312: Out-of-hospital cardiac arrest: use of automated external defibrillators and in-hospital death

Introduction The availability of automated external defibrillators (AEDs) has spread throughout urban areas, for use by the general population in an effort to improve the outcomes of patients with out-of-hospital cardiac arrest (CA). The efficacy and safety of this approach are not well known. We sought to assess the in-hospital outcomes of patients treated with such AEDs for out-of-hospital CA. Methods Between 2004 and 2010, 12,144 consecutive patients with out-of-hospital CA were enrolled in the RENAU-RESURCOR permanent registry, which is being conducted in the French Alps. Since 2008, 190 AEDs have been placed in cities in this region, mainly in public areas. We report in-hospital survival rates in patients treated or not treated with these AEDs. Results Data were analysed from 3249 consecutive patients with CA occurring before the arrival of emergency non-medical care services and with cardiopulmonary resuscitation attempted by prehospital emergency medical staff. The cause of CA was cardiac in 2135 patients (572 were in ventricular fibrillation) and non-cardiac in 1114 (eg, drowning, respiratory failure, asphyxia, trauma, haemorrhage, poisoning). Twenty-four patients were treated with AEDs: these patients were younger, more often male and the median time from collapse to electric shock was shorter (Table). Over time the rate of patients treated with an AED increased: 1/1606 (0.1%) in 2008; 8/1688 (0.5%) in 2009; 15/1638 (0.9%) in 2010. In-hospital survival was 25% for patients treated with AED vs 3.4% for those not treated with AED (P Conclusion The rate of in-hospital survival in patients with out-of-hospital CA could be improved with the use of AEDs available in the community. These preliminary data need to be evaluated and confirmed in larger studies with analysis taking account of confounding factors. Table. Patient characteristics and in-hospital survival rates according to use or lack of use of out-of-hospital automated external defibrillator (AED). Treated with AED (n=24) Not treated with AED (n=3225) Age, median (interquartile range), yrs 60 (45–70) 65 (45-70) Men, n (%) 16 (67) 2294 (71) Time from collapse to shock, median (interquartile range), min 6 (2–12) 14 (10–18) Overall survival, n (%) 6 (25) 110 (3.4) Survival (cardiac cause of CA), n (%) 6/20 (30) 84/2115 (4.0) Survival (non-cardiac cause of CA), n (%) 0/4 (0) 26/1110 (2.3) Survival (CA and ventricular fibrillation), n (%) 5/12 (42) 1/560 (0.2)