Automated external versus blind manual defibrillation by untrained lay rescuers

Abstract

Introduction: sudden cardiac death is an important cause of mortality in the United States today. A major determinant of survival from sudden cardiac death is rapid defibrillation. Communities with high rates of bystander cardiopulmonary resuscitation (CPR) and early defibrillation enjoy the highest survival rates from out-of-hospital cardiac arrest. First responders and emergency medical technicians (EMTs) have been trained to use automated external defibrillators (AEDs). The period of instruction for successful use of the AED remains to be determined. It was the purpose of this study to compare AED versus blind manual defibrillation (BMD) by untrained lay rescuers using a simple instruction sheet and following a 20-min training period. Methods: 50 employed volunteers were confronted with a simulated cardiac arrest and asked to attempt defibrillation using either AED or BMD by following a written instruction sheet. Success was defined as delivery of three countershocks during the simulated resuscitation. Time to first and third shocks were recorded. Results: 24 of 25 volunteers (96%) were successful in operating the AED compared to none in the BMD group. Time to delivery of first shock averaged 119.5 ± 45.0 s and time to third shock averaged 158.7 ± 46.3 s. A 95% confidence interval for time to first shock for untrained lay rescuers was 100.5–138.4 s. Conclusions: untrained lay rescuers demonstrated a very high success rate using the AED during simulated cardiac arrest. Success with BMD by untrained rescuers is poor. This study suggests that prehospital personnel can be successfully trained in the use of AED in a substantially shorter period of time than in current practice. Strategic placement of AEDs like fire hoses and pool-side life preservers could result in improved survival from sudden cardiac death.