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Bmj Usa

Public access defibrillation: good or great?

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:E271
  1. Myron L Weisfeldt, William Osler Professor of Medicine, chair (
  1. Department of Medicine Johns Hopkins University School of Medicine Baltimore, MD

    It depends on proper use and future research

    Two carefully conducted studies in this issue—one of efficacy (p 23) and the other of cost (p 28)—are very significant cautionary notes to the literature on public access defibrillation. They reinforce two important points from the world literature on this topic: 1) If an intervention shortens the time from witnessed cardiac arrest to defibrillation to less than four minutes or so, remarkably high survival rates are seen. If, in contrast, the intervention results in shortening the time to defibrillation from, say, an average of 13 minutes to an average of 11 minutes, very little improvement in outcomes will be seen. 2) If admission to a hospital is increased by a defibrillation program but discharge rates and long-term survival are not, there will be bad news from conventional costs and effectiveness analyses.

    In rural areas, where the …

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