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Public-access defibrillators. (Clinical Capsules).

Untrained bystanders made excellent use of public-access automated external defibrillators in two Chicago airports, resuscitating 11 of 18 people who collapsed with ventricular fibrillation, reported Sherry L. Caffrey, an emergency medical technician with the Chicago Department of Aviation, and her associates.

In a 2-year prospective observational study, 40 defibrillators were installed in high-traffic areas of the airports. The devices were equipped with digital data cards that recorded ECG and other clinical data, the machine's prompts to rescuers, and rescuers' voices during rescue attempts (N. Engl. J. Med. 347[16]:1242-47, 2002).

The defibrillators correctly identified and did not deliver shocks to four people who had collapsed for reasons other than cardiac arrest and four whose cardiac arrests weren't due to ventricular fibrillation. For the remaining 18 people with ventricular fibrillation, the devices restored spontaneous circulation to 11(56%), all of whom regained consciousness rapidly. There were no complications from the use of the device, and 10 of the 11 patients were alive with good neurologic outcomes at 1 year.

This is a considerable improvement over the estimated survival rate of less than 5% with conventional emergency medical services. Outcomes were much better than those achieved in conventionally resuscitated patients, most of whom are still comatose on hospital arrival and half of whom never regain consciousness, the investigators noted.

The cost of the public-use defibrillator program was about $35,000 per year, or $3,000 per patient and $7,000 per life saved. The costs are further offset by the reduced need for resources such as mechanical ventilation and other ICU treatment in these patients, who quickly regained consciousness.
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Author:Moon, Mary Ann
Publication:Internal Medicine News
Date:Dec 1, 2002
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