A new study reveals that a move among many hospitals to automated external defibrillators (AEDs) may be contributing to a higher rate of fatalities than would have been the case with older defibrillators. About 1000 patients are said to die annually thanks to AEDs.
Defibrillation is the stimulation of the heart with a therapeutic stream of current between two electrodes. The purpose is to recalibrate a normal heart beat for an individual suffering from cardiac arrhythmia or other similar conditions. Some arrhythmias are "nonshockable" rhythms, meaning they are not amenable to defibrillation. These include asystole, or flatlines. In the interest of telling between nonshockable and shockable rhythms, a professional would normally be required to use an external defibrillator. AEDs were invented to act as smart defibrillators, so anyone can use them in case of emergency. However, the results are not encouraging.
Part of the reason for AEDs' weak performance is the time it takes to apply the AED's pads to the patient from the moment the AED is accessed: 46 to 52 seconds. With only a few minutes to save a patient's life, this has proven to be too long of a time span.
The study, published in the Journal of the American Medical Association, tracked 11,700 patients with cardiac arrests across the United State from 2000 to 2008. Patients survived 16.3% of the time when AEDs were used, but survived 19.3% of the time when AEDs were not used. When controlling for just shockable rhythms, AEDs saved 38.4%, compared with the 39.8% survivability rate without AEDs.
Although AED's have been responsible for saving lives, the study above gives a fascinating look at some harsh statistics. The next time you learn of someone having a heart attack find out whether an AED was available and if it was, whether it was applied. If so, did it convert their cardiac rhythm and did the person survive. If no AED was available, the question will arise whether an AED would have helped.
We all like to believe that if the equipment was available that it would have helped. That's why it was developed and is now commonplace in schools, airports and businesses.
Two years ago, I had the privilege to see my son, a firefighter, jump into action and use an AED while we were waiting for a flight from Florida back home to New York. At the airport gate we were waiting to board our flight. An elderly man had been sitting in his seat by the gate and literally keeled over. My son dropped his backpack, ran over, announced he was a first responder, found no pulse or breathing and immediately began CPR.
He was joined by a JetBlue gate attendant who called for an ambulance. This was a witnessed arrest. Within minutes multiple police officers were on scene and one of them had an AED. My son opened the AED and then applied it to the elderly man. I had never seen one in use. Once the pads are attached to the patient, you press a button and the AED determines automatically if the heart rhythm is one it can and should convert by applying a shocking voltage to the patient.
It announced initially that it was not able to apply a shock and they should continue CPR. Minutes later they tried again to apply a shock with the AED. This time the emegency responders were told to step away from the patient and gave a countdown to when the electrical shock would be triggered. The crowd surrounding this emergency could see exactly when the AED had triggered.
The patient's body involuntarily jumped even though he was still not responsive.
CPR continued. The AED automatically detected a slight heart rhythm and advised it would shock the patient again. It directed the emergency personnel to move away, shocked the patient and finally, a heart rhythm was restored. The patient was not yet responsive and it was initially unknown whether he suffered any brain damage from this cardiac event.
After returning home to New York, my son followed up with the Port Authority police to learn the patient's status. He was thrilled to learn that this elderly man was discharged from the hospital one week after suffering a heart attack. This was a great result where the AED did make a difference. It also mattered that it was a witnessed cardiac arrest and my son and others were able to immediately help.
I felt really proud of my son that day watching him help save this man's life. It was really cool to watch.
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