Should ward nurses be using automatic external defibrillators as first responders to improve the outcome from cardiac arrest? A systematic review of the primary research

Introduction: The outcome from in-hospital cardiac arrest has improved little since the implementation of cardiopulmonary resuscitation 40 years ago. Early defibrillation improves survival following ventricular fibrillation and pulseless ventricular tachycardia. The emergence of automatic external defibrillators and advisory defibrillators has been heralded as the answer to defibrillation delays in-hospital. Aim: To locate and evaluate the evidence supporting automatic external defibrillator use in-hospital on general wards. Method: A systematic review of indexed and grey literature to identify primary research. Results: Fifteen in-hospital automatic external defibrillator studies were located, five met the inclusion criteria. Conclusions: There is limited primary research evaluating automatic external defibrillators in-hospital. Manual defibrillators remain the most commonly used device for in-hospital defibrillation. Automated external defibrillators offer an alternative to manual defibrillation providing they have a screen and manual override capability, and the technology for pacing is close to hand. For in-hospital automatic external defibrillator programmes to be effective a change in nursing philosophy must occur, and defibrillation must become an expected rather than an extended nursing role. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.