Part 4: The Automated External Defibrillator Key Link in the Chain of Survival Major Guidelines Changes

1. Early defibrillation (shock delivery within 5 minutes of EMS call receipt) is a high-priority goal. 2. Healthcare providers with a duty to perform CPR should be trained, equipped, and authorized to perform defibrillation (Class IIa). 3. For in-hospital defibrillation: a. Early defibrillation capability, which is defined as having appropriate equipment and trained first responders, should be available throughout hospitals and affiliated outpatient facilities (Class IIa). b. The goal of early defibrillation by first responders is a collapse-to-shock interval, when appropriate, of ,3 minutes in all areas of the hospital and ambulatory care facilities (Class I). c. Response time intervals for in-hospital resuscitation events are often inaccurate and must be corrected before documented times to defibrillation can be considered reliable (Class IIa). 4. Evidence supports establishment of public access defibrillation (PAD) programs in the following cases: a. The frequency of cardiac arrest events is such that there is a reasonable probability of one AED use in 5 years (estimated event rate of 1 sudden cardiac arrest per 1000 person-years). b. An EMS call–to-shock time interval of ,5 minutes cannot be reliably achieved with conventional EMS services. In many communities, this EMS call–toshock time interval can be achieved by training and equipping laypersons to • Function as first responders in the community • Recognize cardiac arrest • Activate the EMS system (phoning 911 or another appropriate emergency response number) at appropriate times • Provide CPR • Attach/operate an AED safely. c. For BLS responders such as police, firefighters, security personnel, sports marshals, ski patrol members, ferryboat crews, and airline flight attendants (referred to as level 1 responders in this document), education in CPR and the use of an AED is a Class IIa recommendation. For level 2 targeted responders such as citizens at worksites or in public places, this is a Class Indeterminate recommendation at this time. Likewise, for level 3 responders (family and friends of persons at high risk) this is a Class Indeterminate recommendation. 5. Use of AEDs in children $8 years of age (approximately .25 kg body weight) is a Class IIb recommendation. 6. Use of AEDs in infants and children ,8 years of age is not recommended (Class Indeterminate). 7. Biphasic waveform defibrillation with shocks #200 J is safe and has equivalent or higher efficacy for termination of ventricular fibrillation (VF) compared with higher-energy escalating monophasic-waveform shocks (Class IIa).