Cardiac Health Questions - Should you have a defibrillator?

Cardiac Health

The Role of Defibrillators

The perception that cardiac arrest is an event that can only be managed by a physician in a hospital must change. Early bystander-initiated CPR and rapid defibrillation are the two major contributions in salvaging lives in a sudden cardiac arrest situation. Sudden cardiac arrest happens anywhere in the community, and therefore the citizenry at large must be informed and equipped to provide early bystander-initiated CPR. A lot more people in the community other than physicians, nurses, or paramedics must know the technique of CPR. It is most ideal that every able adolescent and adult be proficient in the technique of CPR. Next to that, all police officers, firefighters, security guards, teachers, air flight crew, health aides and other volunteers must be taught in the skill of CPR with periodic updates and reviews. Spouses and significant others of high-risk cardiac patients must be encouraged to take CPR courses.

CPR can provide a temporizing first step in the sudden cardiac arrest victim. The most significant lifesaving measure comes from the defibrillation. With very rare exception, sudden cardiac arrest results from ventricular fibrillation (salvos of ineffective chaotic cardiac electrical activity). If the situation is allowed to continue over 4 minutes, irreversible brain death is almost sure to occur. Many communities have tried to reach the victim within a period of 3-5 minutes with a team such as EMTs and paramedics equipped with defibrillators. In the United States, only about 40% of the EMTs are actually equipped with automatic external defibrillators. However, our goal of a community equipped with adequate numbers of defibrillators and individuals who know how to use them continues to be a Utopian ideal, and the life loss from sudden cardiac arrest of about 1000 per day continues unabated. In large urban and rural communities, the paramedics can’t reach the location in time, due to heavy traffic or poor route directions.

Terri Folts, N.P. with an automatic defibrillator

Ideally, a portable automatic defibrillator must be available to every citizenry within about four minutes from the outset of a disastrous cardiac arrest. Implementing an aggressive defibrillation strategy with the use of AEDs (automatic external defibrillators) has shown significant improvement in the survival of sudden cardiac arrest victims. These automatic external defibrillators are small, portable, and easy to use. The use of AEDs can be safely integrated into the currently existing public safety systems such as EMTs, police, firefighters, and the first aid responders who have a duty to respond to a sudden death event.

Air Force One and several other commercial airlines currently have AEDs with trained personnel in case of cardiac emergencies. Barring several legal and ethical issues, the prospectus of having AEDs in public places such as office buildings, hotels, cruise ships, shopping malls, retirement communities, airports, public buildings, and apartment buildings are real possibilities in the near future.

Prompt defibrillation remains the cornerstone of survival of an out-of-hospital cardiac arrest. In New York State, in 1994, only 26 out of 2329 (9%) sudden cardiac arrest victims survived when SCA was out-of-hospital. However, in Rochester, Minnesota, when police vehicles were equipped with portable defibrillation devices, 21 out of the 44 victims (50%) attended by the police survived with the help of defibrillators. The usefulness of defibrillators in the field is self-explanatory.

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