An important review of the literature on defibrillation for ventricular fibrillation has just been published in the September 19th issue of the Journal of the American College of Cardiology. Graham Nichol, MD, MPH, and colleagues at the University of Washington summarize the state-of-the-art related to defibrillation in treating sudden cardiac arrest. Topics include a brief history of the evolution of defibrillation, technical characteristics of modern automated external defibrillators (AEDs), strategies to improve AED access and increase survival, ancillary treatments, and use of implantable cardioverter defibrillators (ICDs) and wearable cardioverter defibrillators (WCDs).
The researchers note that since survival to discharge is strongly associated with whether the first rhythm is shockable, considerable efforts have been invested in reducing the time to defibrillation by increasing the use of AEDs before the arrival of EMS providers at the scene. They also note that 75 percent of out-of-hospital cardiac arrest events occur in the home.
According to the researchers, strategies to increase AED use include:
- Training personnel in AED use and AED placement at locations where large number of people gather
- AED placement in homes
- AED placement in schools
- Mobile phone-based systems designed to reduce time to defibrillation
- Residential response systems
- Mobile AEDs, including drone delivery of AEDs.
Researchers conclude that sudden cardiac death continues to be an important public health problem. Rapid response to cardiac arrest with highly trained EMS and use of AEDs, along with the use of ICDs in patients with indications, have contributed to a reduction in sudden cardiac death. The most promising interventions, they say, include mobile-phone based reminder systems, personal defibrillation, and wearable anti-arrhythmic devices. For more information, click here.