UT Arlington associate dean gains national attention as part of defibrillation research team
A UT Arlington associate nursing dean is co-author of a new, nationally-noted paper that raises questions about the effectiveness of in-hospital use of automated external defibrillators, or AEDs.
The findings from the research team that included UT Arlington professor Beth Mancini and other researchers say that while AEDs improve survival for out-of-hospital cardiac arrest, similar use in a hospital setting does not lead to an improved rate of survival. The work is published in the Nov. 17, 2010 issue of the Journal of the American Medical Association, and is available online.
Researchers evaluated the outcomes of 11,695 hospitalized patients with cardiac arrests from Jan. 1, 2000 to Aug. 26, 2008 using data from 204 hospitals in the American Heart Association’s National Registry of Cardiopulmonary Resuscitation, or NRCPR.
Of the 11,695 patients in the study, the rate of survival to hospital discharge was 16.3 percent among patients in whom AEDs were used and 19.3 percent among patients in whom AEDs were not used. After adjusting for hospital site and clinical characteristics, AED use was associated with a 15 percent lower rate of survival, JAMA reported.
Mancini, associate dean of the UT Arlington College of Nursing, said that while the use of AEDs in community settings has been demonstrated to increase survival, researchers wanted to determine whether using AEDs in a hospital setting yielded better outcomes than not using the devices. The finding that AED use did not translate into increased or even the same survival rates surprised researchers, she said.
"We need to better understand the effect of using an AED for patients in the hospital setting," said Mancini, who oversees UT Arlington’s undergraduate nursing programs and serves as Chair of the Science Advisory Board for NRCPR. "This is not to say that AEDs don’t work. There are other factors that impact patient survival, such as the interruption in chest compressions necessary to assess a patient and attach equipment to the patient."
Mancini is also the co-chair for the Education, Implementation, and Teams Task Force of the International Liaison Committee on Resuscitation or ILCOR. ILCOR is the body responsible for developing the international consensus on science and treatment recommendations for CPR released last month.
The new study published in JAMA also seems to show a link between survival and whether patients had what is known as shockable on nonshockable rhythms when the AEDs were used. Victims of cardiac arrest in the community setting most commonly have a shockable cardiac rhythm such as ventricular fibrillation. Patients who have a cardiac arrest in the hospitals are more likely to have nonshockable rhythms, such as in cases of asystole or pulseless electrical activity. Hospitalized patients with shockable rhythms showed little variation in survival rates with or without the AED being used. Those with non-shockable rhythms, however, had a 26 percent lower survival rate when the AED was used.
Dr. Paul S. Chan, of Saint Luke's Mid America Heart Institute in Kansas City was the lead author of the JAMA study. Others authors included researchers at Yale University School of Medicine, The Children’s Hospital of Philadelphia, University of Michigan, The University of Iowa and Virginia Commonwealth University. The findings were announced this week at the American Heart Association’s annual meeting in Chicago.
A news release from JAMA said researchers note that their findings should inspire more study on the potential benefit of AEDs in the hospital setting.
"Between 2003 and 2008, more than 50,000 AED units were sold to U.S. hospitals, and marketing reports project annual sales growth of 9 percent to 12 percent over the next 5 years," the authors said. "... In light of our data, national organizations and hospitals may need to reconsider the use of AEDs in general hospital ward units or develop different strategies for using them."
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