Posted on August 11, 2004 at 5:00 p.m.
BIRMINGHAM, AL — Participation in the successful Public Access to Defibrillation (PAD) clinical study, to appear in the August 12 New England Journal of Medicine, was a major factor in UAB becoming one of a 10-member national consortium that will look for other ways of improving resuscitation survival rates.
Dr. Thomas Terndrup, professor and chair of the emergency medicine department at the University of Alabama at Birmingham, says the ability of his team to inform and train the community in using the life-saving automatic defibrillators in public sites was key to becoming part of the recently announced Regional Coordinating Centers for Resuscitation in North America.
UAB, the only designated center in the southeastern United States, will receive $3.5 million from the National Heart, Lung and Blood Institute (NHLBI) over the next five years to fund the core program and infrastructure. Importantly, these resuscitation studies will include people who have suffered severe trauma potentially leading to cardiac arrest. These studies will be coordinated locally by Dr. Jeffrey Kerby from the Department of Surgery, and co-P.I. of the UAB study team.
The final results of the PAD study as they will be published in tomorrow’s NEJM confirm the preliminary results announced last November, Terndrup said. Automatic external defibrillators (AEDs) were known to improve outcomes after out-of-hospital cardiac arrest when used by trained public-safety personnel. PAD showed that the same is true when the devices are used by trained laypersons in public locations, such as shopping malls and recreational facilities.
Terndrup said the findings of the trial encourage wider use of AEDs in public places. “A two-fold increase in survival from any disease is a huge leap forward. Our ability to save more of the approximately 5,000 victims who die of out-of-hospital sudden cardiac arrest in Alabama each year has been enhanced. Unfortunately, most out-of-hospital cardiac arrests occur in private homes, not in public places, and cost would be a factor in seeking to place AEDs in the home of everybody at risk of having a cardiac arrest,” he said.
“It will be part of the task of UAB and others in the new resuscitation consortium to look for other ways to improve survival. In Alabama, only about 1 percent of people who suffer arrests outside the hospital setting will survive the incident. We hope to make a dent in this dismal statistic and this important public health problem.”
The PAD trial mobilized broad community resources to place the AEDs in public locations. The concept had been validated in highly controlled public areas such as commercial airplanes and casinos, but it was not known whether they would have a positive effect on survival statistics in less-controlled public areas.
“We placed AEDs in 38 public places in the Birmingham metropolitan area, and trained lay people who work in those places in how to use the devices,” Terndrup said. In addition, UAB was required to undertake a massive community education program before starting the PAD study in lieu of obtaining the consent of individuals to participate in the clinical trial. Terndrup gave his praise for the outstanding efforts of Shannon Stephens, who coordinated the PAD trial and led training efforts.
“Ordinarily, people cannot become a participant in a clinical trial unless they sign their consent to do so. It is problematic to conduct a study in the emergency setting because patients may not be conscious and able to give their consent. Therefore we received what’s called an ‘exception from informed consent’ by informing the community at public meetings and receiving community consultation,” he said.
He said similar methods will be utilized by the UAB resuscitation center to conduct other clinical trials, which are expected to take place in early 2005.