IHRSA - Mar 2004 CBI

To Start A Heart

New Study Documents Value of Defibrillators in Health Clubs

The first major study of the use of automated external defibrillators (AEDs) in health clubs has demonstrated that, when utilized by trained staff, the devices can have a dramatic impact on the survival rate of individuals stricken with sudden cardiac arrest (SCA).

That was the conclusion of a study conducted by Kyle McInnis, a professor of exercise science at the University of Massachusetts, in Boston, and his colleagues, the results of which were presented recently at the annual meeting of the American Heart Association (AHA), in Orlando, Florida.

The yearlong study, which involved a chain of 76 facilities in the U.K. with some 50,000 adults members, revealed that AEDs produced a short-term survival rate of 75%, as opposed to what McInnis describes as the 'dismal' rate of 2%-5% for those who suffer SCA outside a medical setting.

The difference represents a 15-to-37.5-factor increase in survival.

Several other papers presented at the AHA conference reported similar, striking results when AEDs were employed.

AEDs have become standard equipment in many fitness facilities, in part because of recommendations promulgated by AHA, the suggestion, by IHRSA, that clubs consider the technology, and the proliferating number of stories of members saved by prompt use of the device. Although the anecdotal evidence has been consistent and continues to mount, there had been no clear scientific evidence that AEDs increase survivability in health clubs. The goal of McInnis' study was to document the frequency with which cardiac arrest could be reversed and members' lives saved by AED programs.

The evidence

The U.K. clubs involved were similar to U.S. facilities in terms of their formal safety guidelines, including the screening of new members, the CPR certification of staff, and the existence of an emergency response plan. The chain placed AEDs in its 76 clubs, trained fitness staff how to use them in concert with cardiopulmonary resuscitation (CPR), revised its response plan to include the use of AEDs, and periodically rehearsed its response procedures. McInnis and his colleagues monitored the number of SCAs that occurred at the clubs, and gauged the success rate of attempted resuscitations in two ways, noting the percentage of cases in which: (1) SCA was reversed and the victim revived at the club; and (2) the member survived the catastrophic event until the time of their discharge from the hospital.

During the surveillance period, eight patrons suffered SCAs while exercising at their club, representing an annual occurrence rate of one incident per 6,250 adult members, or one per every 9.5 facilities. The victims ranged from 47 to 75 years in age, with an average age of 62. Seven of the eight had joined their club within the prior eight months, while the eighth had been a member for five years. One had a known history of heart trouble (i.e., recent coronary artery bypass surgery), and one had diabetes. The remaining six had no major medical conditions identified via routine preparticipation questionnaires.

All were exercising'e.g., doing aerobics, strength training, or working out on a treadmill'when they suffered their SCA.

In each case, in response to the cardiovascular emergency, the club's staff employed an AED and CPR before paramedics arrived on the scene. (The average staff response time wasn't recorded.) Amazingly, six out of the eight victims (75%) were revived by staff at the club, but two (25%) died before emergency response technicians (ERTs) showed up. Two of the individuals who were transported to hospitals had subsequent cardiac arrests and didn't survive.

The implications

'The results of the study are remarkable, and credit should be given to the staff who acted appropriately, according to their well-conceived emergency response plan,' observes McInnis. 'Clearly, of those eight people, the likelihood that any would have survived in this setting, without an AED program that was executed in a timely fashion, is minimal at best. The clubs had a 75% survival rate, in comparison to the average dismal rate of 2%-5% for those who suffer SCA outside a medical setting.'

McInnis' findings reflect and support other earlier studies in which the availability of AEDs in airports and casinos generated a survival rate of approximately 50%. 'Our findings confirm what has been demonstrated in other public settings,' McInnis points out. 'In this case, equipping fitness staff with this technology, and providing them with basic training, greatly increases the likelihood that a member who experiences this sort of medical emergency will have the best possible chance of surviving and, hopefully, of continuing to live a normal, rewarding life.'

Two other AHA presentations detailed similar results. One multi-center study indicated that, among a group of people who suffered SCA, 15 who were given CPR only lived, while nearly twice as many (29) who received both CPR and AED treatments survived. Another study, conducted in the state of Washington, reported a 50% survival rate for victims revived by laypeople using AEDs. 'Survival rates were similar to, or better than, those of people treated by emergency medical services workers,' reports Cardiovascular Week.

The AHA has recommended that larger fitness facilities, or ones with large senior populations, acquire AEDs and train their staffs to use them. IHRSA estimates that approximately 25% of all U.S. clubs have already done so, but notes that the technology may not be appropriate for facilities that are small or have limited staff.

'While, overall, the risk of sudden cardiac arrest in a health club is small,' concludes McInnis, 'the benefit of saving someone's life can't be underestimated.'