(Circulation. 1995;92:2740-2747.)
© 1995 American Heart Association, Inc.
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American Heart Association Report on the Public Access Defibrillation Conference December 8-10, 1994
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Introduction |
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During the past 20 years, morbidity and mortality rates for nearly all types of cardiovascular disease have declined. Progress in these areas is in stark contrast to that for sudden cardiac death, which continues unabated at a rate of approximately 1000 times per day in the United States, with little decline in incidence or improved outcome. Clearly, the problem of sudden cardiac death is best approached through prevention, but horizons in that area seem no more promising and in some respects less promising and substantially more costly than 2 decades ago.
The means necessary for successful resuscitation of a patient in cardiac arrest were known by the early 1960s. Externally performed cardiopulmonary resuscitation (CPR) could maintain an "oxygen plateau" and delay permanent brain damage long enough to allow external defibrillation using direct current (DC). The possibility of long-term survival was increasingly recognized, as early anecdotal experiences accumulated into published series.1 2 3
Given the hindsight of 3 decades, the obstacles to be overcome
before significant progress could be made in out-of-hospital
resuscitation were formidable. First, cardiac arrest was perceived as
an event that typically occurred in the hospital. In-hospital
cardiac arrests are now recognized to represent only a small
proportion of sudden deaths based in the community. Second, the CPR
technique was known to only a limited number of hospital-based
physicians. CPR is no longer restricted to hospitals or physicians; it
is routinely taught to the lay public. Third, only line-powered,
bulky, and awkward defibrillators were available. The first
out-of-hospital defibrillation device
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