En Español (Spanish Version)

by Smoots E

Practical Prevention: How Defibrillators in Public Places Can Save Lives

PD Health and Medicine 2 MD000667 Sudden cardiac arrest victims feel fine one minute, then the next minute they are dead. Can automated external defibrillators (AEDs), make it possible to change the outcome? These devices are effective, fairly simple to operate, and now readily available in many public places. The idea is to have them handy for members of the public to use right away on cardiac arrest victims.

Frequency of Sudden Heart Death

In the United States, sudden heart death is a growing issue that can affect anyone. Researchers blame the trend on an increasing incidence of inactivity, obesity, and other risk factors. Heart disease is a major killer in the United States today, with many of these deaths happening suddenly and unexpectedly from cardiac arrest.

How Rapid Defibrillation Helps

During cardiac arrest, the heart stops pumping, and there is no effective heartbeat. The most common culprit is an irregular heart rhythm called ventricular fibrillation. The irregular rhythm causes the heart to fibrillate, or quiver uncontrollably, and renders the heart unable to pump blood around the body. This can lead to death in minutes.
An important factor in surviving cardiac arrest is early defibrillation. Automated external defibrillators have the potential to improve survival rates. They can be readily available outside of a medical setting and they are relatively easy to operate.

Who Should Use an AED?

Increasingly, nonmedical people are being trained to use defibrillators. The American Heart Association promotes the use of AEDs by all emergency personnel. Additional people who may benefit from AED training include family and friends of persons at high risk and even employees at worksites or public places where large numbers of people gather.
AEDs are usually put in areas where they will most likely be needed and where quick service by paramedics is not readily available. Common locations include airports, shopping malls, casinos, community centers, and sports or medical facilities. With more AEDs around, the key to safe and proper use is training. The American Heart Association and American Red Cross offer AED classes.

How the Devices Work

In addition to being effective, recent advances in technology have made today's AEDs far safer and simpler to use. The lightweight portable devices have self-adhesive electrode pads that usually depict just where to stick them. Voice and text prompts guide the user through the few simple steps. The AED analyzes heart rhythm, automatically charges the machine when appropriate, and tells the user when to push the shock button. It then shocks the heart with a brief burst of electricity.

Legal Ramifications

Since AEDs now are more available and much easier to use, concerns regarding inappropriate use by a nontrained lay person have significantly diminished. Many states have also passed legislation protecting laypersons from medical litigation when an AED has been used in good faith.

Home use

The majority of cardiac arrests occur at home. Patients with heart disease at risk for cardiac arrest are frequently treated with implantable cardioverter defibrillators (ICD). Some patients, such as those who have contraindications to ICD implantation, may benefit from having an AED at home. Discuss this with your doctor.

CPR Is Still Important

For years, people have been encouraged to learn cardiopulmonary resuscitation (CPR). Learning to use an AED takes that lifesaving effort one step further. The American Heart Association says the five links in the chain of cardiac arrest survival are:
  1. Recognizing cardiac arrest and calling 911
  2. Early CPR
  3. Early defibrillation
  4. Early advanced medical care
  5. Post-cardiac arrest care

RESOURCES

American Heart Association http://www.heart.org

American Red Cross http://www.redcross.org

National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada http://www.heartandstroke.com

References

About cardiac arrest. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/About-Cardiac-Arrest%5FUCM%5F307905%5FArticle.jsp. Updated February 26, 2013. Accessed March 18, 2013.

Cardiac arrest. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 8, 2013. Accessed March 18, 2013.

Cardiac arrest statistics. American Heart Association website. Available at: http://www.heart.org/HEARTORG/General/Cardiac-Arrest-Statistics%5FUCM%5F448311%5FArticle.jsp. Updated January 17, 2013. Accessed March 18, 2013.

Chain of survival. American Heart Association website. Available at: http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/ECCIntro/Chain-of-Survival%5FUCM%5F307516%5FArticle.jsp. Updated January 2,3 2013. Accessed March 18, 2013.

Chen PS, Wolf PD, Ideker RE. Mechanism of cardiac defibrillation: a different point of view. Circulation. 1991;84:913.

Defibrillation. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Defibrillation%5FUCM%5F305002%5FArticle.jsp. Updated February 21, 2012. Accessed March 18, 2013.

Eisenberg MS, Moore J, Cummins RO, et al. Use of the automatic external defibrillator in homes of survivors of out-of-hospital ventricular fibrillation. Am J Cardiol. 1989;63:443-446.

External defibrillators. Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/CardiovascularDevices/ExternalDefibrillators/default.htm. Updated January 3, 2011. Accessed March 18, 2013.

How does an automated external defibrillator work? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health//dci/Diseases/aed/aed%5Fhowdoes.html. Accessed March 18, 2013.

Marenco JP, Wang PJ, Link MS, Homoud MK, Estes NA 3rd. Improving survival from sudden cardiac arrest: the role of the automated external defibrillator. JAMA. 2001;285:1193-1200. Review.

McDaniel CM, Berry VA, Haines DE, et al. Automatic external defibrillation of patients after myocardial infarction by family members: practical aspects and psychological impact of training. Pacing Clin Electrophysiol. 1988;11:2029-2034

SoRelle R. States set to pass laws limiting liability for lay users of automated defibrillators. Circulation. 1999;99:2606-2607.

State laws on cardiac arrest & defibrillators. National Conference of State Legislatures website. Available at: http://www.ncsl.org/issues-research/health/laws-on-cardiac-arrest-and-defibrillators-aeds.aspx. Updated January 2013. Accessed March 18, 2013.

Zipes D, Wellens H. Sudden cardiac death. Circulation. 1998;98:2334-2351. Available at: http://circ.ahajournals.org/content/98/21/2334.long. Accessed March 18, 2013.

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