Early defibrillation in the community: breaking barriers to save lives

It is considered that in Spain, every year, we have more than 24,500 out-of-hospital cardiac arrests. Around 85% of these are secondary to ventricular fibrillation, with possibility of reversion in more than 90% if defibrillation is performed in the first minute of arrhythmia. However, if we delay this defibrillation, survival possibilities disappear in a few minutes. Clinical advances in last decades have not achieved satisfactory results in the treatment of cardiac arrest as survival rates at hospital discharge do not exceed 7%. Aware of this situation, the International Scientific Societies are recommending decreasing time to defibrillation, advising, at best, a time less than five minutes between the 112-call (emergency) and adequate electric discharge. Development of automated defibrillators in Emergency Medical Systems and their use by of emergency services (police, fire fighters, etc) contribute to reach this objective. Because of this, Emergency Medical Systems are modifying their assistance strategies, to implement the early defibrillation as . Literature showed the effective value of automated defibrillators in the public areas but their efficiency level is less than that reached with the Emergency Services. Efficiency depends on multiple factors such as type of installation, accessibility level to emergency medical services or incidence rate of sudden cardiac arrest. Thus, their introduction should be preceded by a cost-effectiveness study. Effectiveness of automated defibrillators at home, where up to 80% of cardiac arrest are produced, has still not been evaluated. Nevertheless, in the USA, its marketing with this indication has been authorized.