Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-27T00:29:31.302Z Has data issue: false hasContentIssue false
  • English
  • Français

Rapid On-site Defibrillation versus Community Program

Published online by Cambridge University Press:  28 June 2012

J.C. Fedoruk ,
D. Paterson ,
M. Hlynka ,
K.Y. Fung ,
Michael Gobet  and
Wayne Currie
J.C. Fedoruk
Affiliation:
Essex-Kent Base Hospital Program, Hotel-Dieu Grace Hospital, Windsor, Ontario, CANADA
D. Paterson
Affiliation:
Essex-Kent Base Hospital Program, Hotel-Dieu Grace Hospital, Windsor, Ontario, CANADA
M. Hlynka
Affiliation:
University of Windsor, Windsor, Canada
K.Y. Fung
Affiliation:
University of Windsor, Windsor, Canada
Michael Gobet
Affiliation:
Essex-Kent Base Hospital Program, Hotel-Dieu Grace Hospital, Windsor, Ontario, CANADA
Wayne Currie*
Affiliation:
Essex-Kent Base Hospital Program, Hotel-Dieu Grace Hospital, Windsor, Ontario, CANADA
*
1030 Ouellette Avenue, Windsor, Ontario, N9A 1E1 CANADA E-mail: wcurrie@basehospital.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

For patients who suffer out-of-hospital cardiac arrest, the time from collapse to initial defibrillation is the single most important factor that affects survival to hospital discharge. The purpose of this study was to compare the survival rates of cardiac arrest victims within an institution that has a rapid defibrillation program with those of its own urban community, tiered EMS system.

Methods:

A logistic regression analysis of a retrospective data series (n = 23) and comparative analysis to a second retrospective data series (n = 724) were gathered for the study period September 1994 to September 1999. The first data series included all persons at Casino Windsor who suffered a cardiac arrest. Data collected included: age, gender, death/survival (neurologically intact discharge), presenting rhythm (ventricular fibrillation (VF), ventricular tachycardia (VT), or other), time of collapse, time to arrival of security personnel, time to initiation of cardiopulmonary resuscitation (CPR) prior to defibrillation (when applicable), time to arrival of staff nurse, time to initial defibrillation, and time to return of spontaneous circulation (if any). Significantly, all arrests within this series were witnessed by the surveillance camera system, allowing time of collapse to be accurately determined rather than estimated. These data were compared to those of similar events, times, and intervals for all patients in the greater Windsor area who suffered cardiac arrest. This second series was based upon the Ontario Prehospital Advanced Life Support (OPALS) Study database, as coordinated by the Clinical Epidemiology Unit of the Ottawa Hospital, University of Ottawa.

Results:

The Casino Windsor had 23 cases of cardiac arrests. Of the cases, 13 (56.5%) were male and 10 (43.5%) were female. All cases (100%) were witnessed. The average of the ages was 61.1 years, of the time to initial defibrillation was 7.7 minutes, and of the time for EMS to reach the patient was 13.3 minutes. The presenting rhythm was VF/VT in 91% of the case. Fifteen patients were discharged alive from hospital for a 65% survival rate. The Greater Windsor Study area included 668 cases of out-of-hospital cardiac arrest: Of these, 410 (61.4%) were male and 258 (38.6%) were female, 365 (54.6%) were witnessed, and 303 (45.4%) were not witnessed. The initial rhythm was VF/VT was in 34.3%. Thirty-seven (5.5%) were discharged alive from the hospital.

Conclusion:

This study provides further evidence that PAD Programs may enhance cardiac arrest survival rates and should be considered for any venue with large numbers of adults as well as areas with difficult medical access.

Keywords

advanced life supportbasic life supportcardiac arrestcasinoCPREMSon-site defibrillationparamedicsprehospital carepublic access defibrillationrapid defibrilla-tionresuscitationventricular fibrillationWindsor
Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 17 , Issue 2 , June 2002 , pp. 102 - 106
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Weisfeldt, ML: American Heart Association Report on the Public Access Defibrillation Conference, 8–10 December 1994. American Heart Association Taskforce on Automatic External Defibrillation. Resuscitation 1996; 32(2):127–138.Google Scholar
2. Nichol, G: American Heart Association report on the second public access defibrillation conference, 17–19 April, 1997. Circulation 1998; 97(13): 1309–1314.Google Scholar
3. Cummins, RO: Encouraging early defibrillation: the American Heart Association and automatic external defibrillators. Ann Emerg Med 1990; 19(11):1245–1248.CrossRefGoogle Scholar
4. Bossaert, L: Early defibrillation. An advisory statement by the Advance Life Support Working Group of the International Liaison Committee on Resuscitation. Resuscitation 1997;34(2):113–-114.Google Scholar
5. Valenzuela, TD, Roe, DJ, Cretin, S, Spaite, DW, Larsen, MP: Estimating effectiveness of cardiac arrest interventions. A logistic regression survival model. Circulation 1997; 96: 3308–3313.CrossRefGoogle Scholar
6. Larsen, MP: Predicting survival from out-of-hospital cardiac arrest: A graphic model. Ann Emerg Med 1993;22(11):1652–1658.CrossRefGoogle ScholarPubMed
7. Weisfeldt, ML: Public access defibrillation. A statement for healthcare professionals from the American Heart Association Task Force on Automatic External Defibrillation. Circulation 1995; 92(9): 2763.CrossRefGoogle ScholarPubMed
8. Becker, L: Public location of cardiac arrest. Implication for public access defibrillation. Circulation 1998;97(21):2106–-2109.Google Scholar
9. Riegel, B: Training non-traditional responders to use automated external defibrillators. Am J Crit Care 1998;7(6):402–410.CrossRefGoogle Scholar
10. Moore, JE: Lay person use of automatic external defibrillation. Ann Emerg Med 1987;16(6):669–672.Google Scholar
11. Ontario Prehospital Advanced Life Support Study (O.P.A.L.S.), Ottawa Civic Hospital, Clinical Epidemiology Unit, Ottawa ON, Phase III R Table, 7/19/00.Google Scholar
12. Page, RL, Joglar, JA, Kowal, RC, Zagrodzky, JD, Nelson, LL, Ramaswamy, K, Barbera, SJ, Hamdan, MH, McKenas, DK: Use of automated external defib-rillators by a U.S. airline. N Engl J Med 2000;343(17):1210–1215.CrossRefGoogle Scholar
13. Cummins, RO: From concept to standard-of-care? Review of the clinical experience with automated external defibrillators. Ann Emerg Med 1998;18(12):1269–1275.CrossRefGoogle Scholar