Posting in Technology
A team of emergency room physicians found simple chest compression is just as effective in the first five minutes after a heart attack as an expensive portable defibrillator.
A new study in the journal BMC Medicine is calling into question one of the hottest new medical device markets.
The market is for portable defibrillators. A 2008 story touting the devices stated "having these portable devices stored in public institutions is the difference between life and death."
Turns out, maybe, not so much. (Picture from Wikipedia.)
A team of emergency room physicians at the University of Michigan headed by Comilla Sasson (now at Colorado) found that simple chest compression is just as effective in the first five minutes after a heart attack, the minutes that are critical to survival.
If the ambulance is more than five minutes away, in fact, chest compression may offer a better chance of survival.
It must be added this is still a slim chance. Only 8% of people who suffer sudden cardiac arrest outside a hospital survive.
This is the second study to turn thumbs-down on portables. A 2008 study of 7,000 records in Seattle showed that having a defibrillator at home offered no more hope of survival than knowledge of CPR.
Rapid chest compressions can be performed, in an emergency, even by someone who has never been trained in the procedure. Rescue breathing (the dreaded mouth-to-mouth) is no longer considered necessary.
The assumption that fibrillation is best has spawned a decade-long boom in the market, with both new and used gear in strong demand.Even hotels and resorts have been urged to keep them on hand (at nearly $3,000 each) or risk a lawsuit if someone dies and there wasn't one available.
There are actually three defibrillator markets, and the latest study only impacts one of them:
- Implanted defibrillators, like one long used by former Vice President Cheney, are installed following an extensive history, by professional cardiologists, and work well.
- Hospital defibrillators, used in emergency rooms or cardiac wards, are used by trained professionals and work well.
- Portable defibrillators, often used by people with little training, turn out to be no better than CPR chest compression.
The rush to market, however, has resulted in some recalls and lawsuits.
It's all a great example of something important. An expensive solution to a deadly problem is not always the right one. Sometimes a cheap, even free solution can work just as well, or better.
Sep 12, 2010
Looked at the origional studies. I agree with the above posts. It looks like Dana got caught cherry picking again.
What a miserable piece of inaccurate reporting by Dana Blankenhorn. I urge everyone to read the actual original articles as written by the researching physicians - both the Seattle Survey and the BMC Study (widely available on the net). The Seattle Study states that AEDs are effective and need to be used MORE at home. The BMC study is purely about the sequence of when an AED is used - not whether to use one.
Isn't it interesting that the source article doesn't say that AED's are a waste of time at all. It suggests that they offer no additional benefit unless help is delayed. How many EMT?s have a response time from ?collapse? to ?arrival? of 5 minute anyway?. international response times show that at best 8 minutes from dispatch to arrival at the scene is more realistic. However you have to take into consideration the extra time for finding a phone and calling the emergency service, where you are, the age of the person etc (phone triage system). A combination of both chest compressions and timely AED use will improve the odds of recovery ? if I had a cardiac arrest, I would like every possible intervention to be used! After all I want to grow old enough to be a problem for my children.
I'd like for you to tell the 14 year old boy who's life was saved by a portable defibrillator that the equipment is a waste of time. I think his parents are also glad the school he attended had an AED on site, and that his relatively untrained PE teacher used it successfully to save his life. I find your article an uneducated topical look at AEDs.
Your article is misleading at best. While the title of the new research study ("Using chest compressions first just as successful as immediate defibrillation after cardiac arrest") appears to indicate that defibrillation is no longer necessary, this couldn't be further from the truth. The keyword you and many other are missing is "first," as in "perform CPR prior to defibrillation," not "in lieu of." Additionally, you're misrepresenting the price of AED equipment by more than two-fold. The price quotes you're citing appear to include manual AED units (with EKG screens) as well as those built for lay-rescuers. AED units for the public access market can be acquired from reputable companies for well under their $1500 price tags. Perhaps one way to "Rethink Healthcare" would be to paint the full picture, including the facts, prior to blatantly posting a harmful title that might discourage AED deployment. While its clear you've elected to position your article in a manner so as to elicit emotions relevant to current events (such as national health care and deficit spending), you've suffered from those faults which are all-to-common in Congress today: failure to read the language used as a foundation for policy decisions.
But Doctor, with all due respect, how many people outside of a professional setting are going to REMEMBER THE SPECIFICS of CPR chest compression?
Remember, Congressi s the institution that passed the law requiring them to be on all aircraft, public spaces, Federal buildings, state building etc etc etc in the belief that having them around will allow untrained people to restart a non-beating heart. Of course finding it in the building / mall, taking it to where the person is, reading the instructions for setting it up, preparing the person for the electrical shock , and hitting that one button, based upon the ability of (especially non military trained people) to work in a panic situation and the ability to read and understand English, would take most people 10 to 15 minutes to peform. It was more of a feel good solution than a practical one. Also, having to have around 2 million of them built (and replaced and upgraded and routinely tested, with multiple ones per building and on each and every commerical aircraft flying) at $3,000 apiece - that cost of 6 billion inintial plus ongoing costs is all paid for by tax dollars or more expensive goods in the stores.
I am a former CPR Instructor Trainer. Most of the research I have seen on effectiveness of CPR, and I assume on defibrillators as reflected in this article, do not cover important issues that are very relevant to the effectiveness of resuscitation after sudden cardiac arrest. These issues include: age of person, presence or absence of underlying heart disease, circumstances of cardiac arrest (electric shock, drowning, blockage, etc.), and the person's quality of life after a successful resuscitation. I "retired" from the CPR industry after reviewing research on CPR and found that except for a very slim percentage, it was a waste of time, created more damage and disability than it prevented, and created more distress for unsuccessful rescuers.