Device Helps Bystanders Restart Failing Hearts

Minimal training and defibrillators could save thousands

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HealthDay Reporter

WEDNESDAY, Aug. 11, 2004 (HealthDayNews) -- Thousands of lives could be saved by putting defibrillators in public places and giving volunteers basic training on how to use them when someone's heart stops beating properly, two new studies say.

And that basic training, which includes a course on cardiopulmonary resuscitation (CPR) for ordinary citizens, gives even better lifesaving results than special training for paramedics, one of the studies found.

The studies, appearing in the Aug. 12 issue of the New England Journal of Medicine, are important because they are the first to look specifically at the effectiveness of citizen use of defibrillators in ordinary situations, said Dr. David J. Callans, a professor of medicine at the University of Pennsylvania and the author of an accompanying essay.

"All the other trials were done in specialized workplaces or with paramedic units whose duty it was to respond to an emergency," Callans said. "This is the first effort to show a benefit from public access to defibrillators."

A defibrillator delivers an electric shock that can restore a normal rhythm to a heart that has stopped pumping blood because of an irregular heartbeat. More than 500,000 Americans die every year from such cardiac arrests.

One of the studies done to see if training ordinary people in defibrillator use could reduce that toll was conducted in the United States. More than 19,000 volunteers from 993 community units were divided into two groups, one of which was given training in CPR and defibrillator use while the other was given only CPR training. At the same time, defibrillators were placed in public places such as shopping malls.

A total of 128 cardiac arrests were given emergency treatment by the CPR- and defibrillator-trained volunteers, and there were 30 survivors. There were only 15 survivors among the 107 persons with cardiac arrest who were treated by volunteers trained only in CPR.

"The study shows that a layperson can safely and effectively use so-called smart defibrillators," said study author Dr. Joseph P. Ornato, chairman of the department of emergency medicine at the Virginia Commonwealth University Health System.

The devices "worked quite perfectly" and "no inappropriate shocks were delivered," Ornato said. Only two to four hours were needed to train each volunteer to give CPR, call 911, and use a defibrillator, he said, and some lives were saved by individuals who used a defibrillator without training.

The researchers concluded the widespread implementation of these devices in public places could save between 2,000 and 4,000 lives each year in the United States.

The second study, done in the Canadian province of Ontario, looked at survival rates for more than 5,500 cardiac arrest patients who were given on-the-spot treatment either by paramedics trained in what are called advanced-life-support (ALS) techniques or by ordinary bystanders who administered CPR and used defibrillators available in public places.

The survival rate for those given ALS by professionals was 1.1 percent, the study found. It was 3.7 percent for those given CPR by a bystander, and 3.4 percent for those given rapid defibrillation.

"There was no improvement in the rate of survival with the use of advanced life support in any subgroup," the report said.

Both studies show that "defibrillation is really the most important factor" in preventing death from cardiac arrest, Callans said. But money is a complicating factor, he added.

The U.S. Food and Drug Administration gave approval for use of public-access defibrillators in 2002. But each defibrillator costs about $2,000, and the question is how much our society is prepared to spend on them, Callans said.

"There is a medical benefit of public access to defibrillators," he said. "But the issue [is] implementing public programs that are medically sound but expensive. If we are trying to budget our resources for cardiac arrest, defibrillators seem most important."

But having these devices in public places will save only so many lives. The researchers noted that roughly four in five cases of cardiac arrest take place not in public but at home.

More information

Why and how to use a defibrillator as part of emergency treatment of cardiac arrest is explained by the American Heart Association.

SOURCES: David J. Callans, M.D., professor, medicine, University of Pennsylvania School of Medicine, Philadelphia; Joseph P. Ornato, M.D., chairman, department of emergency medicine, Virginia Commonwealth University Health System, Richmond; Aug. 12, 2004, New England Journal of Medicine

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