Treatment of Out-of-Hospital Cardiac Arrests with Rapid Defibrillation by Emergency Medical Technicians

Eisenberg MS, Copass MK, Hallstrom AT, et al New England Journal of Medicine 1980 Vol 302 Pages 1379-1383 OF HISTORICAL INTEREST

Survival for patients of out-of-hospital cardiac arrest is low in communities where emergency care is provided solely by Emits. In the study community (Auburn/Federal Way area of King County, Washington-258 sq km and population of 79,000), EMTís were trained to recognize and treat out-of-hospital ventricular fibrillation with up to 3 defibrillation shocks, but no medications or advanced airway protection. Outcomes were compared from the two years prior to this training (1976-1978) and the year following implementation (1978-1979). 123 cardiac arrests (81% heart disease related) were studied in the pre-defib period and 77 (70% heart disease related) in the defib time frame. There were significant increases (P<0.01) in the percentage of patients admitted and discharged during the defib period. Only 4/100 (4%)were resuscitated and discharged alive from hospital in the earlier period, as compared with 10/54 (19%) during the defibrillation period (P<0.01). Of 36 patients to whom shocks were administered, 14 received only EMT-delivered shocks; 12/14 (86%) were admitted to hospital and 6 (43%) eventually discharged. The authors temper the findings by noting that the intervention of rapid defibrillation was not randomly assigned, so there was no true control group. They further note that the benefit appears to lie in the rapid administration of the shocks; average time interval from collapse to arrival of defib-trained personnel in the study was 6.4 mins. The authors conclude by not advocating the replacement of paramedics with defibrillator-trained Emits who are useful for but one extreme medical emergency. In communities without paramedics however, EMT defibrillation under careful physician control offers an opportunity to improve the previously dismal chances of surviving cardiac arrest.