What is Sudden Cardiac Arrest?
Sudden cardiac arrest (SCA) simply means that the heart unexpectedly and abruptly quits beating. This is usually caused by an abnormal heart rhythm called ventricular fibrillation (VF). Approximately 235,000 Americans suffer SCA each year without warning. It can leave the victim dead within a matter of minutes.
Is Sudden Cardiac Arrest the same as a heart attack?
No. A heart attack is a condition in which the blood supply to the heart muscle is suddenly blocked, resulting in the death of the heart muscle. Heart attack victims usually (but not always) experience chest pain and usually remain conscious. Heart attacks are serious and sometimes will lead to sudden cardiac arrest. However, sudden cardiac arrest may occur independently from a heart attack and without warning signs. SCA results in death if not treated immediately.
Who is at risk for Sudden Cardiac Arrest?
SCA is difficult to predict and most victims have no prior symptoms. Anyone who has suffered SCA, a heart attack, or knows they have an arrhythmia may be at greater risk for this malady. While the average age of sudden cardiac arrest victims is around 65, sudden cardiac arrest can strike anyone, anywhere, and at anytime.
What is Ventricular Fibrillation?
Ventricular fibrillation (VF) is an abnormal heart rhythm often seen in sudden cardiac arrest. This rhythm is caused by an abnormal and very fast electrical activity in the heart. VF is chaotic and unorganized; the heart just quivers and cannot effectively pump blood. VF will be short lived and will deteriorate to asystole (a flat line) if not treated promptly. For each minute that VF persists, the likelihood of successful resuscitation decreases by approximately 10 percent.
What is Defibrillation?
The only effective treatment for VF is an electrical shock called defibrillation. Defibrillation is an electrical current applied to the chest, and to be successful, should be administered within 3 to 5 minutes after collapse. The electrical current passes through the heart with the goal of stopping the VF and giving an opportunity for the heart's normal electrical system to take control and pump blood again. After 10 minutes without defibrillation, very few resuscitation attempts are successful. An AED can defibrillate the heart.
What does AED stand for?
AED stands for automated external defibrillator.
What is an AED?
An AED is a device used to administer an electric shock through the chest wall to the heart. Built-in computers assess the patient's heart rhythm, judge whether defibrillation is needed, and then administer the shock. Audible and/or visual prompts guide the user through the process.
What if I mistakenly apply the AED to someone who fainted but still has a pulse which I couldn't feel?
The AED makes shock delivery decisions based upon the patient's heart rhythm, and will not allow a shock to be delivered if not needed. Simply put, the machine will not let you shock a non-shockable rhythm.
How do I recognize the need for defibrillation?
Remember this rule: only put the unit on someone you would do CPR on... someone who is unresponsive, not breathing, and has no pulse.
What if I forget the steps for using the AED?
The steps for shocking a patient in cardiac arrest are simple and straightforward. Just follow the visual and audio prompts provided by the AED. The most difficult part is actually recognizing the need for defibrillation.
What if I can't hear the voice prompts of the AED?
Look for the visual text prompts on the AED screen.
Should I do CPR first or apply the AED?
Do CPR only until the AED arrives. Apply the electrodes to the patient's bare chest and follow the voice prompts and messages of the AED. It will tell you when to resume CPR. CPR is a holding action until the heart is defibrillated.
If defibrillation is so important, why should I do CPR?
CPR provides some circulation of oxygen-rich blood to the victim's heart and brain. This circulation delays both brain death and the death of the heart muscle. CPR buys some time until the AED can arrive, and it also makes the heart more likely to respond to defibrillation.
Can I be sued using the defibrillator?
To date, there has never been a case where someone was held liable for using an AED. However, there have been lawsuits for not having an AED regarding/the "standard of care." Most states have passed "Good Samaritan" legislation protecting the lay rescuer from lawsuits.
Can I accidentally shock myself or another rescuer?
AEDs are extremely safe when used properly. The electric shock is programmed to go from one pad to/another through the victim's chest. Basic precautions, such as verbally warning others to stand clear and visually checking the area before and during the shock, can ensure the safety of rescuers.
Do I need to remove the defibrillator pads before doing chest compressions?
No. The pads remain on throughout the resuscitation and until the patient is transferred to advanced care providers such as paramedics. If the pads are in their correct locations on the patient's chest, they will not interfere with proper hand placement or compressions.
Should I use the AED if the patient has a pacemaker or is pregnant?
Absolutely. Never withhold AED use from a person in cardiac arrest. If the person in question meets all the criteria of cardiac arrest (unresponsive, not breathing, no pulse) they are essentially "dead."
Can I defibrillate on a wet surface?
Yes, as long as the usual safety precautions are observed. Be sure the victim's chest is wiped dry. Keep the defibrillator electrodes away from a damp or conductive surface. Clear the victim and defibrillate.
How much of the patient's clothing needs to be removed to carry out defibrillation?
The chest should be exposed to allow placement of the disposable defibrillation electrodes. A woman's bra should be removed. Clothes may need to be cut off to facilitate early defibrillation.
Do physicians and nurses know how to defibrillate?
Not all medical personnel know how to defibrillate, or they may not be familiar with the type of defibrillator you are using. Once you have been trained, continue to use it. Medical personnel may be needed to administer drugs, and give other advanced medical care.
After I have successfully defibrillated the victim and have return of a pulse, do I keep the AED on the patient?
Yes, even after the patient has been successfully defibrillated, they are still at risk of developing ventricular fibrillation again. The AED will continually monitor the victim for the return of VF. If VF is suspected, the device will prompt you. The AED should be left on until emergency personnel assume responsibility for the patient. The defibrillation pads (electrodes) are disposable.
What if the patient regains a pulse but is not breathing or is breathing slowly?
Give rescue breaths at a rate of 1 every 5 seconds, or 12 per minute.
I shocked a woman in cardiac arrest 3 times within minutes after she collapsed. I heard later that she did not survive. Did I do something wrong?
Unfortunately, because of other underlying medical or heart problems, not all victims of cardiac arrest who are in ventricular fibrillation (VF) will survive, even if defibrillation is done promptly and correctly.
What if I don't perform all the steps of CPR and defibrillation perfectly?
A cardiac arrest is a high stress situation. Even the most experienced health care providers do not always do everything perfectly. In a cardiac arrest, performing CPR, even imperfectly, and using a defibrillator can only help the patient.
Is it okay to place the electrodes directly on a hairy chest?
Electrodes must come in direct contact with the skin. If the chest hair is so excessive as to prevent good adhesion of the electrode, the hair must be removed quickly.
What if the victim is a child?
Follow your protocols regarding/the lower age or size limits for children. The American Heart Association recommends no one under 8 years old receive defibrillation with an automated external defibrillator.
Can anyone buy an automated external defibrillator?
AEDs are devices manufactured and sold under guidelines approved by the FDA. Current FDA rules require a physician's prescription to buy an AED.
How much does an AED cost?
The price of an AED varies by make and model. Most AEDs cost around $2,500.