Efficacy of an automated external defibrillator in the management of out-of-hospital cardiac arrest: Validation of the diagnostic algorithm and initial clinical experience in a rural environment

Abstract

Automatic external defibrillators (AEDs) may have advantages over manual defibrillation in managing prehospital cardiac arrest, particularly in rural communities. We conducted a two-part evaluation of a commercially available AED. We first established the diagnostic accuracy of the AED's rhythm recognition algorithm by challenging it with 205 cardiac arrest rhythms previously recorded from actual patients in the field. The AED demonstrated 100% specificity and 92% sensitivity for ventricular fibrillation (VF) in this nonclinical setting. We then compared the clinical efficacy of AEDs in 18 small communities (study group) with that of manual defibrillation in 18 additional communities (control group) of similar size. Ambulance technicians using manual defibrillators correctly diagnosed VF more frequently than the AEDs (98% vs 83%; p.10). AEDs were able to deliver shocks more quickly than was possible with the manual defibrillators (1.56 vs 2.77 min; p .75). AEDs are an effective alternative to manual defibrillation in small communities.