Very little can reliably be espoused as beneficial in out-of-hospital cardiac arrest: high-quality CPR, and defibrillation of malignant arrhythmias. For each of these, the sooner the better. The remainder of Advanced Cardiac Life Support? Meh.
This population-based survey out of Japan looks at the increasing availability of automated electronic defibrillators for the lay public, frequency of their use, and impact on neurologic survival following OHCA. Between 2005 and 2013, the number of bystander-witnessed events in which an AED delivered a shock increased linearly from a mere 40 patients to 829 patients. Overall good or moderate cerebral performance at hospital discharge in those patients was 38.5%, including an astounding 46.6% in non-elderly adults. By comparison, bystander-witnessed OHCA patients found to be in ventricular fibrillation whose first shock was delivered by EMS demonstrated a CPC good or moderate of only 18.2%.
By all clinical measures, then, AEDs and early defibrillation in bystander-witnessed OHCA is a splendid thing. The authors estimate that public-access AEDs accounted for 201 additional neurologically-intact survivors annually in Japan by 2013.
One small catch – it required an installed base of 428,821 AEDs to garner this small benefit. Considering most AEDs are priced well over USD$1000, this represents at least half-a-billion $USD investment for the 800-odd additional neurologically intact survivors identified during the study period. The magnitude of individual benefit is high – but it’s not cheap!
“Public-Access Defibrillation and Out-of-Hospital Cardiac Arrest in Japan”
Ah… lies, damned lies and statistics. Let’s say £1k per AED and therefore a cost of approx £428.8M for the 428,821 AEDs deployed. These resulted in ‘800-odd additional neurologically intact survivors.’ If you assume 10 additional years of life gained, on average, at an actuarial life value of £100K per year, then that’s £1M per person which is £800M societal return on a £428.8M societal investment…. not bad.
I’m not sure you gain £100k per life per year of productivity across the board; seems generous, when you look at the GDP per capita of working-age folks.
You could also potentially point out statistics saying there were fewer disabled-state folks in their cohort, which is money saved.
I didn’t go into an intensive value analysis because I’m not qualified to do so, but I did find it idly interesting the authors never mentioned it.