EOL tech talks: AEDs
Edition: September 2013 - Vol 21 Number 09
Sudden cardiac arrest is a leading cause of death among adults over the age of 40 in the United States, according to the Sudden Cardiac Arrest Foundation (SCAF). But, cardiac arrest can – and does – occur in people of all ages. Approximately 360,000 Americans experience out-of-hospital cardiac arrests each year (about 1,000/day), and nine out of 10 victims die. That’s about the same number who die annually from Alzheimer’s disease, assault with firearms, breast cancer, cervical cancer, colorectal cancer, diabetes, HIV, house fires, motor vehicle accidents, prostate cancer and suicide combined.
Having the right tools, such as automated external defibrillators (AEDs), and knowing how to deliver cardiopulmonary resuscitation (CPR), can help increase the survival rate from 5 percent to as high as 45 percent, according to the American Heart Association (AHA). In fact, when bystanders intervene by providing CPR and using AEDs before emergency medical services arrive, four out of 10 victims survive, the SCAF reports.
Cardiac arrest is the sudden and abrupt loss of heart function. When the heart’s electrical impulses go haywire, the heartbeat becomes rapid (ventricular tachycardia, or VT) or chaotic (ventricular fibrillation, or VF). VT is a fast but regular heart rhythm, which prevents the heart from adequately filling with blood. As a result, less blood is available to be pumped through the body, to the brain and to key organs. VT can lead to ventricular fibrillation. VF is an erratic, disorganized rhythm in which the ventricles quiver and are unable to contract or pump blood to the body. In most cases, sudden cardiac arrest is triggered by underlying heart disease. However, it can occur during a heart attack, or a few months after a heart attack, when patients are at increased risk. Other triggers of sudden cardiac arrest include respiratory arrest, electrocution, drowning, choking, trauma and previously undiagnosed heart problems that have been present since birth.
In just four to 10 minutes, the lack of oxygen caused by sudden cardiac arrest can result in brain damage. In fact, a victim’s chance of survival decreases by seven to 10 percent with every passing minute. Having an AED available enables bystanders to quickly and effectively “shock” the heart (when a shock is required) to restore a normal rhythm.
Not all victims of sudden cardiac arrest require a shock – at least not initially. However, they all need cardiopulmonary resuscitation (CPR), which helps circulate blood to the brain until a healthy heart rhythm can be established. CPR, together with an AED, can significantly improve a victim’s chances of surviving sudden cardiac arrest. Having an AED available in all healthcare settings is an evolving standard of care. Many states have already enacted – or are in the process of enacting – laws that require dental offices and long-term-care facilities, among others, to have an AED on site. Experts consider an AED an essential tool in every physician’s practice.
What is an AED?
An AED is a battery-operated, portable device that delivers an electric shock to the heart to stimulate the heart’s natural pacemaker to resume a normal rhythm. Designed for use both by laypeople and professional responders, the device detects and analyzes any existing heart rhythm and advises whether or not to shock the victim. Some AEDs automatically administer the shock when appropriate. From the time the operator turns on the AED and attaches electrodes to the victim, the device provides step-by-step voice prompts, text instructions and/or graphics, directing him or her through the rescue process. AEDs may be used on adults or children. However, when using an AED on children younger than eight years, pediatric electrodes, which deliver a low level shock, must be used.
An AED may very well be the cheapest insurance a physician will ever buy. In recent years, the price of AEDs has decreased by half, from about $3,000 to $1,500 or $1,600 for a basic unit. More expensive devices, ranging in price from $3,200 to $4,200, are appropriate for more highly trained users who would like to view the patient’s electrocardiogram (ECG) or who prefer an AED that they can control using the manual mode.
The role of CPR
Indeed, an AED, vital as it is to restoring normal heart rhythm following sudden cardiac arrest, does not replace the need for CPR. After sudden cardiac arrest, the heart distends, or fills with blood. The chemistry in the heart starts to wear down. After five minutes, the heart is so engorged, even if the rescuer tries to administer a shock with an AED, it won’t help much. CPR helps keep oxygenated blood moving throughout the body.
The AHA’s 2010 Guidelines recommend that rescuers push hard, to a depth of at least two inches and at a rate of at least 100 compressions per minute. The rescue breaths that were once part of the CPR protocol have been eliminated for lay rescuers in favor of hands-only CPR. When using an AED, the rescuer is instructed to perform CPR for a two-minute interval. The AED then analyzes the heart to determine if a shock is needed. If not, this cycle is repeated.
Distributor reps should be aware of new developments regarding AEDs and CPR. Every five years, AHA, which sets standards for sudden cardiac arrest treatment and response protocols, revises its guidelines. The group’s 2005 update resulted in a much greater emphasis on CPR in the rescue process. And in its latest guidelines, released in November 2010, the AHA once again stressed the importance of CPR – particularly high-quality CPR. In June, AHA issued a consensus statement outlining steps that should be taken to improve CPR quality and therefore patient outcomes. http://circ.ahajournals.org/content/128/4/417.
The new emphasis on CPR has affected AED technology. Today, at least one manufacturer’s AEDs offer real-time audio and visual feedback that guides rescuers to deliver CPR compressions fast enough and deep enough to save a life, using prompts such as push harder or good compressions.
How to sell
The worldwide AED market has grown substantially in recent years, and chances are more physicians than not understand the importance of equipping their practice with this technology. A few probing questions can help distributor reps assess their customers’ need for AEDs.
• “What are you currently doing to prepare your office should somebody go into sudden cardiac arrest?”
• “Have you looked at some of the latest technology in automated external defibrillators that makes it easy and more cost effective than ever to have one here in the office?”
• “What do you find effective about the way you currently manage patients that go into sudden cardiac arrest?”
• “What would you alter about that process?”
Some physicians might object to purchasing an AED because they have never had a patient go into cardiac arrest during an office visit, or because they are located next to a hospital. Distributor reps should remind their customers that just as they have fire extinguishers in case of the unlikely occurrence of a fire, so, too, should they be prepared for the possibility of a patient going into sudden cardiac arrest. And, a physician’s proximity to a hospital is not enough to ensure that a patient will receive defibrillation in time to save his or her life. When every minute counts, an AED must be in the right place, at the right time.
Editor’s note: Repertoire would like to acknowledge the contribution of ZOLL Medical Corp. to this piece.