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. 2000 Oct 26;343(17):1206-9.
doi: 10.1056/NEJM200010263431701.

Outcomes of Rapid Defibrillation by Security Officers After Cardiac Arrest in Casinos

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Outcomes of Rapid Defibrillation by Security Officers After Cardiac Arrest in Casinos

T D Valenzuela et al. N Engl J Med. .
Free article

Abstract

Background: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest.

Methods: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital.

Results: Automated external defibrillators were used, 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients 153 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attachment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to The arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes.

Conclusions: Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates.

Comment in

  • Sudden death from cardiac arrest--improving the odds.
    Robertson RM. Robertson RM. N Engl J Med. 2000 Oct 26;343(17):1259-60. doi: 10.1056/NEJM200010263431709. N Engl J Med. 2000. PMID: 11071678 No abstract available.
  • Automated external defibrillators.
    Groh WJ, Salive ME, Richardson LD; Public Access Defibrillation Trial Investigators. Groh WJ, et al. N Engl J Med. 2001 Mar 8;344(10):771-2; author reply 772-3. doi: 10.1056/NEJM200103083441013. N Engl J Med. 2001. PMID: 11236785 No abstract available.
  • Automated external defibrillators.
    Jaffe A, Landau WM, Wetzel RD. Jaffe A, et al. N Engl J Med. 2001 Mar 8;344(10):771; author reply 772-3. N Engl J Med. 2001. PMID: 11236786 No abstract available.
  • Automated external defibrillators.
    Fried RE. Fried RE. N Engl J Med. 2001 Mar 8;344(10):772; author reply 772-3. N Engl J Med. 2001. PMID: 11236787 No abstract available.

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