Your chances of surviving sudden cardiac arrest outside of a hospital are one in 20.
But your odds improve 10-fold if an electronic defibrillator is close at hand, according to two new studies in the current issue of the New England Journal of Medicine that tracked the devices’ use in Las Vegas casinos and American Airlines flights.
Defibrillators are portable versions of the emergency room electronic shock paddles seen on shows like ER. The size of a laptop computer, they work by shocking the heart back into its groove after an abnormal heart rhythm or arrhythmia disrupts the heartbeat.
Without immediate defibrillator treatment, studies have found a 2 to 5 percent survival rate in urban areas for the 350,000 Americans who go into sudden cardiac arrest each year. That’s because for every minute lost, survival drops by 10 percent. By 10 minutes, the average time it can take for help to arrive, it is almost always too late.
Lives Could Be Saved If defibrillators were more widely available, say proponents including the American Heart Association, up to 100,000 American lives could be saved annually.
With thousands of portable defibrillators sold to date, the devices are beginning to appear in a variety of public venues, from Grand Central Station in New York City to Chicago O’Hare International Airport. In May, President Clinton called for the devices to be in placed in all federal buildings and in all U.S. airline planes within three years.
Today, CVS pharmacy, in conjunction with Agilent Technologies in Seattle, announced it will begin selling on its Web site the $2,999 devices directly to consumers with a doctor’s prescription.
To further foster their use, two pieces of legislation nearing passage in Congress would establish a ‘good Samaritan’ clause lessening liability concerns and provide funding for the machines in rural areas.
Easy to Use While critics have worried if the devices can be used effectively by those without medical training, these two studies add to the growing body of empirical evidence that they can, says Dr. Terence Valenzuela, a professor of emergency medicine at the University of Arizona in Tucson.
His study looked at 105 gamblers who went in to cardiac arrest in 32 casinos in Nevada and Mississippi and were treated by trained security guards.
Casinos are venues with higher than average amounts of heart failure, not because of the emotional rollercoaster that is gambling, Valenzuela says, but because they typically attract populations at high-risk for heart failure — smokers and the elderly.
The defibrillators saved three-quarters of the adults who were seen suffering cardiac arrest, if they were treated within three minutes. The devices saved half of those treated between three and nine minutes. The average time from collapse to the first administered shock was around 4 ½ minutes. It took nearly 10 minutes, on average, for trained emergency medical technicians in ambulances to arrive.
‘I Wouldn’t Be Here’ Joseph Secco, 74, was one of those patrons revived by a defibrillator after going into cardiac arrest on the dance floor at the Stardust Hotel in Las Vegas three years ago. “If it weren’t for that machine, I wouldn’t be here,” Secco says. “That’s a bold statement, but it’s a fact.”
Filmed footage of Secco’s collapse and defibrillation only a few minutes later is now part of the casino’s training program. “If it can help save the life of somebody else’s loved one,” Secco says, “I think it’s a great thing.”
The second study, led by Dr. Richard Page of the University of Texas Southwestern Medical Center in Dallas, found that 40 percent of passengers on American Airlines flights who went into cardiac arrest and received the appropriate defibrillation survived. The airline installed the machines since 1997 and has trained its flight attendants to use them.
“The devices are pretty simple to use,” says Valenzuela, who believes both journal studies demonstrate that non-medical personnel are perfectly competent using the machine. A recent study found that even sixth-grade children were able to follow directions and correctly use the defibrillators
The defibrillators can automatically recognize when the shock should be administered, reducing the chances for incorrect application. Operators follow a series of audible instructions prompted by the machine.
To see whether a volunteer without specific medical training could actually save lives using the devices, the National Heart Lung and Blood Institute, one of the institutes in the federal National Institutes of Health, initiated a two-year study in August.
At What Cost? Should government agencies and businesses want to purchase the machine, based on current findings, the $3,000 price tag for a defibrillator raises the larger economic question of where the machines should be placed. Should they be in every sports arena? Every office building? Every home? And who will pay for them?
Although many businesses have been reluctant to offer the machines because of liability fears, Valenzuela says several have found it can be good for publicity — and even the bottom line. “Many people who call for reservations now ask whether the [casino] property has a defibrillator,” he notes.
But although Secco’s life was saved by a defibrillator, he says a home machine is probably too expensive and technical for him to purchase.
“That might be something of the future,” he says. “In 30 years, there might be one in every house.