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Bmj Usa

Automated defibrillators

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:E270
  1. Paul E Pepe, professor of surgery, medicine, public health and Riggs Family Chair in Emergency Medicine, medical director (,
  2. Sherry Caffrey-Villari, president, project manager (
  1. University of Texas Southwestern Medical Center and the Parkland Health and Hospital System, Dallas Metropolitan Medical Response System for Anti-Terrorism and the Dallas Metropolitan BioTel (EMS) System Dallas, TX
  2. Public Safety Solutions, Inc, Chicago, IL, Chicago HeartSave Program

    Best seen as part of CPR

    Three articles published in this issue (pp 23, 28, 45) nicely delineate several key issues related to use of automated external defibrillators (AEDs). These articles not only place the relative effectiveness of AEDs into better context, but they also provide insight into the limitations of AEDs and starting points for further research.

    AEDs have been highly effective in certain public settings where designated rescuers (eg, flight attendants or security guards) or a large number of bystanders are immediately available.13 AED use within first two minutes after collapse can dramatically improve outcome over traditional methods.

    In the most successful traditional emergency medical services (EMS) systems, overall rates of hospital admission following sudden out-of-hospital cardiac arrest associated with ventricular fibrillation (VF) exceeded 60%4 when bystanders witnessed the event and performed basic cardiopulmonary resuscitation (CPR). This is a near-miraculous statistic considering that VF is typically unexpected, unheralded, and almost uniformly lethal if CPR or defibrillation is not performed within the first few minutes.4,5

    Nevertheless, even in such successful systems where the community knew and performed …

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