ESC-ERC recommendations for the use of automated external defibrillators (AEDs) in Europe

Hospital-wide first-responder automated external defibrillator programme: 1 year experience

The first year experience with a hospital-wide first-responder automated external defibrillator (AED) programme implemented in a 683-bed University Hospital is reported. Throughout the hospital, 14 "AED access spots" were identified which could be easily reached from all wards and diagnostic rooms within 30s. AEDs were installed (Lifepak 500; Medtronik PhysioControl Corp., Redmond, USA, equipped with a Biolog 3000i portable ECG monitor; Micromedical Industries Ltd., Labrador, Australia). Within 3 months, 120 medical officers, 750 nurses, and 50 administrative or technical staff underwent a 2h training programme. An AED was applied and activated by nurses/medical staff before the cardiac arrest team arrived in 27 of 33 cases (81.8%) of witnessed cardiac arrest. The median time from onset of the emergency call to the activation of the AED (record of ECG) was on average 2.1 min (range 1.0--4.5 min). In 18 of 27 cases in which the AED was installed promptly, the primary arrest rhythm was either VT or VF, and the AED delivered a shock. For this subgroup, the rate of return of spontaneous circulation and the rate of discharge at home were 88.9 and 55.6%, respectively. This encourages us to extend the concept of first-responder AED-defibrillation throughout our hospital.

[First responder defibrillation in the USA, Europe and Germany--prerequisites, experiences, perspectives]

Sudden out-of-hospital cardiac arrest is a leading cause of death and only 5-8% of patients survive such event. Defibrillation is the mose effective treatment and should performed within 5 minutes; however, its effectiveness diminishes with each passing minute. "Early defibrillation" is the use of automated external defibrillators (AEDs) by trained public-safety personnal ("first responder"), whereas "public access" defibrillation describes AED use by persons who have no specific AED training. Several studies in the US and in Europe show that first responder defibrillation will increase the number of survivors of out-of-hospital cardiac arrest compared to paramedics. This is caused by a shorter "call-to-arrival-time" in first responders compared to paramedics. In Europe, programs for the use of automated external defibrillators exist only occasionally. Reasons for this are the lack of open-mindedness, logistic and legal problems. In Germany, there are only few AED programs with promising results. At the present time, placement of automated external defibrillators in public places frequented by a large number of susceptible people will increase overall survival. However, placement of AEDs in all public places is still debatable and further studies are necessary to estimate the potential impact of publicc access defibrillators.

Reality of out of hospital cardiac arrest

The high mortality rates associated with out of hospital cardiac arrest, particularly those occurring in the home, stress the need for early treatment in the form of publicly accessible external defibrillators.

Therapie bedrohlicher Herzrhythmusst�rungen

Tachyarrhythmias represent a frequent problem in intensive care medicine. However, considerable uncertainty prevails among physicians regarding optimal pharmacotherapy, due also to numerous negative study results on chronic antiarrhythmic therapy. Moreover, in an emergency situation, the physician faces the dilemma of treating a potentially life-threatening arrhythmia as quickly as possible while simultaneously ensuring adequate diagnostic work-up, which will be decisive for long-term therapy once the patient has survived the crisis. The differential diagnosis between supraventricular and ventricular tachycardias is primarily facilitated by knowledge of a few salient points from the patient's history and 12-lead electrocardiography. This overview presents the most important principles for treating these arrhythmias. Interventional therapy principles (overstimulation, ablation) play an increasing role in these considerations. New insights on the pathogenesis of "malignant" arrhythmias and implementation of new concepts such as defibrillation by lay responders with the automatic external defibrillator will substantially influence emergency treatment of tachyarrhythmias in the coming years.