Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos

Terence D Valenzuela, Denise Roe, Graham Nichol, Lani L. Clark, Daniel W Spaite, Richard G. Hardman

Research output: Contribution to journalArticle

1055 Citations (Scopus)

Abstract

Background: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest. Methods: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital. Results Automated external defibrillators were used in 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients (53 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (±SD) of 3.5±2.9 minutes from collapse to attachment of the defibrillator, 4.4±2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8± 4.3 minutes from collapse to the arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes. Conclusions Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates. (C) 2000, Massachusetts Medical Society.

Original languageEnglish (US)
Pages (from-to)1206-1209
Number of pages4
JournalNew England Journal of Medicine
Volume343
Issue number17
DOIs
StatePublished - Oct 26 2000

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Defibrillators
Heart Arrest
Out-of-Hospital Cardiac Arrest
Allied Health Personnel
Ventricular Fibrillation
Survival Rate
Emergency Medical Technicians
Survival
Medical Societies
Sudden Cardiac Death
Cardiopulmonary Resuscitation
Shock
Organizations
Equipment and Supplies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. / Valenzuela, Terence D; Roe, Denise; Nichol, Graham; Clark, Lani L.; Spaite, Daniel W; Hardman, Richard G.

In: New England Journal of Medicine, Vol. 343, No. 17, 26.10.2000, p. 1206-1209.

Research output: Contribution to journalArticle

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abstract = "Background: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest. Methods: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital. Results Automated external defibrillators were used in 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients (53 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (±SD) of 3.5±2.9 minutes from collapse to attachment of the defibrillator, 4.4±2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8± 4.3 minutes from collapse to the arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes. Conclusions Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates. (C) 2000, Massachusetts Medical Society.",
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AB - Background: The use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest. Methods: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automated external defibrillators. The locations where the defibrillators were stored in the casinos were chosen to make possible a target interval of three minutes or less from collapse to the first defibrillation. Our protocol called for a defibrillation first (if feasible), followed by manual cardiopulmonary resuscitation. The primary outcome was survival to discharge from the hospital. Results Automated external defibrillators were used in 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patients (53 percent) survived to discharge from the hospital. Among the 90 patients whose collapse was witnessed (86 percent), the clinically relevant time intervals were a mean (±SD) of 3.5±2.9 minutes from collapse to attachment of the defibrillator, 4.4±2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8± 4.3 minutes from collapse to the arrival of the paramedics. The survival rate was 74 percent for those who received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibrillation after more than three minutes. Conclusions Rapid defibrillation by nonmedical personnel using an automated external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three minutes from collapse to defibrillation are necessary to achieve the highest survival rates. (C) 2000, Massachusetts Medical Society.

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