[The automated external defibrillator in the resuscitation chain. The importance of the AED examined].

The survival rate for those suffering an out-of-hospital cardiac arrest (OHCA) is improving slowly, with > 90% of the survivors being discharged from hospital with cognitive function intact. A recent analysis of the ARREST (AmsteRdam Resuscitation Study) group documented an increase in survival rates with favourable neurological outcome from 16.2% in 2006 to 19.7% in 2012. Only those victims whose initial cardiac rhythm is 'shockable' (i.e. ventricular fibrillation or tachycardia) reap the benefits: their survival rate increased from 29.1% to 41.4%. The prognosis for those with a non-shockable rhythm remains grim (< 5% survival). A recent analysis of the ARREST database points to the increasing use of AEDs (by laypersons, but particularly by police officers and fire-fighters with a training in basic life support) as one of the main drivers of this improved prognosis. An AED is now used in 59% of OHCA in the greater Amsterdam area, and has become an essential link in the resuscitation chain.