January 27th, 2011
Shockable Arrhythmias Less Frequent in the Home
Cardiac arrest with a shockable arrhythmia (VF or pulseless VT) is less likely to occur at home than in public, according to a new study published in the New England Journal of Medicine. Myron Weisfeldt and investigators from the Resuscitation Outcomes Consortium (ROC) Investigators evaluated nearly 13,000 out-of-hospital cardiac arrests and found that shockable arrhythmias occurred more than twice as frequently in public than in the home. When AEDs were used, the rate of survival to hospital discharge was 34% for arrests that happened in public compared to only 12% for arrests that happened at home.
The authors conclude that their finding “adds strength to the argument for putting AEDs in public locations” and suggests that “a treatment strategy that emphasizes prompt, bystander-delivered CPR of high quality (e.g., with the assistance of a dispatcher) should be as effective in saving lives as the widespread deployment of AEDs in homes.”
In an accompanying editorial, Gust Bardy suggests the difference between home and public cardiac arrests may be more apparent than real, since the study finding might “be explained simply as a matter of response speed.” Although, he writes, “no grounds exist to broadly promote publicly financed home AEDs… this policy assessment should not dissuade persons from purchasing their own AEDs” and “other than the personal expense, there is no known downside to such a purchase.”
Bardy disagrees with the ROC investigators’ support for CPR, and argues that it is “time to reassess the value of CPR, not dismiss definitive therapy with defibrillation.” A clinical trial would allow us to “stop spending hundreds of millions of dollars and millions of hours of ‘training’ on a ‘therapy’ that makes people feel good but does little else. The cold, hard facts of the persistently low survival rate with the already existing national embrace of CPR make it hard to do worse.”