ORLANDO, Fla. - Training good Samaritans to use automated defibrillators on people whose hearts stop in public places such as malls doubles their survival chances, compared with performing CPR alone, according to a large government-funded study released Tuesday.
The trial was the most extensive effort to date to address cardiac arrest, a public health problem that has one of the most dismal survival rates - it kills 460,000 people outside of hospitals each year. In some communities, survival from cardiac arrest is as low as 1 percent.
Just to pull off the $13 million trial, more than 20,000 volunteers needed to be trained in CPR and the use of an automated external defibrillator. Twenty-four North American cities participated in the study.
A defibrillator delivers an electric shock to a heart that is in an abnormal rhythm. More than 1,600 devices, donated by three defibrillator manufacturers, were installed at 993 locations. Defibrillators can cost between $1,000 and $3,000 each.
The findings were presented at the American Heart Association's annual meeting in Orlando, Fla.
The trial was conducted because even with well-trained, quick-responding paramedic systems, many cardiac arrest patients die before help arrives.
"We know a lot of people die before they get to the hospital," said Raymond Gibbons, a professor of medicine at the Mayo Clinic and Foundation, who was not involved in the research. "Anything we can do to improve survival is enormously important."
That's precisely what happened in Milwaukee, where three lives were saved as a strong public response to the trial, said Tom Aufderheide, one of the study's investigators and a professor of emergency medicine at the Medical College of Wisconsin.
The study resulted in dozens of the devices being placed in Milwaukee area shopping malls, fitness centers, workplaces and office buildings.
"This is a landmark trial," said Aufderheide, who practices at Milwaukee's Froedtert Memorial Lutheran Hospital. "This should change the national practice of medicine and increase the widespread but careful dissemination of public-access defibrillators throughout our communities."
Aufderheide said he was especially heartened by the case of a middle-aged father who collapsed at his fitness center and was revived with a defibrillator. He later was discharged from the hospital without neurological damage, Aufderheide said.
"It was quite inspiring to see," he said.
Because of the quality of Milwaukee's emergency medical system, it has a cardiac arrest survival rate of 9 percent, Aufderheide said.
"In New York City, it's 1 percent," he said. "Nationally, it's 5 percent."
The study's authors say it shows that ordinary people can easily and safely be instructed to use a life-saving technology that once was reserved for emergency medical personnel. More recently the devices have been used successfully by guards and other workers at airports, casinos and convention centers.
To prove that ordinary people could use the devices and save lives, two groups of volunteers were trained around North America. One group got training in traditional CPR. The other group received CPR training plus instruction in how to use a defibrillator.
Over the course of nearly two years, there were 232 attempts to revive people who had gone into cardiac arrest, 44 of whom survived to be discharged from a hospital. The defibrillator group revived 29 people and the CPR group revived 15 patients.
The next step is to do a similar study looking at defibrillator use in 7,000 homes.
"Most cardiac arrests occur in the home, roughly 80 percent," said study co-author Joseph Ornato, a professor of emergency medicine at Virginia Commonwealth University Medical Center.
Most of the funding for the study came from the National Heart, Lung and Blood Institute of the National Institutes of Health and the American Heart Association. In addition, three manufacturers of defibrillators supplied the devices.
(c) 2003, Milwaukee Journal Sentinel. Distributed by Knight Ridder/Tribune News Service.