Use of AEDs in hospitals for cardiac arrest not linked with improved survival

November 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."
-end-
(JAMA. 2010;304[19]:2178-2179. Available pre-embargo to the media at www.jamamedia.org)

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

The JAMA Network Journals

Related Cardiac Arrest Articles from Brightsurf:

Outcomes for out-of-hospital cardiac arrest during COVID-19 pandemic
This study used a large US registry of out-of-hospital cardiac arrests to asses the association between the COVID-19 pandemic and the outcomes of out-of-hospital cardiac arrests, including in areas with low and moderate COVID-19 disease.

Cardiac arrest is common in critically ill patients with COVID-19
Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among patients aged 80 or older, finds a study published by The BMJ today.

In-hospital cardiac arrest in COVID-19
Outcomes of in-hospital cardiac arrest among patients with COVID-19 are examined in this case series.

New risk tool developed for cardiac arrest patients
Experts have developed a risk score to predict cardiac arrest patient outcomes.

Intravenous sodium nitrite ineffective for out-of-hospital cardiac arrest
Among patients who had an out-of-hospital cardiac arrest, intravenous sodium nitrite given by paramedics during resuscitation did not significantly improve their chances of being admitted to or discharged from the hospital alive, according to research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Getting to the heart of epinephrine use in pediatric cardiac arrest patients
The effectiveness of epinephrine treatment during resuscitation of adult patients with cardiac arrest is generally promising, but little is known about its effects in pediatric patients.

Bystanders can help more cardiac arrest victims survive
Only 8% of Americans survive cardiac arrest outside a hospital, but that percentage could increase significantly if bystanders recognize cardiac arrest and perform simple lifesaving tasks, a UVA Health physician says in a New England Journal of Medicine article.

Opioid-related cardiac arrest patients differ from other cardiac arrests
People who suffer cardiac arrest due to an opioid overdose are younger, have fewer chronic medical conditions and may be more likely to be to receive bystander CPR, according to a review of emergency response records in Maine.

Selective coronary angiography following cardiac arrest
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.

Sudden cardiac arrest in athletes: Prevention and management
It's marathon season, and every so often a news report will focus on an athlete who has collapsed from sudden cardiac arrest.

Read More: Cardiac Arrest News and Cardiac Arrest Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.