Schools With AED on Campus May Save Lives

Emergency defibrillator programs at schools linked to better cardiac arrest survival rates

(RxWiki News) Sudden heart failure is the most common cause of death among young athletes during exercise. There's something schools can do that may reduce these cases.

When a person is having sudden cardiac arrest (SCA), an automated external defibrillator (AED) can be used to bring back a regular heart rhythm.

A recent study found that high school students who had sudden cardiac arrest were more likely to survive if there was an AED program on campus compared to those students on campuses where an AED had to be brought from off campus.

The researchers found that the time interval between cardiac arrest and using the AED was the most important factor of survival; they suggested that educators develop AED plans in schools.

"Find out if your school has an AED program."

The lead author of this study was Jonathan A. Drezner, MD, from the Department of Family Medicine at the University of Washington in Seattle, Washington.

The study included 2,045 high schools that were representative of all 50 states who were enrolled in the National Registry for AED Use in Sports.

The average number of students enrolled at each school was 963 and the average number of student-athletes from each school was 367.

A total of 86 percent of the schools were public, 14 percent were private, 48 percent were in a rural area, 33 percent were in a suburban area, 15 percent were in an urban area, and 4 percent were inner city schools.

The researchers asked all of the schools to report all cases of SCA or AED use that happened on a school campus between August 1, 2009 and July 31, 2011.

Each event had to be heart-based, not caused by trauma (except for getting hit in the chest during sports) and the victim had to be unconscious, without a pulse and not breathing.

The researchers compared the survival rates in schools where an AED was on campus versus schools that had an AED brought by EMS. They also compared the survival rates in schools that had an official emergency plan in the case of SCA versus schools that did not have an established plan.

The findings showed that 87 percent of the schools had at least one AED on campus. Of these schools, the average amount of AEDs per campus was 3.1.

A total of 83 percent of the schools reported having an official written emergency plan in the case of SCA.

Of the schools that did not have AEDs on campus, 263 reported the most common barriers.

The findings showed that 80 percent of these schools named limited financial resources as a barrier, 24 percent named legal issues, 13 percent explained that they didn't know where to put the AED, 10 percent reported school policy and 1 percent did not think having an AED was cost-effective.

A total of 59 cases of SCA were reported over the study period, and the researchers determined that this meant the yearly rate of SCA occuring in high school was one in 73 schools per year.

The findings revealed that 26 (44 percent) of these cases involved students and 33 (56 percent) involved adults. The average age of these students was 16 years old and the average age of the adults was 56 years old.

Student-athletes were involved in 18 (69 percent) cases, and eight (31 percent) of the cases involved students who were not athletes.

Athletic facilities were the most common place for SCA to happen, with 66 percent occurring there. The schools reported that 20 (34 percent) of the cases happened during a sports game and 19 (32 percent) happened during practice.

The researchers discovered that SCA was witnessed in 55 (93 percent) of all reported cases, and in every case that involved a student-athlete. None of the unwitnessed SCA victims survived to hospital discharge.

An AED was used in 50 (85 percent) cases total, with 39 (66 percent) of the cases receiving an AED shock on campus.

EMS was on campus for three of the cases. When EMS was off campus, the average time it took for them to arrive was 7.8 minutes. In most of the cases (92 percent), there were school personnel or on-campus EMS personnel who delivered CPR.

The researchers also found that only one school out of all schools reporting SCA did not have an established AED program.

The SCA patient survived to hospital discharge in 42 of the 59 (71 percent) reported cases, with adults representing 22 of 33 (61 percent) and students representing 22 of 26 (85 percent).

The findings also showed that 34 of the 39 (87 percent) cases where an AED shock was used on campus survived to hospital discharge.

Overall, it was found that 80 percent of the SCA victims survived to hospital discharge when the school supplied the AED on campus versus 50 percent survival when the AED was brought by EMS coming from off campus.

This meant that the odds of surviving SCA were increased four fold if the school had an AED on campus rather than needing to have EMS bring one from off campus.

The researchers also determined that there was a 79 percent survival rate in the schools with an official emergency plan for SCA, compared to a 44 percent survival rate in the schools without a plan. Therefore, the odds of survival were increased by almost five fold when the school had an established emergency plan for dealing with SCA.

The researchers concluded that the time between initial cardiac arrest (heart failure) to use of AED was the most important factor of survival.

The authors noted a few limitations of their study.

First, there was only one school with no AED program, so the researchers could not make an adequate comparison of survival rates.

Second, the study did not have data on the SCA patients after they left the hospital. Therefore any issues that happened then were not known. Third, it's possible that not all cases of SCA were reported.

This study was published online on October 11 and will be published in the December print version of the British Journal of Sports Medicine.

The National Operating Committee on Standards for Athletic Equipment provided funding.

Review Date: 
November 21, 2013