Can community volunteers be as effectively trained as emergency medical personnel in the use of automatic external defibrillators (AEDs), devices that shock a stopped heart back into beating?
To answer this question, the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the American Heart Association (AHA), has funded a large multi-center study to test the life-saving potential and cost effectiveness of public access defibrillation (PAD).
PAD, which involves placing defibrillators in the community, is considered a promising means of improving emergency treatment for victims of sudden cardiac arrest who collapse in public places. About one fourth of the 300,000 annual deaths from sudden cardiac arrest occur outside of the home - in public areas.
AEDS are known to work effectively to help victims of sudden cardiac arrest when the devices are used by highly trained emergency medical services personnel and other trained persons such as airline flight attendants.
"We want to know if placing these devices in the community where trained volunteers could access them will prevent additional deaths - and whether such a program is feasible," said NHLBI Director Dr. Claude Lenfant.
"The American Heart Association recognizes that the early use of defibrillators provides the most effective treatment for the majority of sudden cardiac arrest victims," said American Heart Association President Rose Marie Robertson, M.D. "This study will measure the effectiveness of the trained lay responders who treat sudden cardiac arrest using AEDs, and the results will help communities across the country to design the best Public Access
Defibrillation programs possible."
The 2 Ĺ year study will be conducted in 24 centers throughout the US and Canada. Volunteers in participating communities will be trained to recognize cardiac arrest, to access the 911 system, and to perform cardiopulmonary resuscitation. Half of the community units will have AEDs placed in conspicuous locations and the volunteers in those locations will be trained to use the devices. The AEDs will be placed in such community units as residential apartments, shopping centers, senior centers, gated communities, office buildings, and sports venues.
"Survival rates after cardiac arrest are low - averaging 4 percent - and can be increased by shortening the time to defibrillation; perhaps as much as 10 percent for each minute shaved. Resuscitation is almost always unsuccessful with delays of 10 or more minutes. The use of AEDs by the lay-person may become as common as CPR, but we need to find out if itís realistic and cost-effective to train a large number of people to use these devices - thus the PAD trial," said Dr. Al Hallstrom, professor of Biostatistics, School of Public Health and Community Medicine, University of Washington, and director of the PAD study.
The trial began in the Summer of 2000 and is being coordinated through the University of Washington under the direction of Dr. Hallstrom. The study chairman is Dr. Joseph Ornato, chair of the Department of Emergency Medicine, Virginia Commonwealth University, Medical College of Virginia in Richmond.
The 24 sites are located in Birmingham, AL; Calgary, Alberta, Canada; Chicago, IL; Cincinnati, OH; Indianapolis, IN; Milwaukee, WI; Minneapolis, MN; Mission Viejo, CA; New York, NY; Newark, NJ; Phoenix, AZ; Pittsburgh, PA; Portland, OR; Richmond, VA; Seattle, WA; Palm Springs and Riverside, CA; Stony Brook, NY; Syracuse, NY; Virginia Beach, VA; Vancouver, British Columbia, Canada; Washington, D.C.; Salt Lake City, UT; Detroit, MI; and Edmonton, Alberta, Canada.