Shock of Their Life


In the first critical moments after cardiac arrest, commonly called a "heart attack," a defibrillator can help keep a victim alive. It is a powerful medical device, about the size of a small laptop computer but a bit heavier, and one a leading cardiologist at Cedars-Sinai Medical Center in Los Angeles said should be in as many homes as possible – since an estimated 70 percent to 80 percent of cardiac arrests occur at home, often suddenly and without warning.

Now, with FDA's approval last year of over-the-counter, at-home, automated external defibrillators (AEDs), individuals and families have another potent weapon in the battle to keep hearts beating until professional assistance can arrive on the scene. This is the first time defibrillators, which also can be used safely on children, even on those who weigh less than 55 lbs., are available without a physician's prescription.

"Having these machines at home is a long overdue step," said Prediman Krishan Shah, M.D., director of the division of cardiology and the Atherosclerosis Research Center at Cedars-Sinai.

Defibrillators provide the means of restarting the heart – accomplished with a jolt of electricity — following a cardiac arrest. "Most AEDs deliver biphasic [having two distinct phases] shocks of about 150 joules [a measure of mechanical and thermal energy]," explained Shah.

While cardiopulmonary resuscitation can help buy some time, experts, including Shah, estimate that every minute spent waiting for paramedics to arrive with a defibrillator reduces the chances of survival by about 10 percent.

"If cardiac arrest occurs, the first thing to do, of course, is to call 9-1-1. Get help coming, then begin CPR and, if there is an AED and people in the home have been trained properly on how to use it, they should definitely use it," he said.

An AED can cost anywhere from $1,400 to $2,000 a unit, said the doctor, with instruction readily available: "Training is pretty simple, and takes about five to 10 minutes."

Once used the devices can be recharged.

Each year, about 220,000 Americans die of cardiac arrest. It has been well-documented, said Shah, that the earlier a patient receives medical attention – including the use of a defibrillator – the better that person's chances of survival. The potentially life-saving devices are showing up in more and more public places, including synagogues, health and activity clubs, airports and sports stadiums, and even on some airlines.

Another kind of defibrillator, now available more easily to those in need thanks to a new ruling by Medicare, is an implantable cardiac defibrillator (ICD), about the size of a small pager and lightweight.

Arnold Greenspon, M.D., director of the Cardiac Electrophysiology Laboratory at Thomas Jefferson University Hospital in Philadelphia, spoke about ICDs recently. "Previously, ICDs were primarily used for people who had already suffered cardiac arrest. Now, we will be implanting the devices surgically in an operating room in people who have had either a heart attack or another reason for a decrease in pumping function of the heart.

"They have not yet had a serious heart rhythm problem, but, nonetheless, they are at high risk for sudden cardiac death."

The ICD is implanted subcutaneously in the left upper-chest wall, and the procedure takes about one hour. The device is designed to monitor a person's heart, providing a shock if the rhythm suddenly becomes rapid.

"The momentary shock feels a bit different to each individual," said Greenspon, also clinical professor of medicine at Jefferson Medical College of Thomas Jefferson University. "Some people say they feel a sudden jolt in the chest, while others report they are hardly aware of the experience. All wearers say they feel normal again within a few minutes.

"But following the first shock – no matter how the patient feels – wearers are encouraged to call their cardiologist. The physician will likely encourage the patient to come in to be sure everything is okay."

Indeed, ICDs have not been without controversy. At least two companies – Guidant and Medtronic – have been involved in recalls after reported problems from patients.



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