Date:
04/01/2008 04:43 PM Home defibrillators save lives, but so does CPR, study
of heart-shock devices finds
By MARILYNN MARCHIONE
AP Medical Writer
CHICAGO (AP) _ Having a defibrillator at home
can help a heart attack survivor live through a second crisis,
but so can CPR and at a much lower cost. That's the bottom
line from the first test of using these heart-shocking devices
in the home.
The devices worked. But so few people in the
study were stricken at home, and CPR by spouses in the comparison
group was so good, that the 7,000-person study wound up being
be too small to prove that a defibrillator can improve survival.
It did for South Carolinian James Kennedy.
For three years, his family lugged one to the grocery store,
to church and on trips. "Thank God we had it" last
August, when his daughter used it to save his life at home,
said Kennedy's wife, Debra.
Others also benefited — seven friends
and neighbors of people in the study. They got a lifesaving
heart shock, too.
"There's no downside" to having
a home defibrillator, said study leader Dr. Gust Bardy of
the Seattle Institute for Cardiac Research.
However, they cost $1,000 or more. And others
say health dollars are better spent boosting CPR training.
Arguments to expand access to defibrillators "have an
emotional quality" not justified by cost and success
rates, said Dr. David Callans of the University of Pennsylvania.
He wrote an editorial that the New England
Journal of Medicine published on the Internet along with the
study. Results also were given Tuesday at an American College
of Cardiology conference in Chicago.
They come a day after the American Heart Association
changed guidelines to recommend hands-only CPR — pressing
vigorously on a victim's chest until help arrives.
Cardiac arrest happens when the heart beats
chaotically. Automated external defibrillators, or AEDs, can
shock it back into normal rhythm, and have been successfully
used by bystanders in airports, casinos and other public places.
However, three-fourths of the 166,000 cardiac
arrests that occur outside hospitals each year happen at home,
and only 2 percent of victims survive. One home defibrillator,
made by a Seattle-based division of Philips Healthcare, weighs
less than four pounds and is sold on the Internet for as little
as $1,200.
Researchers tested them in 7,000 people in
the United States, Canada, Australia, England, Germany, the
Netherlands and New Zealand. About half were given a device
and a spouse or companion was trained to use it, then told
to call emergency medical services. For the others, family
members were trained in CPR and told to call EMS.
Over about three years, 450 people died, but
only 160 were from cardiac arrest. Of those, only 58 were
at home and suffered the attack in front of someone.
Defibrillators were used in 32 cases —
all of them appropriately. The overall survival in both groups
was comparable and far better than researchers expected.
"We did have some people that simply
panicked and didn't know what to do," he said.
It happened to Debra Kennedy when her 55-year-old
husband James, was stricken in August at their home in North
Augusta, S.C. Her 20-year-old daughter, Brittany, took over
while her mom called EMS.
"I grabbed the defibrillator, I put the
little pads on him and it shocked him. That was really easy.
It gives you all the instructions," the young woman said.
The experience inspired her to return to school
to become a nurse.
"I always thought if a patient was flatlined
I'd freak out and not know what to do. But after this, I figure,
if I can do it on him I can do it on anybody."
Dr. Elizabeth Nabel, director of the National
Heart, Lung and Blood Institute, said the study "does
not invalidate the use of AEDs by any means." They "absolutely"
are a good idea for diabetics, she said. That was the only
subgroup in the study that had significantly better survival
from the defibrillators, compared to CPR.
Nabel's federal agency paid most of the study's
cost. Philips and Laerdal Medical, a subsidiary in England,
provided defibrillators and CPR training mannequins.
The study showed the devices "delivered
the shock that was needed, when it was needed," said
Mike Miller, head of Philips' defibrillator business.
Whether to buy one is "a personal choice"
like having a sprinkler system, a smoke detector or other
safety equipment, he said.
The study shows the value of defibrillators
and CPR, said Mary Fran Hazinksi, a Vanderbilt University
nurse and American Heart Association spokeswoman who has served
on emergency care guideline panels. The association has targeted
schools for expanding CPR training.
"We think that if we train all high school
students, within a few years we will have a whole generation
ready, willing and able to respond," she said.
