Public access defibrillation: improving accessibility and outcomes.

BACKGROUND: Worldwide, out-of-hospital cardiac arrest (OHCA) remains a serious problem. Public access defibrillation (PAD) has been shown to be effective in improving survival in OHCA with good neurological outcome. SOURCES OF DATA: Original articles, reviews and national/international guidelines. AREAS OF AGREEMENT: Limitations to how much we can improve ambulance response times mean that the public have an essential role to play in OHCA survival. Training of laypersons in the use of automated external defibrillators (AEDs) has been shown to improve outcomes. Placement of AEDs should be related to underlying population demographics. AREAS OF CONTROVERSY: Placements of AEDs face cost constraints. PAD programs also face challenges in the upkeep of AEDs. Concerns about legal liability for lay rescuers to act remain. GROWING POINTS: Systematic programs should be in place to train the public in PAD. All AEDs should be listed in national registries and available for usage in an emergency. AREAS TIMELY FOR DEVELOPING RESEARCH: 'Smart' technology is being developed to improve accessibility of AEDs.