Published Online
on March 15, 2004

A more recent version of this article appeared on April 20, 2004

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Submitted on September 3, 2003
Revised on November 18, 2003
Accepted on January 27, 2004

Public Access Defibrillation in Out-of-Hospital Cardiac Arrest. A Community-Based Study

Linda L. Culley BA^*, Thomas D. Rea MD, MPH, John A. Murray MD, Barbara Welles RN, Carol E. Fahrenbruch BS, MSPH, Michele Olsufka RN, Mickey S. Eisenberg MD, PhD, and Michael K. Copass MD

From Public Health-Seattle and King County, Emergency Medical Services Division (L.L.C., T.D.R., B.W., J.A.M., M.S.E.); Seattle Medic One (C.E.F., M.O., M.K.C.); and the Department of Medicine, University of Washington (T.D.R., J.A.M., M.S.E., C.E.F., M.O., M.K.C.), Seattle, Wash.

^* To whom correspondence should be addressed. E-mail: Linda.Culley{at}metrokc.gov.

Background--The dissemination and use of automated external defibrillators (AEDs) beyond traditional emergency medical services (EMS) into the community has not been fully evaluated. We evaluated the frequency and outcome of non-EMS AED use in a community experience.

Methods and Results--The investigation was a cohort study of out-of-hospital cardiac arrest cases due to underlying heart disease treated by public access defibrillation (PAD) between January 1, 1999, and December 31, 2002, in Seattle and surrounding King County, Washington. Public access defibrillation was defined as out-of-hospital cardiac arrest treated with AED application by persons outside traditional emergency medical services. The EMS of Seattle and King County developed a voluntary Community Responder AED Program and registry of PAD AEDs. During the 4 years, 475 AEDs were placed in a variety of settings, and more than 4000 persons were trained in cardiopulmonary resuscitation and AED operation. A total of 50 cases of out-of-hospital cardiac arrest were treated by PAD before EMS arrival, which represented 1.33% (50/3754) of all EMS-treated cardiac arrests. The proportion treated by PAD AED increased each year, from 0.82% in 1999 to 1.12% in 2000, 1.41% in 2001, and 2.05% in 2002 (P=0.019, test for trend). Half of the 50 persons treated with PAD survived to hospital discharge, with similar survival for nonmedical settings (45% [14/31]) and out-of-hospital medical settings (58% [11/19]).

Conclusions--PAD was involved in only a small but increasing proportion of out-of-hospital cardiac arrests.

Key words: heart arrest • defibrillation • automated external defibrillator • cardiopulmonary resuscitation

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