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Defibrillation by general practitioners
1Court Road Surgery, Malvern, Worcestershire WR14 3BL, UK. colquhoun@bishopsfrome.u-net.com
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Early defibrillation by general practitioners significantly improves survival rates for cardiac arrest patients with acute myocardial infarction. Equipping more doctors with defibrillators could reduce deaths from coronary heart disease.
Area of Science:
- Cardiology
- Emergency Medicine
- General Practice
Background:
- Acute myocardial infarction (AMI) can lead to cardiac arrest.
- General practitioners (GPs) are often the first medical responders.
- Early defibrillation is critical for survival in cardiac arrest.
Purpose of the Study:
- To investigate cardiac arrest modes in AMI patients attended by GPs.
- To evaluate the effectiveness of early defibrillation by GPs.
Main Methods:
- Retrospective observational study in British general practice.
- GPs were equipped with defibrillators.
- Outcomes measured included cardiac rhythm, survival to hospital admission, and discharge.
Main Results:
- When resuscitation initiated within 4 minutes, 90% had shockable rhythms; >70% survived to hospital, 60% discharged alive.
- Delayed resuscitation resulted in fewer shockable rhythms and lower survival rates.
- If arrest occurred in GP surgery, 85% admitted alive, 75% discharged alive.
Conclusions:
- GPs managing AMI patients should be equipped with defibrillators.
- Widespread community defibrillator deployment can reduce coronary heart disease mortality.
Objective:
To investigate the mode of cardiac arrest in patients with acute myocardial infarction attended by general practitioners, and the effectiveness of early defibrillation.
Design:
Retrospective observational study.
Setting:
British general practice.
Participants:
General practitioners equipped with defibrillators by the British Heart Foundation.
Main Outcome Measures:
Cardiac rhythm when first monitored, response to defibrillation assessed by survival to reach hospital alive and survival to hospital discharge.
Interventions:
Defibrillation and standard cardiopulmonary resuscitation in patients with cardiac arrest complicating acute myocardial infarction attended by British general practitioners.
Results:
When a doctor equipped with a defibrillator witnessed an arrest or was able to initiate resuscitation within 4 min of the patient collapsing, 90% of patients were found to have developed a rhythm likely to respond to a defibrillatory shock. Defibrillation under these circumstances was very successful with more than 70% of patients subsequently admitted to hospital alive and approximately 60% surviving to be discharged alive. When the doctor commenced resuscitation later, fewer patients were found to have rhythms likely to be responsive to a DC shock. A greater proportion was in asystole and resuscitation was less frequently successful under these circumstances. When the arrest occurred in the doctor's surgery, 85% of patients were admitted to hospital alive and three quarters survived to hospital discharge.
Conclusions:
All those who provide the initial care for this vulnerable group of patients should be equipped with defibrillators. The more widespread deployment of defibrillators in the community may be a successful strategy for reducing unnecessary deaths from coronary heart disease.