September 19, 2000
Editorial calls for making defibrillators available for home use to save lives of heart attack victims
Sudden cardiac arrest remains the No. 1 killer of adults in the United States. Coronary artery disease will kill 250,000 or more people this year. One way to reduce the numbers of these deaths dramatically is to make automatic external defibrillators, or AEDs, widely available for home use, said Dr. Mickey Eisenberg. Eisenberg is a professor of medicine and adjunct professor of epidemiology at the University of Washington and director of the emergency medicine service at UW Medical Center in Seattle. He recommends that AEDs be sold over-the-counter to make them more available.
In an article published in the Sept. 20 edition of the Journal of the American Medical Association, Eisenberg wrote that this idea deserves the same acceptance as teaching cardiopulmonary resuscitation to lay people. After years of being restricted first to the surgical suite, and then to emergency and hospital rooms, CPR is now taught to thousands of people each year.
“CPR has become a lay procedure ? anybody can learn it, and it is assumed that bystanders will use it in emergency situations,” Eisenberg said in a recent interview. “Similarly, there is growing awareness that defibrillation is moving into the community. I think we will look back on the early 21st century as a time when defibrillation became a lay procedure.”
Eisenberg has been investigating sudden death for the past two decades and is the author of over 20 books and 80 scientific articles dealing with emergency medicine and sudden cardiac death.
Seventy-five percent of the people who die suddenly of heart disease, and often without previous symptoms, are at home. While AEDs are increasingly available in public places, and some selected members of the public are learning how to operate them, Eisenberg points out that devices in public places would only reach about 16 percent of the cardiac arrest cases occurring in the United States annually. Plans to place AEDs at sports arenas, government office buildings, public gyms and on commercial aircraft would not help the majority of people who collapse at home.
Currently, cost is working against placing AEDs in the average American home. Prices for new AEDs start at about $3,000. Lithium battery packs and cases can add another $200 to the price tag.
“There’s no question $3,000 is a very high cost, and out of the reach of most people,” Eisenberg said. “Diffusion of all new technology, like computers and VCRs, has shown us that over the years these items get smaller and less expensive, while delivering more features. I think a similar phenomenon will occur with defibrillators.”
Eisenberg added that eventually AEDs could cost as little as several hundred dollars.
“To allow over-the-counter sales of AEDs, the Food and Drug Administration must be convinced the device is safe and effective, with proper labeling,” Eisenberg said. “Those, combined with appropriate training, would allow almost anyone to use an AED at the right time, and in the right way.”
Improper use of AEDs could be prevented through the use of keypads like those used to control household security systems. Eisenberg suggested the home use of AEDs would probably be safer than widespread dispersal in public locations, because the device would be targeted to a specific user and location.
Currently, the only way to obtain a defibrillator is through a physician’s prescription. Eisenberg wrote this helps keep AED prices high. Before doctors would prescribe the devices widely, and insurance companies would cover the cost, evidence needs to show the use of AEDs in settings outside the hospital would save lives.
Eisenberg said he expected his editorial to generate discussion on this controversial issue.
(Disclosure: Eisenberg has received contributions from defibrillator manufacturers to support his research.)
