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This editorial refers to ‘Prospective assessment of integrating the existing emergency medical system with automated external defibrillators fully operated by volunteers and laypersons for out-of-hospital cardiac arrest: the Brescia Early Defibrillation Study (BEDS)’† by R. Cappato et al ., on page 553 Out-of-hospital cardiac arrest (OHCA) occurs with an incidence of approximately 55 per 100 000 inhabitants per year1 and a probability of survival-to-hospital discharge of only 1–3%. OHCA accounts for approximately 450 000 deaths in the United States per year.2 The advent of automated external defibrillators (AEDs) triggered high expectations to improve these figures. AEDs are safe even in the hands of untrained schoolchildren who (under experimental conditions) required only 23 s longer than trained medical professionals to apply a shock for ventricular fibrillation.3 One of the most convincing studies has been reported by Valenzuela et al .4 who deployed AEDs in casinos and trained casino officers in their use. By this intervention, the time from collapse to application of the first shock was shortened to a mean of 4.4 min and survival increased to 53%.Similar studies also showed significant improvement in survival from OHCA at a community level, predominantly by equipping paramedics, police officers, and firefighters with AEDs,5 or by deploying AEDs in busy public locations such as airports.6 However, other investigators were not able to demonstrate a significant … *Corresponding author. Tel: +69 6301 83293; fax: +69 6301 3813. E-mail address : c.w.israel{at}em.uni-frankfurt.de

european heart journal

Automated external defibrillation in emergency medical systems: what has been achieved and where to go?The opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology.