Circulation, Vol 73, 701-709, Copyright © 1986 by American Heart Association
KR Stults, DD Brown and RE Kerber
Automatic external defibrillators (AEDs) may have advantages over manual
defibrillation in managing prehospital cardiac arrest, particularly in
rural communities. We conducted a two-part evaluation of a commercially
available AED. We first established the diagnostic accuracy of the AED's
rhythm recognition algorithm by challenging it with 205 cardiac arrest
rhythms previously recorded from actual patients in the field. The AED
demonstrated 100% specificity and 92% sensitivity for ventricular
fibrillation (VF) in this nonclinical setting. We then compared the
clinical efficacy of AEDs in 18 small communities (study group) with that
of manual defibrillation in 18 additional communities (control group) of
similar size. Ambulance technicians using manual defibrillators correctly
diagnosed VF more frequently than the AEDs (98% vs 83%; p less than .025).
Specificity for VF was similar in the two groups (100% for AEDs vs 94% for
technicians; p greater than .10). AEDs were able to deliver shocks more
quickly than was possible with the manual defibrillators (1.56 vs 2.77 min;
p less than .001). The ability of the AEDs to terminate VF was excellent,
converting VF in 28 of 29 (97%) patients to some other rhythm compared with
only 37 of 53 (70%) patients in the control group (p less than .01).
Hospital admission and discharge rates were similar for the two groups. Ten
of the 35 (29%) patients managed with AEDs achieved admission and six (17%)
were ultimately discharged. In the control group 17 of 53 (33%) patients
with VF were admitted and seven (13%) were discharged (p less than .75).
AEDs are an effective alternative to manual defibrillation in small
communities.
ARTICLES
Efficacy of an automated external defibrillator in the management of out-of-hospital cardiac arrest: validation of the diagnostic algorithm and initial clinical experience in a rural environment
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