Navigation Links
Use of AEDs in hospitals for cardiac arrest not linked with improved survival
Date:11/15/2010

While automated external defibrillators improve survival for out-of-hospital cardiac arrest, an analysis of data indicates their use for cardiac arrest in a hospital does not result in an improved rate of survival, according to a study in the November 17 issue of JAMA. The study is being released early online because it will be presented at the American Heart Association's annual meeting.

Use of automated external defibrillators (AEDs) has been proposed as a strategy to reduce times to defibrillation and improve survival from cardiac arrests that occur in the hospital setting, according to background information in the article. However, current evidence to support the use of AEDs in hospitals has been mixed and limited to single-center studies. Also, these devices may be less effective or potentially harmful when used in hospitals where only 1 in 5 hospitalized patients have initial cardiac arrest rhythms that respond to defibrillation. "Before the widespread dissemination of AEDs in hospitals, it therefore becomes critical to demonstrate that AED use improves survival," the authors write.

Using data from the National Registry of Cardiopulmonary Resuscitation, Paul S. Chan, M.D., M.Sc., of Saint Luke's Mid America Heart Institute, Kansas City, and colleagues evaluated the association of AED use and survival after an in-hospital cardiac arrest. The study included 11,695 hospitalized patients with cardiac arrests between January 1, 2000 and August 26, 2008, at 204 U.S. hospitals following the introduction of AEDs on general hospital wards. Of these patients, 2,079 (17.8 percent) had shockable rhythms, such as ventricular fibrillation or pulseless ventricular tachycardia (rapid heart rhythm), and 9,616 (82.2 percent) had nonshockable rhythms, such as asystole or pulseless electrical activity. AEDs were used to assess initial rhythm in 4,515 patients (38.6 percent).

Overall, 2,117 patients (18.1 percent) survived to hospital discharge. Within the entire study population, the rate of survival to hospital discharge was 16.3 percent among patients in whom AEDs were used and 19.3 percent among patients in whom AEDs were not used. After multivariable adjustment for hospital site and clinical characteristics, AED use was associated with a 15 percent lower rate of survival.

The association between AED use and survival to discharge differed by the initial cardiac arrest rhythm. Among the 9,616 cardiac arrests due to nonshockable rhythms, AED use was associated with a 26 percent lower in-hospital survival (10.4 percent for AED use; 15.4 percent for no AED use). In contrast, for the 2,079 cardiac arrests due to shockable rhythms, there was no association between AED use and in-hospital survival (38.4 percent for AED use; 39.8 percent for no AED use).

"Our results may appear surprising because AEDs have been shown to improve survival for witnessed out-of-hospital cardiac arrests in public locations. However, our results may differ substantially from those investigations due to differences in the initial cardiac arrest rhythm," the authors write.

The researchers note that despite lack of data on the potential benefit of AEDs in the hospital setting, hospitals have increasingly adopted the use of AEDs in patient areas in response to local and national efforts to improve defibrillation time and resuscitation survival. "Between 2003 and 2008, more than 50,000 AED units were sold to U.S. hospitals, and marketing reports project annual sales growth of 9 percent to 12 percent over the next 5 years. In light of our data, national organizations and hospitals may need to reconsider the use of AEDs in general hospital ward units or develop different strategies for using them."

(JAMA. 2010;304[19]:2129-2136. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 8 a.m. CT Monday, November 15 at www.digitalnewsrelease.com/?q=jama_3765.

Editorial: Automated External Defibrillators and the Law of Unintended Consequences

The findings from this study should lead to consideration of a change in practice for in-hospital cardiac arrest, writes David E. Haines, M.D., of the Oakland University William Beaumont School of Medicine, Royal Oak, Mich., in an accompanying editorial.

"Initiation of prompt and effective chest compressions should be the highest priority by first responders to the arrest. The AED may be used in the automatic mode by non-advanced cardiac life support-trained personnel, but the device should be converted to the manual mode immediately on arrival of the advanced cardiac life support-trained resuscitation team. In the future, prevention of cardiac arrest by use of high-tech monitoring and rapid response teams for earlier detection and treatment of life-threatening conditions may help improve outcomes in this challenging patient cohort."


'/>"/>

Contact: Kerry O'Connor
koconnor@saint-lukes.org
816-932-8646
JAMA and Archives Journals
Source:Eurekalert

Related medicine news :

1. New ratings of American hospitals released with quality study by HealthGrades
2. National Institutes of Health awards $1.2 million to GSU for collaborative study on discharge decisions at hospitals
3. University Hospitals Case Medical Centers neuroscience intensive care unit earns Beacon Award
4. University Hospitals Case Medical Center implements AutoLITT system for treatment of brain tumors
5. Lack of trust in hospitals a major deterrent for blood donation among African-Americans
6. Hospitals face legal dilemma if they test incapacitated patients after needle accidents
7. US hospitals making only modest gains in adoption of electronic health records
8. MRSA policies differ among hospitals, study shows
9. Smaller hospitals can provide safe and high-quality surgical care comparable to larger counterparts
10. Leeds Teaching Hospitals Trust and RSLSteeper Team Up to Help Paralympian Walk His Sister Down the Aisle
11. Pay-for-performance for hospitals
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/8/2016)... ... February 08, 2016 , ... Coast Dental has a new way to help ... Month and family dentist Yvonne Dorrian, DMD, is hosting a free seminar on Friday, ... next to Target at 1207 North Peachtree Parkway in Peachtree City. Dr. Dorrian will ...
(Date:2/8/2016)... ... ... who has struggled to quit smoking, a man who has struggled with hair loss – ... his problems – and he did. Now Nabat, a serial entrepreneur featured as the October ... to the world and better people's lives. His own experience with nicotine addiction led to ...
(Date:2/8/2016)... ... February 08, 2016 , ... Tingley Rubber Corporation , ... provide its range of unique and advantaged protective solutions to a growing ... provide bilingual customer service and marketing support. A new distribution center in Brampton, ...
(Date:2/8/2016)... ... 08, 2016 , ... Local insurance agency Dennis Fuller & ... has initiated a fundraiser for a two year old little girl named Bella, ... To support this beautiful child who is facing life’s journey without her loving ...
(Date:2/8/2016)... ... , ... Remember the old saying “rub some dirt on it”? Perhaps you ... “Calcium Bentonite Clay” the health benefits of integrating clay into a daily diet are ... A former motivational speaker, Perry A~ has since dedicated her life to learning about ...
Breaking Medicine News(10 mins):
(Date:2/8/2016)... , Feb. 8, 2016  Ventana Medical ... that hundreds of the world,s top oncologists, pathologists, ... at the 12 th annual Tucson Symposium ... evolving theories and new outcomes in cancer research ... patients, lives. Thomas Grogan , annually ...
(Date:2/8/2016)... 2016 Nueterra, the nation,s largest ... the development of equity partnerships and focused ... divided its interests between two new companies—NueHealth ... continue the founding company,s private equity investment ... national system of integrated provider networks that ...
(Date:2/8/2016)... , Feb. 8, 2016 ... "Knee Reconstruction Devices Market by Product Type ... and Geography (U.S., Canada, Eu-5, Japan, Bric, Turkey, ... report to their offering. --> ... the "Knee Reconstruction Devices Market by Product ...
Breaking Medicine Technology: