Experts say defibrillators should be standard equipment in GP clinics.

People who suffer a cardiac arrest while in a GP clinic are twice as likely to survive if they are promptly defibrillated with an automated external defibrillator rather than waiting for paramedics to arrive, according to new research.

More than 25 000 out-of-hospital cardiac arrests are recorded in Australia each year; the mean survival rate to hospital discharge or 30 days is 12 per cent.

“To effectively manage a patient experiencing a cardiac arrest, clinic staff must immediately undertake the initial steps in the ‘chain of survival’: call 000, provide cardiopulmonary resuscitation, and perform defibrillation with an automated external defibrillator (AED),” say researchers led by Brian Haskins; a paramedic Lecturer at Monash University.

“Although clinic administrative staff must undertake cardiopulmonary resuscitation training every 3 years, accreditation by the Royal Australian College of General Practitioners does not require general practices to have onsite AEDs.”

Dr Haskins and colleagues analysed data from the Victorian Ambulance Cardiac Arrest Registry, looking for patients who had non-traumatic cardiac arrests who emergency medical services staff attempted to resuscitate. 

They found 6363 cases of cardiac arrest in the two decades from January 1, 200 to 30 December 2019. Of these, 216 were in general practice clinics (3.4 per cent) and 6,147 witnessed by paramedics (96.6 per cent).

“The proportion of general practice clinic cases in which defibrillation was provided in the clinic increased from 2 of 37 in 2000–2003 (5 per cent) to 19 of 57 patients in 2016–2019 (33 per cent),” the report states.

“Survival increased from 7 of 37 (19 per cent) to 23 of 57 patients (40 per cent).

“For patients with initial shockable rhythms, 57 of 126 patients in clinic cases (45 per cent) and 1221 of 1929 people in paramedic-witnessed cases (63.3 per cent) survived to hospital discharge; of 47 general practice patients defibrillated by clinic staff, 27 survived (57 per cent).

“For patients with initial shockable rhythms, the odds of survival were greater following paramedic-witnessed events [adjusted odds ratio [aOR], 3.39) or general clinic arrests with defibrillation by clinic staff (aOR, 2.23) than for general practice clinic arrests in which arriving paramedics provided defibrillation.”

Dr Haskins and colleagues are calling for the AEDs to be made standard equipment in general practice clinics to enable prompt defibrillation when required.