Document Detail


Home use of automated external defibrillators for sudden cardiac arrest.
MedLine Citation:
PMID:  18381485     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care. Consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival for patients at risk. METHODS: We randomly assigned 7001 patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter-defibrillator to receive one of two responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cardiopulmonary resuscitation [CPR]) or the use of an AED, followed by calling emergency medical services and performing CPR. The primary outcome was death from any cause. RESULTS: The median age of the patients was 62 years; 17% were women. The median follow-up was 37.3 months. Overall, 450 patients died: 228 of 3506 patients (6.5%) in the control group and 222 of 3495 patients (6.4%) in the AED group (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77). Mortality did not differ significantly in major prespecified subgroups. Only 160 deaths (35.6%) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed. AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks. CONCLUSIONS: For survivors of anterior-wall myocardial infarction who were not candidates for implantation of a cardioverter-defibrillator, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods. (ClinicalTrials.gov number, NCT00047411 [ClinicalTrials.gov].).
Authors:
Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; William D Toff; Andrew M Tonkin; Warren Smith; Paul Dorian; Douglas L Packer; Roger D White; W T Longstreth; Jill Anderson; George Johnson; Eric Bischoff; Julie J Yallop; Steven McNulty; Linda Davidson Ray; Nancy E Clapp-Channing; Yves Rosenberg; Eleanor B Schron;
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2008-04-01
Journal Detail:
Title:  The New England journal of medicine     Volume:  358     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-04-24     Completed Date:  2008-04-30     Revised Date:  2008-09-30    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1793-804     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2008 Massachusetts Medical Society.
Affiliation:
Seattle Institute for Cardiac Research, Seattle, WA 98103-4819, USA. gbardy@sicr.org
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00047411
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiopulmonary Resuscitation*
Death, Sudden, Cardiac / epidemiology,  etiology
Defibrillators*
Emergency Medical Services
Female
Heart Arrest / etiology,  mortality,  therapy*
Home Nursing*
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Mortality
Myocardial Infarction / complications
Grant Support
ID/Acronym/Agency:
U01-HL67972/HL/NHLBI NIH HHS
Investigator
Investigator/Affiliation:
C S Barr / ; A Tselios / ; M Saim / ; H McAlister / ; L Lowe / ; D Peek / ; S Jaques / ; W D Toff / ; J D Skehan / ; I Squire / ; R Pathmanathan / ; R Pearse / ; P DeSouza / ; K Fairbrother / ; O Brett / ; E Parker / ; L Shipley / ; M Mirro / ; R Plant / ; J Needham / ; D Rosenbaum / ; G Gregory / ; D Colquhoun / ; S McColl / ; C Langford / ; A Ward / ; J Cha / ; J Otis / ; C Wall / ; A Pandey / ; B Pugh / ; J Waites / ; P Cahill / ; P Parsons / ; A Janmohamed / ; B Bozak / ; K Brown / ; D Packer / ; K Monahan / ; C Bluhm / ; L Peterson / ; K Wock / ; J Harldson / ; M Gupta / ; J Burtcher / ; I Crozier / ; C Cruickshank / ; M Hume / ; B Davies / ; A Soward / ; T Lauder / ; R Johns / ; T B To / ; S Coleman / ; E Vogl / ; J Kesby / ; S MacKinley / ; G Syan / ; S Syan / ; R Coomba / ; S Chenard / ; R Nitkin / ; D Hutton / ; L Charles / ; R Bhargava / ; C Stata / ; C Stafford / ; L Nair / ; P Nail / ; R Woods / ; G Armstrong / ; G McAnnalley / ; R Haycock / ; J Shirtcliffe / ; N Krishnan / ; C McBride / ; P Kannampuzha / ; D Kennedy / ; H Hink / ; Z Wulffhart / ; C Mc Pherson / ; C Jones / ; S Mohiuddin / ; E Butkus / ; S Byers / ; M West / ; A Carle / ; J West / ; M Kilborn / ; K O'Connor / ; M Hall / ; V Miller / ; M Pryor / ; E Crystal / ; E Levitin / ; J Vecchio / ; J Horowitz / ; C Zeitz / ; J Rose / ; B Hoffman / ; A N Sulke / ; C Harrison / ; S Wilkinson-Cox / ; J Horowitz / ; C Green / ; R Mitrani / ; D Weaver / ; C Basignani / ; M Di Mattia / ; T Marwick / ; C Hall / ; R Dick / ; N Thurston / ; J Boxall / ; N Cummings / ; L Jenkins / ; M S Kremers / ; K McEachern / ; J Bumgarner / ; S Hart / ; B Singh / ; M a'Campo / ; J Franklin / ; G Trobaugh / ; A Trobaugh / ; D Cross / ; L Lilwall / ; L Hindom / ; J Leitch / ; J Holliday / ; E Hicks / ; M Beshara / ; J Medicis / ; P Dorian / ; L Austin / ; A Weeks / ; S Stoger / ; D Heaven / ; J Leary / ; P Grey / ; R Schilling / ; L Richmond / ; V Mullan / ; J Herre / ; K Barackman / ; L Klevan / ; W Short / ; M Thompson / ; O Rotandaro / ; M Davis / ; L Ferguson / ; C Venn-Edmonds / ; F Halperin / ; V Stedman / ; M Geer / ; D McDaniel / ; A York / ; M Sami / ; D Liebling / ; H Strauss / ; P Anderson / ; S Silver / ; J Morgan / ; S Earles / ; D McGill / ; P Tavener / ; A Kam / ; P Thompson / ; N Mammatt / ; M Raitt / ; A Van Deusen / ; T Krall / ; F Leyva / ; S Chalil / ; N Irwin / ; J Cleland / ; R Brothwell / ; W Walsh / ; M Madigan / ; A Russell / ; S Coverdale / ; C Cocks / ; S Murray / ; M Courtney / ; D Exner / ; L B Mitchell / ; D Ramadan / ; S Dudley / ; I Shukrullah / ; J Cuellar / ; J Lane / ; J Cooper / ; E A Courtney-Eighmy / ; A Barnes / ; S Johnson / ; M Marks / ; V Graves / ; K Curry / ; R Labonte / ; N Mayhew / ; M Martini / ; J Benson / ; W Mialis / ; G Fini / ; J Amarena / ; D Campbell / ; L Wilson / ; G Aroney P Hicks / ; B Stamble / ; S Mazzurco / ; S Mecci / ; J Jacobson / ; W McCrea / ; C Wretham / ; L Mann / ; R O'Connor / ; M Bollinger / ; J Kostis / ; N Cosgrove / ; D Bankowski / ; P Peterson / ; L Heaney / ; B Peterson / ; S Khoury / ; D Bliss / ; J Edwards / ; C Werner / ; J Cleland / ; P Atkin / ; R Brothwell / ; R Williams / ; L Kvill / ; K Paradon / ; A Sharma / ; A Skadsen / ; S Allen / ; L Carling-Chambers / ; A Magi / ; J Louis-Charles / ; K Kwok / ; D Dejewski / ; D Todd / ; H Lindsay / ; H Rogers / ; W Heddle / ; A Graham / ; C Edwards / ; W Smith / ; M Hood / ; P Hughes / ; H Hinds / ; R Ziffer / ; A Johnson / ; J Dennett / ; P Ma / ; C Robertson / ; L Gessman / ; N Wiener / ; J Ryan / ; M Pearce / ; C McBride / ; M James S Burtchaell / ; G Flaker / ; K Belew / ; J Counsell / ; N Cummings / ; L Jenkins / ; R Canby / ; D Cardinal / ; C Scallion / ; M Anderson / ; L Bastin / ; K Richards / ; M Senaratne / ; J Powell / ; A Dacyk / ; F DeRook / ; K Comess / ; S Carswell / ; E Miller / ; D Rowlands / ; L Archer / ; W Joyce / ; J Gorham / ; M Mires / ; C Holcomb / ; K Gayles / ; M Bhargava / ; S Manchester / ; C Rinaldi / ; P Spurrell / ; A Renouf / ; S O'Nunain / ; A MacKenzie / ; N Cooter / ; J Ip / ; L Blaske / ; T Zambon / ; J DeYoung / ; M Watt / ; P Broadhurst / ; M Jamieson / ; A Lewis / ; G DeVaughn / ; J Delcampo / ; B Peart / ; K Peart / ; J Stein / ; C Morillo / ; V Malcolm / ; S Morgan / ; T Vakani / ; R Yee / ; B Spindler / ; C Bentley / ; S Pham / ; C Clayton / ; K Reilly / ; S Adler / ; L Nelson / ; J Gilliam / ; P Roberts-Thomson / ; P Neid / ; C McIntosh / ; J E Mitchell / ; M Caboral / ; E Nsah / ; L Arminger / ; D Morrison / ; J Boehmer / ; K Dwyer / ; W Groh / ; S Bondurant / ; M Lowe / ; D Suresh / ; D Bliss / ; C Jenkins / ; G Porter / ; J Goodson / ; M Mandawat / ; L Reese / ; T Raines / ; J Johns / ; L Brown / ; M Nora / ; H Iyengar / ; K Caputo / ; K Quealy / ; L McGowen / ; K Svoboda / ; Z Juma / ; C Travill / ; S Gent / ; W Harvey / ; R Andrews / ; J Wiseman / ; T Simpson / ; D Andresen / ; C Baxter / ; A McLeod / ; K Knops / ; M Ilton / ; G McKendall / ; S Spencer / ; P Barnes-Griffin / ; M Fitzpatrick / ; D Schoveres / ; K Pepper / ; J Speer / ; L Gordon / ; S Kimber / ; L Haykowsky / ; W Voyles / ; D Robeson / ; A Russo / ; D Meehan / ; S Chiaramida / ; D Adams / ; A Doctor / ; T Mattioni C Williams / ; B Vandermate / ; R Aggarwal / ; L Wright / ; T Banks / ; B Kneale / ; L Huggins / ; J Scott / ; G Wilkins / ; L Gulliver / ; R Oskam-Schmidt / ; J Chambers / ; D Butler-Sharp / ; G Rewa / ; S Raskin / ; E Gill / ; S Dianzumba / ; D Chilson / ; J Thornton / ; F Munkenbeck / ; S Roth / ; A Morgan / ; M Wong / ; L Biao / ; J Stein / ; R Luceri / ; M Fisher / ; A Agocha / ; J Buergler / ; N Peters / ; A Davis / ; L Maher / ; J Cheung / ; E Ofili / ; J Morgan / ; A Houghton / ; R Bijou / ; S Krueger / ; W Leimbach / ; P Boyd / ; H Saint-Jacques / ; G Hilliard / ; L Rosenthal / ; C Ezeugwu / ; B Walters / ; I Singer / ; S Freedman / ; I Ternouth / ; G H Bardy / ; J E Poole / ; J Anderson / ; G W Johnson / ; E Bischoff / ; C D Munkers / ; K L Lee / ; S E McNulty / ; M A Smith / ; D B Mark / ; L Davidson-Ray / ; N E Clapp-Channing / ; D Minshall-Liu / ; W Douglas Weaver / ; Kathleen Dracup / ; Robert Zalenski / ; Joni Beshansky / ; Barry R Davis / ; John P DiMarco / ; Eleanor Schron / ; Yves Rosenberg / ; Michael Proschan / ; Nancy L Geller / ; Marcel Salive / ; Michael J Domanski / ; Jerome L Fleg / ; Gust H Bardy / ; Kerry L Lee / ; Daniel B Mark / ; Jeanne E Poole / ; Andrew Tonkin / ; William D Toff / ; Warren Smith / ; Paul Dorian / ; Will Longstreth / ; Douglas L Packer / ; Roger D White / ; Eleanor Schron / ; Yves Rosenberg / ; Douglas L Packer / ; Kerry L Lee / ; Greg Flaker / ; L Brent Mitchell / ; Bruce Stambler / ; William D Toff / ; Warren Smith / ; Judith Mitchell / ; Andrea Russo / ; Paul Dorian / ; Roger D White / ; Derek Exner / ; Arjun Sharma / ; John Amarena / ; Mark S Kremers / ; Yves Rosenberg / ; Eleanor Schron / ; Jeanne E Poole / ; Merritt H Raitt / ; Blair Halperin / ; Ramakota K Reddy / ; Sue A Thomas / ; Erika Friedmann / ; Patricia G Morton / ; Janice Anarino / ; B Waine Kong / ; Melanie Dowdell / ; Tammie Bell / ; Felicia Warren /
Comments/Corrections
Comment In:
N Engl J Med. 2008 Apr 24;358(17):1853-5   [PMID:  18381486 ]
Evid Based Nurs. 2008 Oct;11(4):113   [PMID:  18815325 ]
ACP J Club. 2008 Aug 19;149(2):9   [PMID:  18710182 ]
N Engl J Med. 2008 Jul 31;359(5):533-4; author reply 534-5   [PMID:  18669435 ]
N Engl J Med. 2008 Jul 31;359(5):534; author reply 534-5   [PMID:  18677801 ]

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