BMJ 2002;325:515 ( 7 September )

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Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study

Jill P Pell, honorary clinical senior lecturer, ^a Jane M Sirel, research assistant, ^a Andrew K Marsden, medical director, ^b Ian Ford, professor of statistics, ^c Nicola L Walker, senior house officer, ^a Stuart M Cobbe, Walton professor of medical cardiology. ^a

^a Department of Medical Cardiology, University of Glasgow, G31 2ER, ^b Scottish Ambulance Service Headquarters, Edinburgh EH10 5UU, ^c Robertson Centre for Biostatistics, University of Glasgow G12 8QQ

Correspondence to: Stuart M Cobbe stuart.cobbe{at}clinmed.gla.ac.uk

Objective: To estimate the potential impact of public access defibrillators on overall survival after out of hospital cardiac arrest.
Design: Retrospective cohort study using data from an electronic register. A statistical model was used to estimate the effect on survival of placing public access defibrillators at suitable or possibly suitable sites.
Setting: Scottish Ambulance Service.
Subjects: Records of all out of hospital cardiac arrests due to heart disease in Scotland in 1991-8.
Main outcome measures: Observed and predicted survival to discharge from hospital.
Results: Of 15 189 arrests, 12 004 (79.0%) occurred in sites not suitable for the location of public access defibrillators, 453 (3.0%) in sites where they may be suitable, and 2732 (18.0%) in suitable sites. Defibrillation was given in 67.9% of arrests that occurred in possibly suitable sites for locating defibrillators and in 72.9% of arrests that occurred in suitable sites. Compared with an actual overall survival of 744 (5.0%), the predicted survival with public access defibrillators ranged from 942 (6.3%) to 959 (6.5%), depending on the assumptions made regarding defibrillator coverage.
Conclusions: The predicted increase in survival from targeted provision of public access defibrillators is less than the increase achievable through expansion of first responder defibrillation to non-ambulance personnel, such as police or firefighters, or of bystander cardiopulmonary resuscitation. Additional resources for wide scale coverage of public access defibrillators are probably not justified by the marginal improvement in survival.

What is already known on this topic Three quarters of all deaths from acute coronary events occur before the patient reaches a hospital Defibrillation is an independent predictor of survival from out of hospital cardiac arrest The probability of a rhythm being amenable to defibrillation declines with time Interest in providing public access defibrillators to reduce the time to defibrillation has been growing, but their potential impact on overall survival is unknown What this study adds Most arrests occur in sites unsuitable for locating public access defibrillators Arrests that occur in sites suitable for locating defibrillators already have the best profile in terms of ambulance response time, use of defibrillation, and survival of the patient Public access defibrillators are less likely to increase survival than expansion of first responder defibrillation or bystander cardiopulmonary resuscitation

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