From Loeb Medical Research Institute, University of Ottawa, Canada;
University of Washington, Seattle; Department of Emergency Medicine, Medical
College of Virginia, Richmond; San Diego State University, San Diego;
Department of Emergency Medicine, University of Arizona, Tucson; Mayo Clinic,
Rochester, Minn; and Department of Medicine, Columbia-Presbyterian Medical
Center, New York, NY.
Correspondence to Graham Nichol, MD, Clinical Epidemiology Unit F-6, Ottawa Civic Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
Methods and Results—A decision model compared the potential
cost-effectiveness of standard emergency medical services (EMS) systems
with that of EMS supplemented by PAD. We considered defibrillation by
lay responders or police, using an analysis with a US
health-care perspective. Input data were derived from published data or
fiscal databases. Future costs and effects were discounted at 3%.
Monte Carlo simulation was performed to estimate the variability in the
costs and effects of each program. Sensitivity analyses
assessed the robustness of the results to changes in input data. A
standard EMS system had a median cost of $5900 per cardiac arrest
patient (interquartile range, IQR, $3200 to $10 900) and yielded a
median of 0.25 quality-adjusted life years (IQR, 0.20 to 0.30). PAD by
lay responders had a median incremental cost of $44 000 per additional
quality-adjusted life year (IQR, $29 000 to $68 900). PAD by police
had a median incremental cost of $27 200 per additional
quality-adjusted life year (IQR, $15 700 to $47 800). The results
were sensitive to changes in the cost and relative survival benefit of
PAD.
Conclusions—Although more expensive than standard EMS for sudden
cardiac arrest, PAD may be economically attractive. The effectiveness
and cost-effectiveness of PAD should be assessed in a randomized,
controlled trial.
External cardiopulmonary resuscitation and defibrillation were
first described as effective treatments for sudden cardiac arrest >30
years ago. However, survival after out-of-hospital cardiac arrest is
still poor.4 5 6 7 The American Heart Association
previously addressed this problem by emphasizing the importance of the
chain of survival8 : early access, early
cardiopulmonary resuscitation, early defibrillation, and early
advanced life support. Because early defibrillation is the single most
important treatment, we previously proposed a novel defibrillation
strategy that includes defibrillation by minimally trained members of
the public, referred to as PAD.9 This strategy
seeks to distribute AEDs at specific sites at which sudden cardiac
arrest occurs frequently, such as public places where large numbers of
older people are under stress (eg, airports and casinos), or to provide
AEDs to nontraditional responders such as police.
Economic evaluation of a new medical technology such as PAD assesses
the effectiveness and cost of the technology so that physicians and
policy-makers can decide whether it offers sufficient value for money.
Although a nonexperimental study of enhanced defibrillation suggests
that it is very effective,10 the potential costs
of implementation of PAD have not been assessed. Therefore, the
objective of this analysis was to estimate the potential
cost-effectiveness of PAD in an urban center in the United States.
Input Data
Structure of Decision Model
Probabilistic simulation was incorporated into the model as
follows.11 12 A probability distribution was
specified for each variable. Then Monte Carlo simulation was
performed by randomly drawing the value of each variable from its
corresponding distribution. Sampling was repeated 10 000 times to
estimate the variability of the cost and effectiveness of each
diagnostic strategy.
All analyses were performed with DATA
3.013 and spreadsheet software.
Assumptions
Each variable in the decision model was modeled with the
distribution that best described the underlying physical process,
because the true value of the variables was
unknown.14 The proportion of sudden cardiac
arrests that occur in public was modeled as a triangular distribution.
For standard EMS systems, the probability of survival was modeled as a
ß-distribution. The relative benefit of PAD compared with a standard
EMS system was modeled as a triangular distribution. Finally, cost
variables were modeled as triangular or log-normal
distributions.
Data
Costs
The cost of treatment by the EMS system was not included in the
analysis because it was common to both strategies. Future costs
were not included in the analysis because of ongoing
controversy about inclusion of such costs in an economic evaluation and
lack of information about the true value of such
costs.23 24 25
A secondary analysis considered only the immediate costs of PAD
(ie, the costs incurred in providing the treatment
itself).26 Such a restricted perspective was
considered because the costs of providing EMS, hospitalization, or
subsequent care are not relevant to stakeholders, such as municipal
governments, who pay only for police services.
Sensitivity Analyses
Multiway sensitivity analyses were also performed as follows.
Because the effectiveness of standard EMS and of PAD may be correlated,
we varied these characteristics simultaneously. Because the
costs of implementing and maintaining a PAD program may vary together,
we also varied the value of these variables
simultaneously.
In an urban EMS system with an overall survival of 8%, implementation
of PAD by police was associated with a median cost of $27 200 (IQR,
$15 700 to $47 800) per additional quality-adjusted life year
compared with a standard EMS system (Table 3
When only the immediate costs of defibrillation by police were
considered, implementation of PAD was associated with a median cost of
$6500 (IQR, $4300 to $9700) per additional quality-adjusted life year
compared with a standard EMS system in an urban EMS system with an
overall survival of 8% (Table 4
Sensitivity Analyses
To place the incremental cost-effectiveness of police defibrillation in
perspective, we considered a range of possible values for survival with
standard EMS systems and relative benefit of police defibrillation (Fig 2
The results of the analysis were also sensitive to changes in
the costs of the defibrillation program or hospitalization. For
example, PAD by police cost more than $50 000 per additional
quality-adjusted life year compared with standard EMS systems if the
immediate cost of defibrillation was 10 times its baseline value or if
the costs of hospitalization were 1.5 times their baseline values.
In summary, the results of the analysis were sensitive to very
large changes or simultaneous changes in the value of
several variables in the decision model.
Impact on Public Health
The cost-effectiveness of PAD was sensitive to changes in the value of
several variables in the decision model. In particular, the results
were sensitive to changes in the proportion of patients who survive
cardiac arrest and the costs of implementing and maintaining PAD.
Therefore, decisions about implementation of a PAD program in an
individual community should consider the survival achieved by the
existing EMS system and the costs of the program.
This analysis is consistent with a previous
cost-effectiveness analysis of EMS, which suggested that
improvements that decrease the time to defibrillation were economically
attractive.5 However, there are some important
differences between these two analyses. First, the previous
analysis considered only improvements to existing EMS systems,
rather than introduction of enhanced defibrillation by nontraditional
responders. Second, the previous analysis based estimates of
the effectiveness of resuscitation on the results of a
meta-analysis, whereas the present analysis based
the estimates on a single study.
Despite the differences between these economic evaluations,
collectively they suggest that methods of decreasing the time between
onset of out-of-hospital cardiac arrest and defibrillation are
potentially economically attractive.
The potential costs and outcomes of PAD estimated by this
analysis should be interpreted cautiously. However, the
incremental cost per additional quality-adjusted life year is similar
to that of other common medical interventions (ie, <$50 000 per
quality-adjusted life year).30 If PAD is as
effective and inexpensive as we believe, then it will be economically
attractive compared with other interventions.
Our estimate of the effectiveness of PAD was derived from a
nonexperimental study of the impact of enhanced defibrillation. This
study evaluated use of defibrillators by police who were targeted
responders to cardiac emergencies, rather than use by minimally trained
members of the public. At present, there are no published data that
describe the effect of use of defibrillators by the public on time to
defibrillation or on survival. However, implementation of enhanced
defibrillation in casinos in the United States has been associated with
a large decrease in the time interval between the onset of cardiac
arrest and the provision of defibrillation (personal communication, T.
Valenzuela, June 27, 1997). Experimental studies are now necessary to
demonstrate whether PAD is an effective and cost-effective treatment,
because outcomes after cardiac arrest may be influenced by several
factors.31
This analysis used Monte Carlo simulation to evaluate the
magnitude of uncertainty in the cost-effectiveness of
PAD.27 The range of the incremental
cost-effectiveness of PAD was very large because the value of several
input variables was highly uncertain. Furthermore, the distribution
of the results was skewed because several of the input variables
were not normally distributed. However, if the incremental cost of PAD
is as low as $15 700 per quality-adjusted life year, then the program
will be quite economically attractive. Conversely, if the incremental
cost of PAD is as high as $68 900 per quality-adjusted life year, then
the program may not be economically attractive. Therefore, any
experimental study of the cost-effectiveness of PAD should have
sufficient power to detect a meaningful economic
difference.32
This analysis may have overestimated the incremental
cost-effectiveness of PAD (ie, may have been biased against finding it
economically attractive), for several reasons. First, the proportion of
cardiac arrests that occur in public was close to the lower end of the
range of values reported. Second, we deliberately underestimated the
relative effectiveness of PAD compared with the relative effectiveness
of enhanced defibrillation that was reported by White et
al10 (relative benefit, 2.2).
There are several limitations to this analysis. First, the
input data were derived from several sources. Because multiple sources
were used, these estimates may be confounded by information that was
not incorporated into the model. For example, the effectiveness of
resuscitation was not adjusted for the response time interval. Second,
we assumed that the costs of EMS systems were equivalent between the
two strategies. However, it is plausible that implementation of PAD may
increase the costs of EMS systems, because the number of patients who
experience restoration of circulation in the field will increase.
Finally, it is unlikely that the relative benefit of defibrillation
will be constant as the proportion of patients who survive with
standard EMS systems increases. Therefore, our analysis should
be revised to reflect better estimates of the true effectiveness and
costs of the program as results from trials of enhanced defibrillation
become available.
Conclusions
Each police officer requires $100 of initial training in rapid
defibrillation and $35 of retraining every 4 months. An average of 10
vehicles are staffed 24 hours per day and 7 days per week. Each vehicle
costs $19 254 to purchase and has annual costs of $3900 during a
2-year lifespan. Each vehicle is staffed by one police officer
who receives annual salary and benefits of $43 963. Allowing for
vacation and sick time, 5.2 full-time equivalents are needed to staff
each vehicle. Of the $9.8 million police department budget, 10% is
used to provide administrative support. The costs of police
defibrillation were calculated by adding the training and equipment
costs to the wage, administrative, and vehicle costs. These latter
costs were allocated to the defibrillation program by multiplying by
the ratio of cardiac arrest cases to total call volume. Thus, the net
cost of the police defibrillation program is $223 per cardiac
arrest.
© 1998 American Heart Association, Inc.
Special Reports
Potential Cost-effectiveness of Public Access Defibrillation in the United States
Abstract
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Background—Approximately 360 000
Americans experience sudden cardiac arrest each year; current
treatments are expensive and not very effective. Public access
defibrillation (PAD) is a novel treatment for out-of-hospital sudden
cardiac arrest that refers to use of automated external defibrillators
by the lay public or by nonmedical personnel such as police. A clinical
trial has been proposed to evaluate the effectiveness of public access
defibrillation, but it is unclear whether such early defibrillation
will offer sufficient value for money. Our objective was to estimate
the potential cost-effectiveness of public access defibrillation by use
of decision analysis.
Key Words: cost-benefit analysis • heart-assist device • heart arrest
Introduction
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Cardiovascular
disease is the most common cause of death in North
America.1 2 During the past 20 years, morbidity
and mortality rates for nearly all types of
cardiovascular disease have declined. However, there
has been little decline in the incidence of sudden cardiac arrest. In
the United States, 
1000 patients experience cardiac arrest each
day.1 3
Methods
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Interventions
We considered treatment of out-of-hospital sudden cardiac arrest
by an EMS system (standard EMS system) or by an EMS system supplemented
by PAD. Because PAD may be implemented by training and equipping either
lay responders or police, separate analyses considered either
of these programs.
Data were obtained by a search of the English-language MEDLINE
reference media from 1966 to 1997, under the subject heading "heart
arrest," combined with "randomized controlled trials (PT)," or
"prospective studies" (Table 1
). Most
of these articles described cohort studies of patients who had
experienced sudden cardiac arrest. This was supplemented by information
from a recent nonexperimental study of the implementation of expanded
defibrillation by police.10
View this table:
[in a new window]
Table 1. Input Data
A simple decision tree was constructed to compare costs and
outcomes after out-of-hospital cardiac arrest treated by each program
(Fig 1). According to the decision model,
a patient who experienced sudden cardiac arrest either died before
hospital, died in hospital, or lived to discharge. If the EMS system
was supplemented by PAD by lay responders, then patients who
experienced sudden cardiac arrest in a public place potentially
benefited from enhanced defibrillation. If the EMS system was
supplemented by PAD by police, then all patients who experienced sudden
cardiac arrest potentially benefited from enhanced defibrillation.
View larger version (20K):
[in a new window]
Figure 1. Decision model.
We made several assumptions about the costs of implementing and
maintaining a PAD program because the magnitude of the costs of such
programs is unknown at present. First, implementation of PAD would
not change the costs of treatment of sudden cardiac arrest by EMS.
Second, the individual cost of a defibrillator will decrease from the
current list price of $3000 to $2500 as competition increases among
defibrillator manufacturers. Third, the density of distribution of
defibrillators in a community was such that one device was available
for each cardiac arrest that occurred in public. Fourth, the training
and maintenance costs for the PAD program were equivalent to
10% of the total device costs.
Outcomes
The probability of each outcome associated with standard EMS or
PAD was derived from the literature review described above (Table 1
).
For standard EMS systems, the probability of survival to hospital
admission was derived from a meta-analysis of the effectiveness
of resuscitation for out-of-hospital cardiac
arrest.5 Then the probability of survival from
admission to discharge was calculated, so that the overall survival to
hospital discharge was 8%. The relative benefit of PAD compared with
standard EMS systems was based on a case-control study of provision of
early defibrillation by police.10 Life expectancy
after discharge from hospital was calculated from a large cohort of
survivors of cardiac arrest, by use of a declining exponential
approximation of life expectancy.21 The quality
of life of survivors of cardiac arrest was estimated from a recent
prospective study of the health-related quality of life of survivors of
cardiac arrest.20
The economic perspective was that of society. All costs were
expressed in 1996 American dollars (Table 1). Capital costs of
equipment were discounted over their anticipated lifespan, with a
discount rate of 3%.22 The cost of police
defibrillation was estimated from the budget of the police
defibrillation program in Rochester, Minn (Appendix). The costs of
hospitalization were derived from a cohort of patients who were treated
at a single medical center after experiencing out-of-hospital cardiac
arrest in Tucson, Ariz, in 1996, stratified according to whether the
patients survived to hospital discharge (personal communication, L.
Clark, August 20, 1997). Then the net cost of any outcome (ie, death
before hospital, death in hospital, or survival to discharge) was
calculated as the sum of the costs of prehospital care and
in-hospital care.
One-way sensitivity analyses evaluated the robustness of
the results as follows. We substituted the upper and lower limits of
the value of each variable in the decision model while holding all
other values constant (Table 1).27 28 For
empirical variables (eg, cost of hospitalization), these upper and
lower limits were considered to be equivalent to the 95% confidence
limits for the value of each variable. For assumed or estimated
variables (eg, overall survival in standard EMS system, cost of a
defibrillator, cost of implementing and maintaining the defibrillator
program, and discount rate), the upper and lower limits were based on
reasonable possible limits. Threshold analyses were conducted
to identify the value of each variable across its range, if any, at
which one should be indifferent between standard EMS or PAD (ie, the
costs and outcomes of the two strategies were
equal).28
Results
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Cost-effectiveness of PAD
The analyses suggested that in an urban EMS system with an
overall survival of 8%, implementation of PAD by lay responders was
associated with a median incremental survival of 0.7% (IQR, 0.5% to
0.9%) (Table 2). Compared with a
standard EMS system, PAD was associated with a median cost of $44 000
(IQR, $29 000 to $68 900) per additional quality-adjusted life
year.
View this table:
[in a new window]
Table 2. Potential Cost-effectiveness of PAD by Lay
Responders ).
View this table:
[in a new window]
Table 3. Potential Cost-effectiveness of PAD by Police ).
View this table:
[in a new window]
Table 4. Potential Immediate Costs and Outcomes of PAD
by Police
The difference between the costs and outcomes of PAD compared with
standard EMS systems was not affected by reasonable
univariate changes in values for most variables.
Because the results of the sensitivity analyses were similar
for either type of PAD program, we will focus on the robustness of the
results for police defibrillation. ). As the rate of survival with standard
EMS systems increases, the cost per additional quality-adjusted life
year decreases. Also, as the relative benefit of PAD increases, the
cost per additional quality-adjusted life year decreases.
View larger version (15K):
[in a new window]
Figure 2. Cost-effectiveness of police defibrillation
according to survival with standard EMS systems and relative benefit of
police defibrillation. Sensitivity analysis comparing the
incremental cost-effectiveness of police defibrillation compared with
standard EMS systems across a range of possible values for survival to
hospital discharge with standard EMS systems and relative benefit of
police defibrillation. QALY indicates quality-adjusted life year.
The United States has a population of 267 792 000 people. Of
these, 85% live in an urban center; 27% are >50 years
old.29 The annual incidence of sudden cardiac
arrest among people 
50 years old in Seattle, Wash, is 0.7% (personal
communication, A. Hallstrom, August 15, 1997); 20% of cardiac arrests
occur in public places; the average survival to hospital discharge
after out-of-hospital sudden cardiac arrest is 8%. If PAD has a
relative benefit of 1.5, implementation of defibrillation by lay
responders may save >4065 additional lives annually. Alternatively,
implementation of defibrillation by police may save >20 000
additional lives annually.
Discussion
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Our analysis shows that implementation of PAD in an urban
center in the United States is potentially economically attractive.
Furthermore, defibrillation of out-of-hospital sudden cardiac arrest
patients by lay or police responders may save the lives of thousands of
Americans each year. These represent important potential public
health benefits.
Implementation of PAD in the United States is potentially
associated with an incremental cost-effectiveness ratio similar to
other common medical interventions. Therefore, a randomized, controlled
trial is necessary to evaluate the effectiveness and cost-effectiveness
of expanded use of defibrillation in sudden cardiac arrest.
Selected Abbreviations and Acronyms
AED
=
automated external defibrillator
EMS
=
emergency medical services
IQR
=
interquartile range
PAD
=
public access defibrillation
Appendix 1
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
Costs of Police Defibrillation
The costs of implementing PAD by police responders were based on
the costs of the police defibrillation program in Rochester, Minn
(personal communication, Roger D. White, August 20, 1997). This program
serves 40 cardiac arrest cases among 60 000 calls annually in a
geographic area of 32.6 square miles.
Acknowledgments
We would like to thank Lani Clark for assistance with the
costing of hospitalization and Patricia Bowser for her invaluable
administrative support.
Footnotes
Reprint requests to Pat Bowser, 3606 Reposo Way, Belmont, CA 94002.
References
Top
Abstract
Introduction
Methods
Results
Discussion
Appendix 1
References
This article has been cited by other articles:
 |
|
 |
|
  K J Cairns, A J Hamilton, A H Marshall, M J Moore, A A J Adgey, and F Kee The obstacles to maximising the impact of public access defibrillation: an assessment of the dispatch mechanism for out-of-hospital cardiac arrest Heart, March 1, 2008; 94(3): 349 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. H Ibrahim Recent advances and controversies in adult cardiopulmonary resuscitation Postgrad. Med. J., October 1, 2007; 83(984): 649 - 654. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ali and A. M. Zafari Narrative Review: Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Review of the Current Guidelines Ann Intern Med, August 7, 2007; 147(3): 171 - 179. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. England, P. S. Weinberg, and N. A. M. Estes III The Automated External Defibrillator: Clinical Benefits and Legal Liability JAMA, February 8, 2006; 295(6): 687 - 690. [Full Text] [PDF]
|
|
|
|
 |
|
 Part 5: Electrical Therapies: Automated External Defibrillators, Defibrillation, Cardioversion, and Pacing Circulation, December 13, 2005; 112(24_suppl): IV-35 - IV-46. [Full Text] [PDF]
|
|
|
|
|
|
A. P. van Alem, M. G.W. Dijkgraaf, J. G.P. Tijssen, and R. W. Koster Health System Costs of Out-of-Hospital Cardiac Arrest in Relation to Time to Shock Circulation, October 5, 2004; 110(14): 1967 - 1973. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Priori, L. L. Bossaert, D. A. Chamberlain, C. Napolitano, H. R. Arntz, R. W. Koster, K. G. Monsieurs, A. Capucci, and H. J. Wellens ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe Eur. Heart J., March 1, 2004; 25(5): 437 - 445. [Full Text] [PDF]
|
|
|
|
|
|
M. F. Hazinski, D. Markenson, S. Neish, M. Gerardi, J. Hootman, G. Nichol, H. Taras, R. Hickey, R. O'Connor, J. Potts, et al. Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: The Medical Emergency Response Plan for Schools: A Statement for Healthcare Providers, Policymakers, School Administrators, and Community Leaders Circulation, January 20, 2004; 109(2): 278 - 291. [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Hazinski, D. Markenson, S. Neish, M. Gerardi, J. Hootman, G. Nichol, H. Taras, R. Hickey, R. O'Connor, J. Potts, et al. Response to Cardiac Arrest and Selected Life-Threatening Medical Emergencies: The Medical Emergency Response Plan for Schools. A Statement for Healthcare Providers, Policymakers, School Administrators, and Community Leaders Pediatrics, January 1, 2004; 113(1): 155 - 168. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Walker, J. M Sirel, A. K Marsden, S. M Cobbe, and J. P Pell Cost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest BMJ, December 6, 2003; 327(7427): 1316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J P Pell The debate on public place defibrillators: charged but shockingly ill informed Heart, December 1, 2003; 89(12): 1375 - 1376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Nichol, T. Valenzuela, D. Roe, L. Clark, E. Huszti, and G.A. Wells Cost Effectiveness of Defibrillation by Targeted Responders in Public Settings Circulation, August 12, 2003; 108(6): 697 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Cram, A. M. Fendrick, S. Vijan, P. W. Groeneveld, S. Caffrey-Villari, and P. E. Pepe Public Use of Automated External Defibrillators N. Engl. J. Med., February 20, 2003; 348(8): 755 - 756. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Swor, S. Compton, L. Farr, S. Kokko, F. Vining, R. Pascual, and R. E. Jackson Perceived Self-Efficacy in Performing and Willingness to Learn Cardiopulmonary Resuscitation in an Elderly Population in a Suburban Community Am. J. Crit. Care., January 1, 2003; 12(1): 65 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. L. Caffrey, P. J. Willoughby, P. E. Pepe, and L. B. Becker Public Use of Automated External Defibrillators N. Engl. J. Med., October 17, 2002; 347(16): 1242 - 1247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Stryer and W. Lawrence Automated External Defibrillators Ann Intern Med, October 1, 2002; 137(7): 622 - 622. [Full Text] [PDF]
|
|
|
|
|
|
J. P Pell, J. M Sirel, A. K Marsden, I. Ford, N. L Walker, and S. M Cobbe Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study BMJ, September 7, 2002; 325(7363): 515 - 515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke, P. W. Groeneveld, and A. M. Garber Cost-effectiveness of Aircraft Safety Measures JAMA, February 6, 2002; 287(5): 584 - 585. [Full Text] [PDF]
|
|
|
|
|
|
T. S. Takata, R. L. Page, and J. A. Joglar Automated External Defibrillators: Technical Considerations and Clinical Promise Ann Intern Med, December 4, 2001; 135(11): 990 - 998. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Groeneveld, J. L. Kwong, Y. Liu, A. J. Rodriguez, M. P. Jones, G. D. Sanders, and A. M. Garber Cost-effectiveness of Automated External Defibrillators on Airlines JAMA, September 26, 2001; 286(12): 1482 - 1489. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Sotoodehnia, A. Zivin, G. H Bardy, and D. S Siscovick Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research Cardiovasc Res, May 1, 2001; 50(2): 197 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Jaffe, W. M. Landau, R. D. Wetzel, W. J. Groh, M. E. Salive, L. D. Richardson, The Public Access Defibrillation Trial Investigato, R. E. Fried, M. Bassan, T. D. Valenzuela, et al. Automated External Defibrillators N. Engl. J. Med., March 8, 2001; 344(10): 771 - 773. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Marenco, P. J. Wang, M. S. Link, M. K. Homoud, and N. A. M. Estes III Improving Survival From Sudden Cardiac Arrest: The Role of the Automated External Defibrillator JAMA, March 7, 2001; 285(9): 1193 - 1200. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Robertson Sudden Death from Cardiac Arrest -- Improving the Odds N. Engl. J. Med., October 26, 2000; 343(17): 1259 - 1260. [Full Text]
|
|
|
|
 |
|
 G. A. Ewy and J. P. Ornato Emergency cardiac care: introduction J. Am. Coll. Cardiol., March 15, 2000; 35(4): 825 - 880. [Full Text] [PDF]
|
|
|
|
|
|
J. L. Anderson, A. P. Hallstrom, A. E. Epstein, S. L. Pinski, Y. Rosenberg, M. O. Nora, D. Chilson, D. S. Cannom, and R. Moore Design and Results of the Antiarrhythmics vs Implantable Defibrillators (AVID) Registry Circulation, April 6, 1999; 99(13): 1692 - 1699. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||