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Automatic external defibrillators: changing the way we manage ventricular fibrillation
K L Smith1, P A Cameron, A Peeters
1Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Melbourne, VIC. karen.smith@med.monash.edu.au
Objective:
To discuss recent developments in automatic defibrillation and to review the evidence that first-responders equipped with automatic external defibrillators (AEDs) improve survival from out-of-hospital cardiac arrest.
Data Sources:
MEDLINE search from 1966 to 1999 (articles in English only) and examination of bibliographies.
Study Selection:
Published studies of out-of-hospital cardiac arrest and first-responders equipped with AEDs. Studies had to have a control group and to report survival to hospital discharge from ventricular fibrillation (VF).
Data Extraction:
Six studies met the selection criteria (two prospective randomised trials, two prospective controlled trials, and one cohort study and one retrospective study, both with historical controls).
Data Synthesis:
A random effects meta-analysis of odds ratios for survival from VF.
Conclusions:
Meta-analysis suggests that equipping first-responders with AEDs increases the probability of survival to hospital discharge after out-of-hospital cardiac arrest (odds ratio, 1.74; 95% CI, 1.27-2.38; P < 0.001). However, most of the studies lacked sufficient power to draw definitive conclusions. Until the impact of wide deployment of AEDs is fully understood, first-responder defibrillation in Australia should only occur as part of coordinated multicentre research studies.