The Department of Health National Defibrillator Programme: analysis of downloads from 250 deployments of public access defibrillators

doi:10.1016/j.resuscitation.2005.01.003

Resuscitation

Volume 64, Issue 3, March 2005, Pages 269-277

https://doi.org/10.1016/j.resuscitation.2005.01.003 Get rights and content

Abstract

From April 2000 to November 2002, the Department of Health (England) placed 681 automated external defibrillators (AEDs) in 110 public places for use by volunteer lay first responders. An audit has been undertaken of the first 250 deployments, of which 182 were for confirmed cardiac arrest. Of these, 177 were witnessed whilst 5 occurred in situations that were remote or initially inaccessible to the responders. The response interval between collapse and the initiation of CPR or AED placement was estimated to be 3–5 min in most cases.

Ventricular fibrillation or rapid ventricular tachycardia (one case) was the first recorded rhythm in 146 cases (82%). In all, 44 of the 177 witnessed cases are known to have survived to hospital discharge (25%). Complete downloads are available for 173 witnessed cases and of these 140 were shocked: first-shock success, defined as termination of the fibrillatory waveform for 5 s or more, was achieved in 132 of them. When data quality permitted, the downloads were analysed with special reference to the numbers of compressions given and also to interruptions in compression sequences for ventilations, for rhythm analysis by the AED, for clinical checks, and for unexplained operator delays.

The average rate of compressions during sequences was 120 min⁻¹, but because of interruptions, the actual number administered over a full minute from the first CPR prompt was a median of only 38.

The speed of response by the lay first responders in relation to AED use was similar to that reported for healthcare professionals.

Introduction

First responder and public access defibrillation are widely recommended strategies to achieve more rapid defibrillation and thereby provide definitive treatment for victims of sudden out-of-hospital cardiac arrest [1], [2], [3]. Important factors that determine the potential success of this strategy include: the proportion of victims with shockable rhythms as the immediate cause, the delay between collapse and delivery of shocks, the presence of serious co-morbidity, and the expertise of the first responders both in regard to conventional basic life support (BLS) and the use of the automated external defibrillators (AEDs). Insight into these factors will help to predict the value of first responder programmes, identify factors that might improve results, and define training requirements.

The Department of Health (DH) in England has a National Defibrillator Programme that placed 681 automated external defibrillators (AEDs) in 110 public places from April 2000 to November 2002 as suitable sites were identified and personnel were trained [4], [5], [6]. The first responders are lay volunteers who work at the site where the AED is installed; they record details of each AED deployment and resuscitation attempt on a specially designed AED event form. This paper provides a detailed analysis of information obtained from the AED event report forms and the downloads of electronic data recorded by the AEDs during the first 250 deployments; there is special reference to cases of cardiac arrest. Included in this report is the first large-scale detailed analysis of the performance of trained lay first responders—who are neither healthcare professionals nor (with few exceptions) members of a disciplined force.

Details of the National Defibrillator Programme, an evaluation of the training programme, and earlier information on clinical outcome are described elsewhere [4], [5], [6].

Section snippets

Clinical data

The AED event forms record the site of the cardiac arrest, the sex and approximate age of the victim, whether CPR and shocks were administered, the initial outcome, and the receiving hospital. Estimates of the delays between collapse and responses were usually available. These data were supplemented in a few instances by additional information provided by healthcare professionals or police attending the scene.

AEDs and downloads

In this first phase of the national defibrillator programme, two models of AED were

Overall numbers

Most downloads showed ECG rhythms associated with cardiac arrest, but in some cases the AED was applied to individuals who had collapsed or who had caused concern to responders for reasons other than cardiac arrest. A breakdown of the AED deployments that provided data for this analysis is shown in Fig. 4, together with the proportions of cardiac arrest cases with shockable or non-shockable rhythms.

Of the 250 uses, 182 were for confirmed cardiac arrests. Five of them occurred in inaccessible or

Discussion

The Department of Health National Defibrillator Programme has provided the opportunity for the first large-scale detailed analysis of events associated with public access on-site defibrillation by lay responders. In addition to presenting the clinical results of the programme, we have been able to make important observations on the rhythms of cardiac arrest in busy public locations, to examine the performance of the trained lay rescuers, and to assess the effectiveness of the AEDs that were

Acknowledgements

The audit would not have been possible without the help of a dedicated team within the Department of Health: Anna Oakley, Helen Williams and Rachael Priest. We are also indebted to the manufactures of the two models of AED used in this study for making available templates that helped in the analyses. We wish particularly to acknowledge the support of hospital staff, patients, and their families for allowing the programme to receive outcome data after successful resuscitation. DAC is supported

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Citation Excerpt :
For home AED deployment, three studies (LOE 1197,403; LOE 2404) showed that home AED programs are safe and feasible but were unlikely to result in a significant increase in survival of out-of-hospital VF cardiac arrest. For on-site AEDs in public places, 11 studies (LOE 1197; LOE 2357; LOE 3224,361,362; LOE 4226,363–366,405) supported on-site AEDs. This approach demonstrates high survival at low deployment rates.

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^☆: A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at 10.1016/j.resuscitation.2005.01.003.

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The Department of Health National Defibrillator Programme: analysis of downloads from 250 deployments of public access defibrillators☆

Abstract

Introduction

Section snippets

Clinical data

AEDs and downloads

Overall numbers

Discussion

Acknowledgements

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Lancet

Resuscitation

Resuscitation

Annu Emerg Med

Resuscitation

Resuscitation

Resuscitation

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J Am Colloid Cardiol

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