Defibrillation by general practitioners.

Abstract

To investigate the mode of cardiac arrest in patients with acute myocardial infarction attended by general practitioners, and the effectiveness of early defibrillation. Retrospective observational study. British general practice. General practitioners equipped with defibrillators by the British Heart Foundation. Cardiac rhythm when first monitored, response to defibrillation assessed by survival to reach hospital alive and survival to hospital discharge. Defibrillation and standard cardiopulmonary resuscitation in patients with cardiac arrest complicating acute myocardial infarction attended by British general practitioners. When a doctor equipped with a defibrillator witnessed an arrest or was able to initiate resuscitation within 4 min of the patient collapsing, 90% of patients were found to have developed a rhythm likely to respond to a defibrillatory shock. Defibrillation under these circumstances was very successful with more than 70% of patients subsequently admitted to hospital alive and approximately 60% surviving to be discharged alive. When the doctor commenced resuscitation later, fewer patients were found to have rhythms likely to be responsive to a DC shock. A greater proportion was in asystole and resuscitation was less frequently successful under these circumstances. When the arrest occurred in the doctor's surgery, 85% of patients were admitted to hospital alive and three quarters survived to hospital discharge. All those who provide the initial care for this vulnerable group of patients should be equipped with defibrillators. The more widespread deployment of defibrillators in the community may be a successful strategy for reducing unnecessary deaths from coronary heart disease.