The biggest news of the past few years about in-hospital resuscitation...

...relating to in-hospital resuscitation, at least in my view, has been rather conclusive evidence that AHA/ILCOR's promotion of AEDs to address the problem of delayed in-hospital defibrillation has been a failure. Three large studies have produced essentially he same results: AED use does not improve survival from shockable arrhythmias and decreases survival from asystole and PEA:

• Forcina MS, et al. Cardiac arrest survival after implementation of automated external defibrillator technology in the in-hospital setting. Crit Care Med. 2009;37(4):1229-36.
• Chan PS, et al. Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA. 2010;304(19):2129-2136.
•  Smith RJ, et al. Automated external defibrillators and in-hospital cardiac arrest: Patient survival and device performance at an Australian teaching hospital. Resuscitation. 2011;82(12):1537-1542.

The most noticed (and most convincing) of these is the Chan study, which analyzed data from the AHA's own NRCPR (now Get with the Guidelines--Resuscitation) database that includes hundreds of hospitals.

I know that nobody likes to hear "I told you so," but this is my blog, and just this once I'll say that I did tell them so, in the January 1996 issue of Annals of Emergency Medicine, excerpt below.

The AHA should encourage objective evaluation of innovative approaches to treatment, particularly those that involve new technologies, before they gain widespread acceptance: “In the emotionally charged atmosphere of medical care, the momentum of a new technology too often puts the burden of proof on those who question the evidence for it, rather than on those who propose it. The result is that the technology quickly becomes the accepted thing to do [and] further attempts to test it are subject to the charge of being unethical . . . ”

 AED manufacturers will keep the AED option in the forefront of discussions about delayed in-hospital defibrillation; as a public service organization the AHA should actively encourage consideration of a broad range of alternatives. There may be ways to achieve the goal of rapid in-hospital defibrillation less expensively–and much sooner–than by making progress contingent on the successful marketing of AEDs to hospitals.