Medical Malpractice Case of the Month
March 2002

Rapid defibrillation is a key element in improving survival rates for people with out-of-hospital cardiac arrest. Two studies provide data on the use of defibrillators by people other than emergency medical personnel.
In the first study, automated external defibrillators were placed in casinos in Nevada and Mississippi, and security officers were taught how to use them. A total of 18 people suffered cardiac arrest in those casinos; the defibrillators were used in 105 whose initial rhythm was ventricular fibrillation. Of these 105 people, 56 (53%) survived to hospital discharge. Among a subgroup of 35 people whose collapses were witnessed and who received defibrillation within 3 minutes, the survival rate was 74%. The authors assert that "no survivor was dependent on others for daily support," but no further details on neurologic outcomes were given.
The second study was sponsored by a U.S. airline that put defibrillators on all flights and trained attendants in defibrillator use. The defibrillator was placed on 99 passengers who experienced loss of consciousness and actually was used to deliver shocks in 13 people with defInite, and 2 with possible, ventricular fibrillation (the remaining patients had sinus rhythm, agonal rhythm, or other abnormal rhythms). Six of the 15 defibrillated people (40%) survived to hospital discharge, all reportedly with full neurologic and functional recovery.
Comment: The availability of automated external defibrillators in strategic areas outside hospitals clearly improves survival after cardiac arrest. Several questions of policy remain, including how widely defibrillators should be deployed, and who should be trained to use them.

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