Elsevier

Resuscitation

Volume 83, Issue 11, November 2012, Pages 1411-1412
Resuscitation

Short communication
The Los Angeles public access defibrillator (PAD) program: Ten years after

https://doi.org/10.1016/j.resuscitation.2012.03.029Get rights and content

Abstract

Background

Public access automated external defibrillator (PAD) programs have been shown to be successful in several municipalities. This study sought to determine the usage of and survival rate from a large, urban PAD program in the first 10 years since its implementation.

Methods

This was a prospective, longitudinal, observational study from January 2002–2012 conducted in Los Angeles, California, a city with a population of 3.8 million. An incremental rollout resulted in a current total of 1300 automated external defibrillators (AEDs) in place in city-owned buildings and other public places, including all 3 area airports, golf-courses, and public pools. All instances where an AED was applied were included in the study.

Results

There were 59 incidents of cardiac arrest with a public access AED applied, of which 42 (71%) occurred at an airport. 51 (86%) of the patients were male, with a median age of 64 years (interquartile range, 56.5 to 70 years). A shockable rhythm was detected and shocks were applied in 39 (66%) patients, with 30 (77%) of these patients achieving a return of spontaneous circulation (ROSC). Of those patients who received shock(s) by public access AED, 27 (69%) survived to hospital discharge. The youngest survivors were a 25 year old male and a 34 year old female.

Conclusion

While the majority of PAD cases occurred at an airport, there were also survivors from other public locations. AEDs deployed as part of a large PAD program resulted in a very high survival rate for patients with cardiac arrest.

Section snippets

Background

Sudden cardiac death is a leading cause of mortality in North America and Europe.1, 2, 3 Patients whose presenting rhythm is ventricular fibrillation have the highest chances of survival, which has led to efforts to expedite the rapid availability of defibrillators.3, 4, 5 Given the fact that each one minute delay in defibrillation decreases the patient's chances of survival by almost 10%,6, 7 automated external defibrillators (AEDs) have been strategically placed in public areas with very high

Methods

This was a prospective, longitudinal, observational study from 2002–2012 conducted in Los Angeles, California, a city with a population of 3.8 million. Automated external defibrillators (AEDs) were placed in city-owned buildings and other public places, including all 3 area airports, golf-courses, and public pools.

Initial funding was approved by the Los Angeles City Council in the 1999–2000 budget. This initial funding provided for purchase of 62 AEDs, which were placed in various City-owned

Results

There were 59 incidents of cardiac arrest with a public access AED applied, of which 42 (71%) occurred at an airport. 51 (86%) of the patients were male, with a median age of 64 years (interquartile range, 56.5 to 70 years).

A shockable rhythm was detected and shocks were applied in 39 (66%) patients, with 30 (77%) of these patients achieving a return of spontaneous circulation (ROSC). Of those patients who received shock(s) by public access AED, 27 (69%) survived to hospital discharge. All

Discussion

Early defibrillation is a vital link in the chain of survival. Since the interval from time of collapse to first shock is directly related to survival, and success of defibrillation decreases 8–10% with each minute that defibrillation is delayed,6, 7 public access defibrillator programs have become widespread.8, 9, 10, 11, 12

Several published reports detail the success of public access AED programs. Caffrey, et al. described the success of a PAD program at 3 airports in Chicago, which found a

Conclusion

AEDs deployed as part of a large PAD program resulted in a very high survival rate for patients with cardiac arrest, with the majority of cases occurring at area airports. This resulted in an average of three additional lives saved per year.

Conflict of interest statement

No conflicts of interest to declare.

Acknowledgement

I would like to acknowledge the efforts of Valerie Munoz and June Andrade, the Los Angeles AED Program Managers, whose dedicated efforts made this program possible.

References (15)

There are more references available in the full text version of this article.

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    Table 3 shows the rate of survival to hospital discharge for various patient subgroups who were first shocked by a bystander with a public AED in Victoria, Australia, alongside comparable data from other published PAD studies. Survival to hospital discharge rates seen in our study are quite favourable compared to previous PAD studies.13–18 Table 4 shows that first defibrillation by a bystander using a public AED was independently associated with an increased odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared with patients first defibrillated by EMS.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.03.029.

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