Nov. 16, 2000 NEW ORLEANS, Nov. 15 – Strategically placing automated external defibrillators (AEDs) one minute apart, and making them easy to spot, has helped prevent sudden cardiac deaths at Chicago’s heavily trafficked O’Hare and Midway Airports, according to a study presented today at the American Heart Association’s Scientific Sessions 2000.
The City of Chicago Airport System’s HeartSave Program placed 49 AEDs on walls throughout O’Hare and Midway Airports in June 1999. Two more AEDs were placed in parking facilities. Approximately 80 million passengers each year travel through O’Hare and 20 million move through Midway. The devices were mounted in plain view. With easy-to-use audio and visual prompts, the devices helped minimize critical response times to emergency care.
In the first ten months of operation, 14 sudden cardiac arrests occurred. Twelve of the 14 victims were in ventricular fibrillation – the often fatal, unsynchronized contraction of the heart’s ventricles that permits little or no blood to be pumped from the heart. Nine of the victims were revived with an AED and sustained no neurological damage. In nine of the incidents, airport travelers successfully operated the devices, rather than on-site staff formally trained in the airport’s HeartSave Program. In places without rapid response to these lethal heart rhythms, survival has averaged 4 percent. Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and defibrillation. Chances of survival are reduced by 7-10 percent with every minute of delay. Few attempts at resuscitation are successful after 10 minutes.
“Easy access and high visibility may be ingredients for success,” says the study’s lead author, Paula J. Willoughby, D.O., emergency medical services advisor for the Chicago Fire Department. “The real issue right now for these devices is where to put them.” Willoughby is also an attending physician at West Suburban Hospital and Medical Center in Oak Park, Ill.
AEDs have proven effective in rapidly correcting ventricular fibrillation. The device delivers an electrical charge that briefly stops the heart and allows it to resume a normal rhythm. Individuals who have ventricular fibrillation quickly collapse, and without an electrical shock to correct the abnormal rhythm, they will most likely die.
“When these devices were first introduced, there was a lot of trepidation about where to put them and whether people would get shocked right and left if the lay public used them,” Willoughby says. “Our data suggest that these devices can be simple to use and that the public can use them properly when given simple instructions.
“The Chicago HeartSave Program is continually planning for strategic placement and further expansion of the program into work site locations. If the intent is to use them publicly, there needs to be very close access and people need to see right where they are,” Willoughby says. She points out that while AEDs have been rapidly disseminated in emergency response vehicles, there has yet to be a national effort to strategically place them in public places around the nation. She believes that training the lay public in the use of AEDs will help avert many sudden cardiac deaths in people with life-threatening ventricular fibrillation.
The American Heart Association recently updated and published “Guidelines 2000 for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC),” which recommend placing more AEDs in public locations and training more lay rescuers in their use. According to these guidelines, AED programs have the potential to be the single greatest advance in the treatment of pre-hospital sudden cardiac arrest since the invention of CPR.
“The association supports efforts to provide prompt defibrillation to victims of cardiac arrest, and AEDs are one of the most promising methods for achieving rapid defibrillation,” says Rose Marie Robertson, M.D. president of the American Heart Association. “The statistics are overwhelming – AEDs save lives and it takes little training to know how to use them.”
In addition to its traditional CPR training courses, the American Heart Association offers courses combining CPR and AED instruction for the lay public (toll free: 1-977-AHA-4CPR.) According to the latest data available, sudden cardiac arrest occurs more than 600 times per day in the United States – most of these are due to ventricular fibrillation. Early CPR and rapid defibrillation combined with early advanced care can result in long-term survival rates as high as 40 percent for witnessed sudden cardiac arrest.
Sherry Caffrey, from the City of Chicago Airport System is a co-author of the paper.
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