Public Education Urged Along With Handy AEDs for Better Cardiac-Arrest Survival

Marlene Busko

September 06, 2016

ROME, ITALY — Basic life-support education may be even more important than the number of available automated external defibrillators (AEDs), although both are important, for reducing the rate of out-of-hospital sudden cardiac death, according to research from France[1].

The education component "is the cornerstone" of programs to improve the use of AEDs by the public, along with AED availability, Dr Nicole Karam (Paris Sudden Death Expertise Center, France) said in a press briefing prior to a best posters session at the European Society of Cardiology (ESC) 2016 Congress.

The implications for policy makers are that just making AEDs more available without educating people in basic life support "will not solve the issue of sudden cardiac arrest [survival]. . . . If you want to increase the rate, you will have to combine the two strategies," she stressed.

"If you educate people [about basic life support], things go better; that's obvious," press-briefing comoderator Dr Josep Brugada Terradellas (University of Barcelona, Spain) told heartwire from Medscape. The question now is whether people should receive intensive education in basic life support or simple instruction in how to use a defibrillator. "I favor very simple information: 'This is a defibrillator; you should know how to use it,' " which is the approach used by US programs, he said.

In contrast, the French government offers a 1-day or a 2- to 3-day educational program that explains CPR, sudden cardiac death, and AED use, Karam said. "We need to educate a person to perform CPR before going to get an AED, because otherwise we won't save lives," she said.

Huge Discrepancies Across 51 Districts

Dr Nicole Karam

Since the 1990s, clinicians have recommended that programs with two components—access to defibrillators and education in basic life support—be implemented to improve survival in out-of-hospital cardiac death, said Karam.

To investigate the impact of these programs in different districts in France, the researchers examined the number of AEDs, the number of people who received basic life-support education, and the number of sports-related out-of-hospital cardiac arrests in 51 districts in France (29 million inhabitants) during 5 years.

They found huge discrepancies across the districts.

The number of people who were educated in basic life support varied from 6955 to 36,636 per 100,000 inhabitants, and the number of AEDs varied from five to 3399 per 100,000 inhabitants in 1000 km2.

Just over a third of the districts (37%) had developed a substantial program for public access to defibrillators, which was arbitrarily defined as being above the median for number of people educated in basic life support (>13,866 people per 100,000 people) as well as number of AEDs available to the public (>22 AEDs per 100,000 people in 1000 km2).

Survival rates after a cardiac arrest varied from none to close to half (43.8%) in different districts; survival was greatest in districts with the most substantial programs to improve public access to defibrillators.

Survival after a cardiac arrest was worse in districts with low (below the median) vs high (above the median) levels of basic life-support education or AED availability.

Specifically, in districts with a low level of basic life-support education, survival after a cardiac arrest was only 4.7% if the district had low AED density and 5.9% if the district had high AED density.

In districts with a high level of basic life-support education, survival after a cardiac arrest was 16.8% if the district had low AED density and 22.5% if the district had high AED density.

After adjustment for multiple variables (patient age, presence of a witness, CPR performed by a bystander, response time, and initial shockable rhythm), basic life-support education (but not AED density) was significantly associated with cardiac-arrest survival (odds ratio 1.64; 95% CI 1.17–2.31, P=0.004).

Current CPR training occurs mainly in the workplace and in colleges and universities, Karam noted. More focus is needed to train children as young as 13 and to train older retired people.

Karam has no relevant financial relationships.

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