In hospitals, automated defibrillators may not work so well

Just over a decade ago, hospitals around the country began spending millions of dollars to buy automated defibrillators to save the lives of patients who go into sudden cardiac arrest. The purchases were spurred by a recommendation from an American Heart Association committee, which concluded that the equipment would bring patients speedier help.

But research done since the switch suggests that the more costly gear, which is now found in nearly all hospitals, saves fewer lives than old, lower-tech defibrillators. One recent study suggests that nearly 1,000 Americans die in hospitals every year because it can take longer to assess patients with the new devices and because nurses aren’t adequately trained on the equipment.

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All told, some doctors now believe that the AHA recommendation came too soon, without investigating whether the new device is as effective in hospital settings as the old gear.

“I think they jumped the gun,” said Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic.

According to members of the AHA committee, concern about slow response times for treating hospital patients in cardiac arrest prompted the switch. The idea was that automated equipment would be so easy to use that almost any medical staffer nearby could operate them and quickly start helping a patient whose heart had stopped.

The new technology “was demonstrated to be effective in saving lives,” said Robert A. Berg, a committee member and the critical care division chief at Children’s Hospital of Philadelphia.

“We just assumed that we were going to make a difference,” added Roger D. White, who was on an AHA subcommittee that studied automated defibrillators and who currently is an anesthesiologist at the Mayo Clinic in Rochester, Minn. But, he said, “what we thought would work hasn’t worked so far.”

AHA officials said the new research is unlikely on its own to force reconsideration of the guidelines when they are eligible for a five-year review in 2015. “Guidelines are based on the entire body of evidence,” said a spokesman for the association.

AED sales soar

Defibrillators use an electrical current to shock hearts back into normal rhythm. Since the 1990s, automated equipment providing step-by-step audio instructions has been in widespread use at public buildings, including some hospitals. But the AHA panel’s 2000 guidelines pushed for far greater use by hospitals, saying this would reduce in-hospital preventable deaths.

Committee members said in interviews that studies had shown that the basic model of the new devices — often known as automated external defibrillators, or AEDs — saved lives in non-hospital settings such as airports.

“Data was accumulating that lay-rescuer AED programs could shorten time from collapse to shock delivery and result in very high rates of survival,” said Mary Fran Hazinski, an AHA science editor and nurse who was a member of the committee.

Among the 11 committee members, three have acknowledged receiving research funding from manufacturers of the devices. (In one case, that funding was disclosed in the committee’s report.) When contacted, they said this funding was not a factor in their decision to approve the guidelines; rather, they were convinced that the automated equipment would save lives.