ORLANDO, Nov. 12 -- Compact devices that shock the heart into a correct rhythm to treat cardiac arrest are found on many firetrucks, police cars and even in casinos. But are the devices, called automated external defibrillators (AEDs), in your doctor's office?
Results of this question, asked by researchers of 93 primary-care physicians in Richmond, Va., were presented in a study today at the American Heart Association's 70th Scientific Sessions.
Surprisingly, airlines and casinos are more likely to have an AED than the average doctor's office, reports Mary Ann Peberdy, M.D., director of the resuscitation team at the Medical College of Virginia in Richmond and lead author of the report.
"Physicians have to consider having equipment like this in their offices because it would be sad to think that an individual 30,000 feet in the air could get defibrillated faster than one sitting in a physician's office," she says. "The sooner you can provide defibrillation the better. Survival decreases by 7 to 10 percent for every minute a person waits for treatment."
An AED corrects ventricular fibrillation, unsynchronized heart contractions that impair the heart's ability to pump blood through the body. It is the most common cause of cardiac arrest.
To determine the preparedness of free-standing primary-care doctors' offices, Peberdy sent a survey to 93 randomly chosen offices asking about patient population, staff training in basic life support (BLS), pediatric advanced life support (PALS) and advanced cardiac life support (ACLS) as well as the kind of emergencies encountered in the offices.
Basic life support (BLS) is the first level of emergency cardiac care using basic CPR methods for individuals suffering from respiratory or cardiac arrest.
Pediatric advanced life support (PALS) teaches healthcare providers how to resuscitate an infant or child. Advanced Cardiac Life Support (ACLS) includes training on the use of drugs and defibrillators and other advanced procedures involving equipment that only a health-care provider would have.
The staffs of the 51 offices that returned surveys treated an average of 243 people per week. Sixty-five percent of the offices had at least one nurse trained in basic life support, which includes recognizing a heart or respiratory emergency and performing cardiopulmonary resuscitation (CPR), which consists of chest compressions and mouth-to-mouth resuscitation. At least one physician was trained in BLS in 65 percent of the offices. Six percent of the offices had at least one nurse trained in ACLS, but only 1 percent had a physician trained in ACLS. For PALS, the figures were 16 percent for nurses and 6 percent for doctors.
Equipment for intubation, a procedure in which a tube is placed in a person's windpipe to deliver oxygen to the lungs, and and suction capabilities were more common in pediatric offices, where respiratory distress is far more common that heart problems, Peberdy says. Only six out of 51 offices had a defibrillator. There were 35 emergencies in 18 of the offices: nine defined as cardiac, 10 respiratory, nine allergic, three metabolic, two neurologic and two toxicologic. Emergency transport was needed for 16 patients, CPR was needed for two individuals, and one person died.
Peberdy created an emergency preparedness program one year ago at the Medical College of Virginia, which has five large outpatient buildings. "It would not be feasible to send the hospital's resuscitation team to those outlying buildings. The team would already have used up five crucial minutes by the time it arrived," she says. Under the program, each building has AEDs and ventilation equipment on every floor. A team of nurses is also trained to use the AEDs and provide BLS.
In the first year, approximately 30 emergencies were reported, none of which were cardiac arrests. "However, the system has worked quite well," says Peberdy.
"Even though we have not used the AEDs in the last year, it is only a matter of time until we have a cardiac arrest that will benefit from an AED."
The training and equipment cost to the hospital came to a nickel per patient visit, she says. A decade ago, to use a standard defibrillator required medical training to diagnose the abnormal rhythm and deliver the shock. Today the AEDs, which are about as large as a thick laptop computer and cost as little as $3,500, are considered "user friendly."
"The machine interprets the rhythm and can deliver the shock without the operator really knowing anything about the heart," Peberdy says. Police and firefighters are now equipped with them in many cities. In some cities, office buildings have security guards trained to use them.
"Airlines are putting AEDs on planes and training flight attendants to use them. And one of the casinos in Las Vegas recently saved three persons with a cardiac arrest," she says.
Medical care also is delivered much differently than it was a decade ago. People spend less time in the hospital, and those treated as outpatients are actually much sicker than in the past, so the number of emergencies is likely to increase, says Peberdy.
Her co-authors are Joseph P. Ornato, M.D., Robert Frank, M.D., Christopher J. Schmeil, M.D., Allan Heffner, M.D., and Peter Kamilakis, M.D.
Media advisory: Dr. Peberdy's number is (804) 828-4889. (Please do not publish telephone numbers.)