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Do Automated External Defibrillators (AEDs) have an impact on outcomes in health-care settings?

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This question was submitted by a practising dentist: AEDs have become somewhat of a comfort object in a number of our offices emergency kit. Recently, a physician colleague commented on the generally unfavourable morbidity/mortality outcomes despite the use of AEDs to re-establish cardiac activity. Is this true??

Dr. Alan Lane, anaesthesiologist at the Ottawa General Hospital provided this initial response:

I would say the literature supports that view. Reports indicate that the rate of successful hospital discharge for out-of-hospital cardiac arrests (OOHCA) is around 5%.

Sudden OOHCA survival depends on adequate bystander CPR, on successful early defibrillation of a shockable rhythm, and on appropriate definitive care via the EMS. It’s then easy to see why survival rates are so low.

An interesting review on OOHCA in Ontario health clinics by Brooks et al (Canadian Family Practice Vol 56 June 2010) showed, among others things, that the rate of AED use was between 5 to 10% in OOHCA in public places and health care clinics. Between 25 and 50% of patients in these 2 settings did not receive CPR, so it appears there are many variables that can influence the survival outcome of which AED is just one element.

Dr. Alan Lane is a specialist anaesthesiologist at the Ottawa General Hospital.

 

Follow-up: What further information would you like on this topic? Email us at jcdaoasis@cda-adc.ca.

Readers are invited to comment on this initial response and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.

3 Comments

  1. David Rose March 6, 2013

    So what is the survival rate of people with OOHCA who receive AED treatment and CPR vs CPR only?

    Reply
    1. Dr A Lane March 10, 2013

      AED use substantially improves survival rates in OOHCA. The problem is that very few OOHCA will have an AED applied.
      A recent study looked at almost 14,000 OOHCA. 32% received bystander CPR with no AED applied before EMS arrival with a survival rate of 9%. Only 2% had an AED applied before EMS arrival and the survival rate was 24% if no shock was delivered and 38% if a shock was given. (Journal of the American College of Cardiology 2010 vol 55 No 16 1713-20.)
      Early AED use substantially improves your survival rate and public access to AED’s is supported by the Health and Stroke Foundation of Canada ( see their position statement from July 2012)

  2. Brian Chapnick March 9, 2013

    The Toronto Academy of Dentistry has recently initiated a programme to assist dentists in placing AEDs in their offices and at the same time generate funds to assist the Mikey Network in placing AEDs in public places.

    Reply

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