The spread of AEDs carries benefits for ICUs
User-friendly defibs help cut your costs
A toaster-size and easy-to-use breed of automated external defibrillators (AEDs) is now available which, advocates say, can save the lives of patients, and money and time for ICUs.These user-friendly defibrillators identify ventricular fibrillation and administer the shock without requiring anything of the operator other than following instructions. This means that people in the field can restore hearts to a normal rhythm in a fraction of the time it would take emergency personnel to arrive. For the ICU, that could mean fewer patients with severe neurologic deficits, and shorter lengths of stay, experts say.
While most intensive care personnel are already trained on use of the more sophisticated defibrillators, experts say ICU managers should be pushing for liberal use of the AEDs in other settings.
"It’s wiser resource utilization," says Sandra Sawyer-Silva RN, MFN, CCRN, critical care instructor for nursing professional development at Miriam Hospitals in Providence, RI. "It’s not cost-effective to have someone stay in the ICU for a month in a vegetative state."
Sawyer-Silva notes that nurses outside of critical care generally are not trained on defibrillators and must rely on CPR in emergencies until a code blue team arrives. In large hospitals and hospital complexes, that can take several minutes, and if the delay is longer than ten minutes, the likelihood of successful resuscitation is low.
"There’s such a short window of opportunity. The degradation in survival rate is 10% each minute defibrillation is delayed," says Beth Mancini RN, MSN, FAAN, senior vice president of nursing administration at Parkland Health and Hospital Systems in Dallas.
Mancini and William Kaye MD, FACP, FCCM, director of critical care medicine and intensive care at Miriam Hospitals, are submitting an article to the American Journal of Critical Care Medicine titled "Automated external defibrillation: What the critical care practitioner needs to know."
"We need to educate [critical care nurses] so they’ll support the use of AEDs throughout the hospital," says Kaye. He says defibrillation — not CPR — is best hope for patient in cardiac arrest. The American Heart Association is also advocating the use of AEDs as an important link in the "cardiac chain of survival."
AEDs are so simple that anyone who is likely to encounter someone in cardiac arrest can be trained to use them. And since they now start at about $2,500, almost anyone can afford to have one.
With fully automated defibrillators, all that is required of the operator is to take off the patient’s shirt, attach the self-adhesive pads, and turn on the machine. The AED will then analyze the rhythm, assess whether shock is necessary, then proceed to charge its capacitors and shock the patient.
When using a "semiautomated" or shock advisory defibrillator, the operator simply presses a button to initiate rhythm analysis and then presses another button when the machine advises shock. Because standard defibrillators have monitoring features which AEDs lack, the AEDS may never outphase the larger and more sophisticated ones in ICUs. However, Kaye says there is a time coming when all defibrillators will have a shock-advisory mode.
In clinical trials, paramedics using automated defibrillators delivered the first shock about one minute quicker than those using standard defibrillators. Kaye attributes this to the "dither factor." In an emergency, he says there is always some amount of uncertainty — is it or isn’t it ventricular fibrillation? The automated units know instantly whether shock is needed.
Eventually, AEDs should be placed in airplanes, stadiums, schools, and anywhere else needed, say Kaye and Mancini. "Why not do something that’s really going to make a difference?" adds Mancini. n
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