders and in the home.Clinical evaluations are now in progress, but they will not resolve all of the issues raised by wide- spread availability of these devices.Background.