As it is unambiguously established today, fibrillation of ventricles is the most frequent reason of a sudden cardiac standstill at adults. Probability to survive at patients with fibrillation of ventricles decreases in process of a current of time, a past after a cardiac standstill and according to modern literary data each next minute falls on average for 7–10%. On the other hand, primary resuscitation actions (such as cardiac massage and artificial respiration) cannot transfer at such patients fibrillation to a normal rhythm without electric defibrillation. The precardiac blow which was tried to be used for the purpose of replacement of a defibrillator did not show any impressive results in large researches; its efficiency by modern estimates is about one percent. Thus, only the early defibrillation is the only chance to restore hemodynamically effective warm reductions and to save the patient in these situations.
In this regard recently among specialists the increasing popularity is gained by the concept of an early defibrillation with use of a public automatic defibrillator monitor. According to this concept, there have to be public automatic defibrillators allowing even to the unskilled user to give first aid to the patient with a cardiac standstill before arrival of team of physicians.
Now there are defibrillators (for example, AED Plus, Zoll Medical Corporation) which help the unskilled rescuer to pass through all process of resuscitation — from assessment of vital functions of the victim (breath and blood circulation) before cardiopulmonary resuscitation and a defibrillation. For example, the protocol of work AED Plus includes the sequence of visual and voice hints (including in Russian) which purpose is the help to rescuers when performing resuscitation and also record function that allows subsequently resuscitators to analyse retrospectively use of this device by the unskilled user.
The automatic external defibrillator analyzes a warm rhythm and at identification of its life-threatening disturbances makes the category, and specificity in recognition of the rhythm which is subject to a defibrillation approaches 100%.
Concerning the solution of the question "At First Category or at First Cardiac Massage?" modern recommendations order that if the adult patient had a cardiac standstill, and the automatic external defibrillator is available immediately, then it is expedient to use a defibrillator as soon as possible. If the cardiac standstill occurred without witnesses or if the defibrillator is not available immediately, then it is necessary to begin carrying out a complex of cardiopulmonary resuscitation and as soon as possible to deliver a defibrillator to the victim.
Still long ago the federal committee on aircraft of the USA obliged all American airlines to supply with automatic defibrillators all planes weighing more than 3 tons, making local and international flights and on which there is at least one stewardess. Some airlines trained the personnel in the address with defibrillators and reported about significant increase in survival at a blood circulation stop in flight. On terminals of the airports where there is always a large number of people, the concept of an early defibrillation with use of a public defibrillator monitor already managed to prove the viability. Several messages about cases of a successful defibrillation at the airports are published.
Today programs for placement of automatic external defibrillators in common areas for patients with a sudden extra hospital cardiac standstill are recommended to be implemented in public places with rather high probability of cases of a cardiac standstill in the presence of witnesses. The airports, stations, casino, sports facilities can be carried to such places.
There are accurate and agreed proofs of increase in level of survival after a cardiac standstill if the casual witness carries out a package of measures of cardiopulmonary resuscitation and quickly uses an automatic external defibrillator. Thus, immediate access to a defibrillator - the most important element of a system of assistance at a sudden cardiac standstill.
Data on need of installation of automatic external defibrillators to premises are still not enough. Victims of an extra hospital cardiac standstill in private houses with smaller probability will receive a cardiac massage before arrival of medical care, than patients at whom the cardiac standstill occurred in the public place.