Using Defibrillators for Heart Health
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SUSAN DENTZER: The shock from a heart defibrillator is a familiar scene in TV medical melodramas like the hit show “ER.”
ACTOR: 300. Come on, buddy, stay with me. Ray, get the hell out of the way. Move. Clear.
SUSAN DENTZER: Now the use of such devices to treat cardiac arrest could become a feature of everyday life. They’re called automated external defibrillators, or AED’s, and portable versions could soon be coming to public places near you. That includes sports stadiums, shopping malls, and train stations like New York’s Grand Central. There, a portable AED helped to save this man’s life.
BOB ADAMS: I was very fortunate, my family was very fortunate that they had an external defibrillator in this terminal, because if they didn’t, I wouldn’t be standing here today.
SUSAN DENTZER: Eight out of 10 major U.S. airlines have put defibrillators onboard most flights, and federal regulators have proposed that all passenger carriers have them by 2003. And at Chicago’s O’Hare Airport, defibrillators have already been placed on the walls, so that trained airport employees can get to them in just 90 seconds. The reason for the growing presence of AED’s is simple: They can save lives that would otherwise be lost. An estimated 350,000 people who aren’t in hospitals go into cardiac arrest each year. That’s as a result of everything from heart attacks to drownings to dehydration. A stunning 95 percent die, mainly because they’re not treated with AEDs. Carol Stemple is a registered nurse who trains people to treat cardiac arrest. We talked with her at one place that is now installing AEDs, The Kennedy for the Performing Arts in Washington.
CAROL STEMPLE: Normally, each of us has an electrical current that runs through our heart, and it is a nice, regular pattern, and that regular pattern produces a contraction of the heart and gives us a pulse, okay? In sudden cardiac arrest, frequently what happens to that nice electrical current, is it becomes disorganized.
SUSAN DENTZER: That disorganized current, called fibrillation, keeps the heart from beating effectively.
CAROL STEMPLE: It’s not regular; it cannot produce a contraction and it cannot produce a pulse, so your victim has an immediate loss of consciousness, no breathing, no pulse. Essentially they’re what we call clinically dead.
SUSAN DENTZER: Only a defibrillator, which administers an electric shock to the heart, can restore the normal electrical pattern and make the heart beat regularly again. And there’s not much time to intervene.
CAROL STEMPLE: That very small window of opportunity is like five minutes or less. For each minute that goes by without defibrillation, we lose another 10 percent survival rate.
SUSAN DENTZER: The National Heart, Lung, and Blood Institute, a division of the National Institutes of Health, is concerned about the heavy toll taken by cardiac arrest. So along with the American Heart Association, it launched a study to learn what would happen if AEDs were distributed more broadly. Under the $15 million study, defibrillators will be placed in roughly 1,000 public places around the United States and Canada.
HEALTH CARE WORKER: That’s telling you to stand clear, so you tell everybody, “Stay away, don’t touch the patient.”
SUSAN DENTZER: To cut short the time it takes to treat victims with AEDs, thousands of non- medical personnel at those places will be trained to use them. Dr. Denise Simons-Morton, who oversees prevention studies for the institute, says this strategy is what the study is mainly designed to test.
DR. DENISE SIMONS-MORTON: There are several different possible strategies: Only have them in emergency medical technicians’ hands in ambulances; have them in first- responders with police officers and firefighters; or put them in public places and have lay people trained in their use. We know the first two work from other studies. We’re not absolutely convinced of what the results would be of putting the devices in public places and training lay people, who are not medical people– training those people in their use.
SUSAN DENTZER: Under the study, an estimated 2,500 to 5,000 volunteers will be trained in what heart experts consider the current standard of care for cardiac arrest. That means providing cardiopulmonary resuscitation, or CPR, to try to keep blood flowing around the body, and then calling 911 to summon emergency medical personnel. A separate group of volunteers will be trained in those procedures plus the use of AEDs. Researchers will study what happens to cardiac arrest victims treated by each group.
DR. DENISE SIMONS- MORTON: So the question we’re asking is if you add AEDs to the current standard of care, is that feasible? Can you train enough people to do it accurately? And will it improve survival from cardiac arrest?
SUSAN DENTZER: Registered nurse Carol Stemple thinks the answer will be “yes.” She says that’s in part because today’s AEDs actually talk operators through the procedure.
AED VOICE: It is safe to touch the patient.
SUSAN DENTZER: That makes them easy for trained lay people to use. At the Kennedy Center, we asked Stemple to demonstrate how an AED works. Nearly 30 are being installed throughout the building, to be used by staff and security guards. The center’s health and safety specialist, Randy Kennedy, played the role of a victim who suddenly collapsed with cardiac arrest.
CAROL STEMPLE: Randy, Randy, are you okay? There’s no response. I don’t see any signs of movement. Susan, go call 911 and bring the AED. I’m going to open his airway; look, listen, and feel. I don’t see that his chest is rising or hear any breathing. The AED is here. Thank you. Going to give him two breaths. Good. And I’m going to apply the AED. The pads go to the right of the chest, just below the collarbone. And the other pad goes on the left side of the chest, about two inches below the armpit– one here and one here. We’ll turn our device on.
AED VOICE: Apply pads to patient’s bare chest. Plug in pads’ connector next to flashing light. Analyzing heart rhythm. Do not touch the patient.
CAROL STEMPLE: We don’t want to touch the patient because the machine needs to do its analysis.
AED VOICE: Shock advised. Charging. Stay clear of patient. Deliver shock now. Press the orange button now.
CAROL STEMPLE: I’m clear, you’re clear, everybody’s clear.
AED VOICE: Shock delivered. Analyzing heart rhythm. Do not touch the patient.
SUSAN DENTZER: After a moment, the machine gave Stemple the go-ahead to proceed.
AED VOICE: No shock advised. It is safe to touch the patient.
CAROL STEMPLE: He’s got a pulse.
AED VOICE: If needed, begin CPR.
CAROL STEMPLE: We’ll stay here with him and wait for the ambulance to come. And in the meantime, we’re going to leave our pads on because there’s a very high probability that his heart could refibrillate, and the machine will let us know that– this device, within 4.5 seconds.
SPOKESMAN: Sir, we have an unconscious man on mall level two.
SUSAN DENTZER: Although it’s clear AEDs can save lives if properly used, other questions remain. For example, the study will evaluate the cost-effectiveness of having the devices widely distributed in public facilities.
DR. DENISE SIMONS-MORTON: It’s quite costly to put these devices in, and also to provide the training. They cost $2,000 to $3,000 each now, and they need to be placed frequently enough so that you can… if you have a cardiac arrest, somebody can go get the device and come back within a minute or two, so… because time is of the essence. I mean, maybe for one building to do it, it would be feasible. But if you do it nationwide, this is a major cost.
SUSAN DENTZER: Another question is whether non-medical volunteers can use even these simple-to-operate devices under extreme pressure.
DR. DENISE SIMONS-MORTON: Will they get confused as to how to use it? Will they feel comfortable opening a person’s shirt?
SUSAN DENTZER: If the answer is no, says Simons-Morton, the volunteers trained to use AED’s could produce even lower survival rates than the other group in the study. But if AEDs in the hands of volunteers do save lives, the study will have shed light on how to close this gap in cardiac care.
DR. DENISE SIMONS-MORTON: People who don’t make it to the hospital because of a cardiac arrest on the street or in their home is still a major public health problem, and public access defibrillation may be a real breakthrough in dealing with that segment of the population.
SUSAN DENTZER: The study’s results are expected to be made public in 2003.