Outcomes of rapid defibrillation by security officers after cardiac arrestin casinos.

Background: The use of automated external defibrillators by persons other t han paramedics and emergency medical technicians is advocated by the Americ an Heart Association and other organizations. However, there are few data o n the outcomes when the devices are used by nonmedical personnel for out-of -hospital cardiac arrest. Methods: We studied a prospective series of cases of sudden cardiac arrest in casinos. Casino security officers were instructed in the use of automate d external defibrillators. The locations where the defibrillators were stor ed in the casinos were chosen to make possible a target interval of three m inutes or less from collapse to the first defibrillation. Our protocol call ed for a defibrillation first (if feasible), followed by manual cardiopulmo nary resuscitation. The primary outcome was survival to discharge from the hospital. Results: Automated external defibrillators were used in 105 patients whose initial cardiac rhythm was ventricular fibrillation. Fifty-six of the patie nts (53 percent) survived to discharge from the hospital. Among the 90 pati ents whose collapse was witnessed (86 percent), the clinically relevant tim e intervals were a mean (+/-SD) of 3.5+/-2.9 minutes from collapse to attac hment of the defibrillator, 4.4+/-2.9 minutes from collapse to the delivery of the first defibrillation shock, and 9.8+/-4.3 minutes from collapse to the arrival of the paramedics. The survival rate was 74 percent for those w ho received their first defibrillation no later than three minutes after a witnessed collapse and 49 percent for those who received their first defibr illation after more than three minutes. Conclusions: Rapid defibrillation by nonmedical personnel using an automate d external defibrillator can improve survival after out-of-hospital cardiac arrest due to ventricular fibrillation. Intervals of no more than three mi nutes from collapse to defibrillation are necessary to achieve the highest survival rates.