BMJ  2003;327:1312 (6 December), doi:10.1136/bmj.327.7427.1312

Paper

Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial

Anouk P van Alem, junior scientist1, Rob H Vrenken, medical director, municipal health service3, Rien de Vos, clinical epidemiologist2, Jan G P Tijssen, clinical epidemiologist1, Rudolph W Koster, lecturer in cardiology1

1 Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands, 2 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, 3 Municipal Health Service, Amsterdam

Correspondence to: A P van Alem a.p.vanalem{at}amc.uva.nl

Objective To test the hypothesis that the use of an automated external defibrillator by police and fire fighters results in higher discharge rates for out of hospital cardiac arrest.

Design Controlled clinical trial with initial random allocation of automated external defibrillators to first responders in four of the eight participating regions; each region switched from control to experimental, and vice versa, every four months.

Setting Amsterdam and surroundings, the Netherlands.

Participants Patients with witnessed out of hospital cardiac arrests, identified by the emergency medical system between January 2000 and January 2002.

Main outcomes measures Survival to hospital discharge; return of spontaneous circulation; admission to hospital.

Results 243 patients (65% in ventricular fibrillation) were included in the experimental area and 226 patients (67% in ventricular fibrillation) in the control area. The median time interval between collapse and first shock was 668 seconds in the experimental area and 769 seconds in the control area (P < 0.001). 44 (18%) patients in the experimental area versus 33 (15%) patients in the control area were discharged (odds ratio 1.3 (95% confidence interval 0.8 to 2.2), P = 0.33), 139 (57%) experimental versus 108 (48%) control patients had return of spontaneous circulation (1.5 (1.0 to 2.2), P = 0.05), and 103 (42%) experimental versus 74 (33%) control patients were admitted (1.5 (1.1 to 1.6), P = 0.02). The median delay from receipt of call to dispatch of the ambulance was 120 seconds, and the delay to dispatch of the first responder was 180 seconds.

Conclusions Use of automated external defibrillators by first responders did not significantly increase survival to discharge from hospital, although it did improve return of spontaneous circulation and admission to hospital. Improved dispatch procedures should increase the success of programmes of first responders using external defibrillators.


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