Journal : Home Use of Automated External Defibrillators for Sudden Cardiac Arrest

Gust H. Bardy, M.D., Kerry L. Lee, Ph.D., Daniel B. Mark, M.D., M.P.H., Jeanne E. Poole, M.D., William D. Toff, M.D., Andrew M. Tonkin, M.D., Warren Smith, M.B., Ch.B., Paul Dorian, M.D., Douglas L. Packer, M.D., Roger D. White, M.D., W.T. Longstreth, Jr., M.D., Jill Anderson, R.N., B.S.N., George Johnson, B.S.E.E., Eric Bischoff, B.A., Julie J. Yallop, Ph.D., Steven McNulty, M.S., Linda Davidson Ray, M.A., Nancy E. Clapp-Channing, R.N., M.P.H., Yves Rosenberg, M.D., Eleanor B. Schron, R.N., Ph.D., for the HAT Investigators
ABSTRACT

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] .)

Source Information

From the Seattle Institute for Cardiac Research (G.H.B., J.A., G.J., E.B.) and the University of Washington (J.E.P., W.T.L.) — both in Seattle; the Duke University Clinical Research Institute, Durham, NC (K.L.L., D.B.M., S.M., L.D.R., N.E.C.-C.); the University of Leicester, Leicester, United Kingdom (W.D.T.); the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T., J.J.Y.); Auckland City Hospital, Auckland, New Zealand (W.S., J.J.Y.); the University of Toronto, Toronto (P.D.); the Mayo Clinic, Rochester, MN (D.L.P., R.D.W.); and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R., E.B.S.).

This article (10.1056/NEJMoa0801651) was published at www.nejm.org on April 1, 2008.

Address reprint requests to Dr. Bardy at the Seattle Institute for Cardiac Research, 7900 E. Green Lake Dr. N., #302, Seattle, WA 98103-4819, or at gbardy@sicr.org.

Full Text of this Article

This article has been cited by other articles:

• Callans, D. J. (2008). Can Home AEDs Improve Survival?. NEJM 358: 1853-1855 [Full Text]
  
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