CPR training more important than defibrillators in public places

19th September 2016

Having defibrillators in public places is important but providing basic life-support education to the public may be even more so, say researchers.

To encourage more use of automated external defibrillators (AEDs) and improve survival for people who have an out of hospital cardiac arrest, the education component is key, Dr Nicole Karam told a press conference at the European Society of Cardiology’s annual congress earlier this month.

Dr Karam, from the Paris sudden death expertise centre, said just making AEDs more available without educating people in basic life support would not increase survival. If you wanted to increase survival you had to combine the two strategies.

"We need to educate a person to perform CPR before going to get an AED, because otherwise we won't save lives," she said.

The French government offers a 1-day or a 2- to 3-day educational programme that explains resuscitation and AED use, Dr Karam said.

To investigate the impact of these programmes in different districts in France, the researchers examined the number of AEDs, the number of people who received basic life-support education, and the number of sports-related out-of-hospital cardiac arrests in 51 districts in France (29 million people) over five years.  They found huge discrepancies across the districts.

The number of people who were educated in basic life support varied from 6,955 to 36,636 per 100,000 inhabitants, and the number of AEDs varied from five to 3,399 per 100,000 inhabitants in 1000 km2.

Just over a third of the districts (37%) had developed a substantial programme for public access to defibrillators - educating more than 13,866 people per 100,000 people and having more than 22 AEDs per 100,000 people in 1000 km2.

Survival rates after a cardiac arrest varied from none to close to half (43.8%) in different districts; survival was greatest in districts with the most substantial programmes to improve public access to defibrillators.

Not surprisingly, survival after a cardiac arrest was worse in districts with low levels of basic life-support education or AED availability.

But in districts with a low level of basic life-support education, survival after a cardiac arrest was only 4.7% if the district had low AED density and 5.9% if the district had high AED density.

In districts with a high level of basic life-support education, survival after a cardiac arrest was 16.8% if the district had low AED density and 22.5% if the district had high AED density.

After adjustment for multiple variables (patient age, presence of a witness, CPR performed by a bystander, response time, and initial shockable rhythm), basic life-support education (but not AED density) was significantly associated with cardiac-arrest survival.

Current CPR training occurs mainly in the workplace and in colleges and universities, Dr Karam said. More focus is needed to train children as young as 13 and to train older retired people.