Ventricular Fibrillation and the Use of Automated External Defibrillators on Children
David MarkensonLee A. PylesSteven R. NeishSteven E. KrugThomas BojkoMargaret A. DolanKaren S. FrushPatricia J. O’MalleyRobert E. SapiénKathy N. ShawJoan E. ShookPaul E. SirbaughLoren G. YamamotoJane W. BallKathleen BrownKim BullockDan KavanaughSharon E. MaceSusan Eads RoleDavid W. TuggleTina TurgelSusan TellezRobert H. BeekmanPeter B. ManningSeema MitalW. Robert MorrowFrank M. GaliotoThomas K. JonesGerard R. MartinReginald WashingtonLynn Colegrove
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Abstract:
The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.Keywords:
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Automated external defibrillator
Early defibrillation is a determinant of survival in both out-of-hospital and in-hospital cardiac arrests from ventricular fibrillation and pulseless ventricular tachycardia. The review summarizes importance of early defibrillation with automated external defibrillators (AED) and presents the International Liaison Committee on Resuscitation (ILCOR) recommendation for universal AED sign. The aim of the recommendation is to unify the AED signs worldwide and to spread the knowledge of this. The public in general, but healthcare professionals particularly, should be able to recognize AED location and use the device immediately in case of cardiac arrest.
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The occurrence of out-of-hospital cardiac arrest (OHCA) is a critical life-threatening event that often warrants initial defibrillation with a semi-automated external defibrillator (SAED). In INDIA, about 4280 deaths in 1Lakh are due to SCA. The optimization of allocating a limited number of SAEDs in various types of communities is challenging. Hence this paper presents the implementation of an off-hospital rural and urban public access defibrillators. This defibrillator is a semi-automated defibrillator, a medical device which analyse the patient’s electrocardiogram in order to establish whether he/she is suffering from ventricular fibrillation and if necessary, delivers an electric shock, or defibrillation, to help the heart re-establish an effective rhythm.
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Immediate defibrillation is the single most effective therapy to reverse ventricular fibrillation cardiac arrest today. The once physician-only skill of defibrillation has entered mainstream society and is saving the lives of many sudden cardiac arrest (SCA) victims in a variety of settings. The automated external defibrillator (AED) and the concept of public access defibrillation (PAD) are a result of collaborative efforts between the American Heart Association (AHA) and medical manufacturers. Today, airports, airlines, casinos, cruise ships, and other public venues have modernized their first aid kits to include an AED. The success of these programs has ignited a trend in public safety and subsequently marketed the worth of AEDs in the home. Although optimal placement of AEDs remains uncertain, PAD is showing great promise in reducing the death rate from SCA. The lay public, both trained and untrained, is emerging as the next level of emergency care responders able to use a defibrillator.
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Automatic external defibrillators (AEDs) may have advantages over manual defibrillation in managing prehospital cardiac arrest, particularly in rural communities. We conducted a two-part evaluation of a commercially available AED. We first established the diagnostic accuracy of the AED's rhythm recognition algorithm by challenging it with 205 cardiac arrest rhythms previously recorded from actual patients in the field. The AED demonstrated 100% specificity and 92% sensitivity for ventricular fibrillation (VF) in this nonclinical setting. We then compared the clinical efficacy of AEDs in 18 small communities (study group) with that of manual defibrillation in 18 additional communities (control group) of similar size. Ambulance technicians using manual defibrillators correctly diagnosed VF more frequently than the AEDs (98% vs 83%; p less than .025). Specificity for VF was similar in the two groups (100% for AEDs vs 94% for technicians; p greater than .10). AEDs were able to deliver shocks more quickly than...
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Early defibrillation is the most important determinant of survival for victims of cardiac arrest due to ventricular fibrillation. The automated external defibrillator (AED) was developed as the result of the American Heart Association's Public Access Defibrillation initiative. The goal of this initiative is to place AEDs in strategic locations so that laypersons with minimal training could promptly defibrillate victims of cardiac arrest. Because of changes in design and the use of alternative waveforms for defibrillation, the modern AED is compact and portable, simple to use, and highly efficacious; in addition, it requires little maintenance. Automated external defibrillators have been used successfully by traditional and nontraditional responders as well as laypersons. In special environments, such as casinos and commercial aircraft, AEDs have performed particularly well. State and federal legislation has eased concerns about AED use by extending legal protection to AED users under Good Samaritan laws. Since the experience continues to be positive, AEDs are being used in increasingly diverse community locations, and public awareness is growing. The American Heart Association's initiative is progressing rapidly.
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Sudden death claims 250,000 lives annually in the U.S. The vast majority of such events are due to ventricular fibrillation and ventricular tachycardia. Even though these arrhythmias can be converted if treated promptly, less than 5% of victims of out‐of‐hospital cardiac arrest survive to hospitalization. This poor survival is often due to delay in the initiation of quality CPR and defibrillation. Several clinical studies have evaluated the use of an AED by nontraditional emergency medical providers and by laypersons in Public Access Defibrillation programs. These studies have demonstrated a significant improvement in survival due to earlier access to defibrillation provided by the AED. The AED has proven to be safe, reliable, and efficacious in the diagnosis and treatment of ventricular arrhythmias when employed by lay providers/rescuers in a variety of outpatient settings. Society has embraced these data and legislation has been passed that supports the implementation of PAD programs into communities and protects lay rescuers and organizations implementing these programs from liability. Concerns about cost versus benefit still serve as barriers to widespread implementation of PAD programs, but with the declining cost of AEDs and increased public awareness, many communities have initiated PAD programs. We encourage widespread implementation of PAD programs and enhanced public awareness about basic life support, with the expectation that such efforts will enhance survival of out of hospital cardiac arrest.
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Rapid delivery of defibrillatory shocks increases survival in patients with cardiac arrest. The automated external defibrillator interprets cardiac rhythms and delivers electrical shocks, permitting appropriate defibrillation by persons with minimal training. California initiated a program for early defibrillation by basic emergency medical technicians, using manual or automated external defibrillators, and by public safety personnel (fire fighters, peace officers, and public lifeguards), using automated external defibrillators. The program includes a system for reporting outcomes statewide. In the first 46 months under this program, 1487 patients received defibrillatory shocks; 1009 (68%) of these patients had witnessed ventricular fibrillation. Of the latter group, 191 were discharged from the hospital, representing 19% of those with witnessed ventricular fibrillation and 13% of all patients who had had shocks applied. California also implemented a framework of training and medical direction for defibrillation by laypersons using automated external defibrillators. Early defibrillation by basic emergency medical technicians and public safety personnel, encouraged by appropriate regulatory changes, results in gratifying survival rates.
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