Circulation. 1998;97:1309-1314
(Circulation. 1998;97:1309-1314.)
© 1998 American Heart Association, Inc.
American Heart Association Report on the Second Public Access Defibrillation Conference, April 17–19, 1997
Graham Nichol, MD;
Alfred P. Hallstrom, PhD;
Richard Kerber, MD;
Arthur J. Moss, MD;
Joseph P. Ornato, MD;
David Palmer, Esq;
Barbara Riegel, DNSc;
Sidney Smith, Jr, MD;
; Myron L. Weisfeldt, MD
From the University of Ottawa, Canada (G.N.); University of Washington,
Seattle (A.P.H.); University of Iowa Hospital, Iowa City (R.K.); Gibson, Dunn
and Crutcher, Inc, Denver (D.P.); University of Rochester, Rochester (A.J.M.);
Medical College of Virginia, Richmond (J.O.); San Diego State University, San
Diego (B.R.); University of North Carolina at Chapel Hill (S.S.);
Columbia-Presbyterian Medical Center, New York (M.L.W.).
Correspondence to Graham Nichol, MD, Clinical Epidemiology Unit, F6, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
Key Words: defibrillation • heart arrest
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Introduction
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During the past 20
years, morbidity and mortality rates for nearly all types of
cardiovascular disease have declined. However, there
has been little decline in incidence or improvement in outcome after
sudden cardiac arrest. Each day 
1000 Americans experience sudden
cardiac arrest.1 2 Of these, 70% experience
ventricular fibrillation. Although patients with advanced
cardiac conditions have at least a 50% incidence of sudden
death,3 individuals with severe heart disease
collectively constitute only a very small percentage of sudden deaths
in this country.1 Therefore, although prevention
is clearly the best approach to the problem of sudden cardiac arrest,
such preventive treatments may be difficult and costly to
implement.
External CPR and defibrillation were first described as effective
treatments for sudden cardiac arrest >30 years ago. However, survival
after out-of-hospital cardiac arrest is still poor. The American Heart
Association previously addressed this problem by emphasizing the
importance of the chain of survival4 : early
access, early CPR, early defibrillation, and early advanced life
support. Because early defibrillation is the single most important
intervention, the American Heart Association challenged manufacturers
to develop simple, low-cost automatic defibrillators for use by
targeted groups at locations in which large numbers of people
congregate.5
We previously proposed extension of this enhanced defibrillation
strategy to include defibrillation by minimally trained members of the
public, referred to as PAD.6 This strategy seeks
to concentrate distribution of AEDs at specific sites at which sudden
cardiac arrest occurs frequently (eg, public places in which large
numbers of older people are present, such . . . [Full Text of this Article]
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