Saving Lives with Automated External Defibrillators

Your patient just suffered cardiac arrest. You know that time is critical. Learn how you, as the first responder, can use an AED to save seconds—and your patient’s life.

SUDDEN CARDIAC ARREST: It may be the most stressful emergency you’ll ever face as a nurse. And if you’re a hospital staff nurse prepared to give basic life support (BLS), you may be the first responder for cardiac arrest occurring outside of critical areas. Historically, as a first responder, you could provide only cardiopulmonary resuscitation (CPR) until the code team arrived, and they’d initiate defibrillation and advanced cardiac life support. But prolonged CPR doesn’t effectively treat ventricular fibrillation. —the most common initial rhythm in cardiac arrest. To treat this deadly arrhythmia. you need to defibrillate the patient quickly—the probability of survival decreases 7-10% every minute, the defibrillation is delayed. Recognizing this, the American Heart Association has expanded its standard of care to include the use of automated external defibrillators (AED’s) by all BLS trained personnel who respond to a cardiac arrest. So if you haven’t yet learned to use AED, you may soon. To get up to speed, let’s review what an AED is and points to remember when using it.

ABCs of AEDs
An AED is a portable defibrillator that automatically detects shockable arrhythmias—ventricular fibrillation and pulseless ventricular tachycardia— in a cardiac arrest victim. You don’t have to know how to recognize an arrhythmia to use an AED. In fact, many AEDs don’t even have a monitor. You must only attach two electrodes to a patient who is unresponsive, pulseless, and not breathing and activate the AED. If the AED detects a shockable arrhythmia, it automatically charges and signals that defibrillation is indicated. After you make sure that no one is touching the patient, you deliver a preprogrammed shock.

BUT HOW ABOUT CPR?
Cardiopulmonary resuscitation had an important role in keeping the patient alive until he could be defibrillated when defibrillators were bulky and required advanced training to operate. But now, thanks to equipment like the AED, defibrillation can be provided quickly in many settings. Delivered promptly, defibrillation dramatically improves the prognosis of the patient with shockable arrhythmias. Delaying CPR to activate an AED will have little effect on the dismal prognosis of patients with nonshockable rhythms, such as asystole and pulseless electrical activity. To make sure you can defibrillate patients as quickly as possible, you’ll need to know how to use an AED. Many hospitals have already adapted their CPR course to include AED training and have made these combination BLS/AED courses the standard educational program for all staff members required to respond to a cardiac arrest.

The probability of survival decreases 7-10% every minute that defibrilation is delayed.

Three rules for using AEDs
When you attend your first BLS/AED course, you should remember these three key points about using an AED.

1. Use an AED only on apneic and pulseless patients. This requirement means that you may need to review and refine your current CPR assessment skills.
2. Give defibrillation priority over CPR. Rather than initiating CPR and you are the only first responder, you must get, attach, and activate the AED. In some situation, you may need to break the long standing- rule to never leave a patient who’s in cardiac arrest. Provide CPR only if there’s a delay in obtaining or attaching the AED or if the AED indicates that a shock isn’t advised.
3. Address safety concerns. An AED, like a conventional defibrillator, delivers an electrical shock. Sop be certain that all people are clear of the patient before discharging the device, and use AED only on an adult.

Moving beyond the hospital walls
The use of AEDs shouldn’t be limited to hospital settings. Any location where people seek health care (such as outpatient clinics, free standing dialysis centers, and occupational health care centers)should have a plan for resuscitation that includes first responder use of an AED. No matter where you work, providing automated external defibrillation will soon be the definitive initial treatment of patients in cardiac arrest.

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by: Mary Elizabeth Mancini RN,CNA,MSN,FAAN, Nancy Richards RN,CCRN, and William Kaye MD FACP ,FCCM from NURSING 97 October issue
References:
Cummins,R.,et al.;”Advanced Life Support Subcommittee and Emergency Cardiac Care Committee of the AHA
Kaye,W.,et al.: Strengthening the In-Hospital Chain of Survival ...
Schneider,A., et al: “In-hospital Cardiopulmonary Resuscitation

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