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Automatic External Defibrillation and Its Effects on Neurologic Outcome in Cardiac Arrest Patients in an Urban, Two-Tiered EMS System

Published online by Cambridge University Press:  28 June 2012

Jeffrey Ho ,
Timothy Held ,
William Heegaard  and
Timothy Crimmins
Jeffrey Ho*
Affiliation:
Departments of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota and Emergency Medical Services Education, Hennepin County, Minnesota, USA
Timothy Held
Affiliation:
Departments of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota and Emergency Medical Services Education, Hennepin County, Minnesota, USA
William Heegaard
Affiliation:
Departments of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota and Emergency Medical Services Education, Hennepin County, Minnesota, USA
Timothy Crimmins
Affiliation:
Departments of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota and Emergency Medical Services Education, Hennepin County, Minnesota, USA
*
Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55415 USA, E-Mail: ho911doc@aol.com
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Abstract

Objective:

To describe the use of the Automatic External Defibrillation (AED) device in an urban, two-tiered Emergency Medical Service (EMS) response setting with regard to its potential effects on cardiac arrest patient survival and neurologic outcome.

Methods:

A retrospective and descriptive design was utilized to study all cardiac arrest patients that had resuscitations attempted in the prehospital environment over a 30-month period. The study took place in a two-tiered EMS system serving an urban population of 368,383 persons. The first tier of EMS response is provided by the City Fire Department, which is equipped with a standard AED device. All first-tier personnel are trained to the level of Emergency Medical Technician-Basic. The second tier of EMS response is provided by personnel from one of two ambulance services. All second-tier personnel are trained to the level of Emergency Medical Technician-Paramedic.

Results:

271 cardiac arrest patients were identified for inclusion. One-hundred nine of these patients (40.2%) had an initial rhythm of either ventricular fibrillation or pulseless ventricular tachycardia and were shocked using the AED upon the arrival of first-tier personnel. Forty-two patients (38.5%) in this group had a return of spontaneous circulation in the field and 22 (20.2%) survived to hospital discharge. Of the survivors, 17 (77.3%) had moderate to good neurologic function at discharge base on the Glasgow-Pittsburgh Cerebral Performance Categories. Faster response times by the first-tier personnel appeared to correlate with better neurologic outcomes.

Conclusion:

First responder-based AED usage on patients in ventricular fibrillation or pulseless ventricular tachycardia can be applied successfully in an urban setting utilizing a two-tiered EMS response. In this study, a 20.2% survival to hospital discharge rate was obtained. Seventy-seven percent of these survivors had a moderate to good neurologic outcome based on the Glasgow-Pittsburgh Cerebral Performance Categories.

Keywords

automatic external defibrillatorcardiac arrestemergency medical servicesfirst respondersMinneapolisneurologic outcomeurban emergency medical services
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 12 , Issue 4 , December 1997 , pp. 51 - 54
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1997

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