Automated defibrillators could be costing lives in hospitals

November 16, 2011

Automatic Electronic Defibrillators save lives in many places, but not in hospitals. Image: Flickr / acme / CC-BY
Automatic Electronic Defibrillators save lives in many places, but not in hospitals. Image: Flickr / acme / CC-BY

Around 2000, the American Heart Association recommended that automated electronic defibrillators be used in hospitals. The belief was that these AEDs would save lives by reducing human error, but a long-term study has found the opposite is true in hospitals.

Study of hospital AEDs

Published in the Journal of the American Medical Association, a study of 11,695 patients in hospitals found that AEDs do not necessarily save more lives in hospitals. In the official language of the study:

Within the entire study population, AED use was associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use (16.3% vs 19.3%; adjusted rate ratio [RR], 0.85; 95% confidence interval [CI]

Or, in translation, about 3 percent more people survived without AED use than those who did get AED shocks. In real terms, this means that 965 individuals who had a heart attack may have been alive if this recommendation had not been followed.

The AHA recommendation

Ten years ago, it was on the recommendation of a subcommittee of the American Heart Association that many hospitals started replacing traditional defibrillators with AEDs. The recommendation was made because the AHA was concerned about the amount of time it took for most patients with cardiac arrest to receive treatment with traditional defibrillators. The recommendation was based mostly upon research studying the effectiveness of AED devices in non-medical settings, such as airplanes, schools and restaurants. The AHA admitted, in the initial recommendation, that the effectiveness of AEDs had not been studied in hospitals.

When and where AEDs should be used

Automated electronic defibrillators do not improve survival rates in hospitals. AEDs, however, do improve heart attack survival rates when they are made available in public spaces and with first responders. In short, automated electronic defibrillators are useful and effective in saving lives, but they are not necessarily the best option in hospital cardiac wards, where staff and nurses are trained in emergency cardiac care.

Sources

Fair Warning: http://www.fairwarning.org/2011/11/bad-shock-automated-devices-for-failing-hearts-may-save-fewer-lives-in-hospitals/
Journal of the American Medical Association: http://jama.ama-assn.org/content/304/19/2129
University of Iowa (PDF): http://medicina.udea.edu.co/programas/Curriculo_Nuevo/9urgen/Urgencias/NOVENO%20SEMESTRE/BIBLIOTECA%20TEMATICA/CLINICA/REANIMACION%202/RCP,%20desfibrilaci%F3n.pdf

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