An article by Lilly Fowler of Fairwarning.org recently addressed the AHA ACLS Subcommittee's decision in 2000 to endorse in-hospital AED use to address the problem of delayed defibrillation--access here or from Links at right. The article emphasizes the role of financial conflicts of interest in coming to the decision. While I think these conflicts were probably a factor, I believe the real strength of the article was in pointing out that there was essentially no evidence at the time that in-hospital use of AEDs would improve survival. The committee extrapolated from the proven benefit of AEDs in treating out-of-hospital cardiac arrests (for which they were designed) without thinking things through. Most hospitals already had manual defibrillators in abundance; the assumption appears to have been that if no one had trained nurses throughout the hospital to defibrillate with the manual devices, it obviously was not possible to do so. This was within the comfort zone of the medical profession: they hadn't missed something important and fairly obvious; there was just no point in addressing it because there was nothing to be done.The problem was, nobody had really tried to train nurses to use manual defibrillators.
I brought the problem of delayed in-hospital defibrillation to the attention of several people in the national AHA ECC programs in the mid-1980s. Those same people began writing and speaking about the problem a few years later, but only in the same breath with promotion of in-hospital use of AEDs. They apparently believed they a technological fix which was used for out-of-hospital arrests was serendipitously the answer to an important problem that nobody had previously been talking about. If AEDs improved out-of-hospital survival, the same should be true in hospitals--never mind that hospitals already had defibrillators. Practically a no-brainer. I agree that it was a no-brainer, but perhaps not in the usual sense--a good example of thinking "inside the box."
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