Category Archives: Cardiac Arrest

London Ambulance Service – Parliament receives lifesaving equipment

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Visitors and employees at the Houses of Parliament can now be assured of receiving the very best in service from the first aid team, following the installation of 16 new defibrillators.

Part funded by the British Heart Foundation, defibrillators are machines that can deliver a shock to restart a patient’s heart should they suffer a cardiac arrest – when the heart stops pumping blood around the body.

The newly qualified six-strong HeartStart training team and the current first aid team at the Houses of Parliament will now be on hand to deliver this lifesaving care 24 hours a day.

London Ambulance Service is responsible for over 800 public-access defibrillators around the capital, placed in tourist attractions, transport hubs, shopping centres and sports facilities.

Last year the scheme helped to save 11 patients who had suffered a cardiac arrest to be discharged from hospital. Overall in London, almost a third of patients suffering cardiac arrest survived in 2011/12 – the highest in the country.

 
See on www.londonambulance.nhs.uk

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‘Cough CPR’

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The BLS/AED Subcommittee has received a number of enquiries from people who have been informed about “cough CPR” and “How to survive a heart attack when alone”. Advice has been put on the Internet that someone who thinks he or she is suffering a heart attack should repeatedly cough and go at once to a hospital, by car if necessary.

This advice is based (very loosely) on published case reports of people being able to maintain some sort of cardiac output during cardiac arrest by vigorous coughing – so-called “cough CPR”. The scenario has usually been of a patient developing ventricular fibrillation whilst being monitored, often whilst undergoing cardiac catheterisation. The patient has been encouraged to cough and a measurable circulation has been recorded. This anecdotal evidence supports the theory that chest compressions during CPR are successful because they increase intrathoracic pressure and result in a flow of blood. The collapsed veins and patent arteries at the thoracic inlet result in this flow being in a forward direction. Coughing produces the same effect.

The BLS/AED Subcommittee knows of no evidence that, even if a lone patient knew that cardiac arrest had occurred, he or she would be able to maintain sufficient circulation to allow activity, let alone driving to the hospital.

December 2005
Reviewed August 2010

References:

Criley JM, Blaufuss JH, Kissel GL. Cough-induced cardiac compression: self-administered form of cardiopulmonary resuscitation. JAMA. 1976;236:1246-1250.
Miller B, Cohen A, Serio A, Bettock D. Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter. J Emerg Med. 1994;12:627-632.
Petelenz T, Iwinski J, Chelbowczyx J, Czyx Z, Flak Z, Fiutowski L, Zaorski K, Petelenz T, Zeman S. Self-administered cough cardiopulmonary resuscitation (c-CPR) in patients threatened by MAS events of cardiovascular origin. Wiad Lek. 1998;51:326-336.
Saba SE, David SW. Sustained consciousness during ventricular fibrillation: case report of cough cardiopulmonary resuscitation. Cathet Cardiovasc Diagn. 1996;37:47-48.
See on www.resus.org.uk

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Stafford Borough Council – Man speaks of night NOT to remember

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A Stone man has now spoken of the night he nearly died at his local gym.

Russell Follows said if it hadn’t been for a quick thinking fitness instructor he wouldn’t be alive today.

Mr Follows suffered a cardiac arrest in the changing rooms of the borough council run Westbridge Park Fitness Centre. But local instructor, Lee Nicklin used CPR and an on-site defibrillator to keep the man alive until an ambulance took him to University of North Staffs hospital.

Speaking about the incident Mr Follows, 55, said: “Thanks to Lee I’m still here and in the world.”

Stafford Borough Council provides defibrillators at a number of its premises including all leisure centres, the Civic Centre, Gatehouse Theatre and the crematorium on Tixall Road with around 70 members of staff trained to use them.

Mr Follows continued: “I’m coming to terms with what’s happened. I can’t remember anything from that night, not even driving to the gym, or using the gym.”

“He acted immediately and did enough that evening to save my life and I can only say a million thank yous. And even that’s not enough. He is a genuinely nice guy, and got very emotional when I went in and thanked him last week.”

Mr Follows said how defibrillators are a much needed piece of equipment: “I’m just grateful that as well as Lee there was a defibrillator on hand which is there for everyone to use in emergencies – and as you can see they save lives.”

But the incident has not put him off using the gym: “I enjoy the gym so it’s hard not to go, but I’ve been told to take it easy. So I’m not going to over do it just yet.”

Mr Follows left hospital on Saturday 2 March after under going surgery where he was fitted with a mini defibrillator, following the cardiac arrest last month: “Having the defibrillator fitted was a big decision to make, but really it’s a no brainer it’s like a comfort blanket in case anything happens again. Plus it’s also peace of mind for my family.”

Lee, 39 said: “It was all part of the job. We are trained to use the defibrillators and knowing that it saved Russell’s life demonstrates how important the machine and our regular training is.”

He continued: “It was just so emotional and great to see Russell when he came back into the gym with a thank you card.”

Councillor Mike Smith, cabinet member for leisure, said: “We had a similar incident happen in Stafford several years ago, and it just highlights how important defibrillators are.”
See on www.staffordbc.gov.uk

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Understanding Defibrillators (AEDs)

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A defibrillator is a life saving device that issues a electrical shock to the heart in some cases of cardiac arrest. This process is called defibrillation and can help save lives. Cardiac arrest happens when the heart stops pumping bloody around the body. At this time it is critical that defibrillation happens as soon as possible.

This electrical shock depolarizes a critical mass of the heart muscle, terminates the arrhythmia, and allows the natural rhythm  of the heart to be re-established by the body’s organic pacemaker, in the sinoatrial node of the heart.

According to the British heart foundation for every minute that a patient is not giving defibrillation their chances of survival decrease by 14 per cent. In fact research also show that’s providing a shock within five minutes of the patient collapsing provide the best chance of survival.

Defibrillators can come in many forms and sizes. These can be external, transvenous, or implanted. This will all depend on the device used. The most common devices are called automated external defibrillators (AEDs) and because they automate the defibrillation process, by automation of the treatable rhythms, meaning that bystanders or people with very little or no training at all can use them.

Because of the importance of the defibrillators and the low numbers available, it is vital that these devices are strategically placed within an area. These are often placed where an ambulance would find it difficult to get to –  i.e.,  placed with traffic congestion, poor infrastructure, or where large crowds gather.

Defibrillation was first successfully performed in 1899 by two physiologists in Switzerland. It was found that small electrical shocks could induce ventricular fibrillation in dogs. However, it wasn’t until 1933 that a serious alternative to injecting powerful drugs straight to the heart. Dr Albert Hyman came up with the invention of a hollow needle, an insulated wire to the heart to deliver the electrical shocks.

These days Defibrillators have come a long way from the Hyman days. In order to use the AED, the machine is turned on and then a voice prompt will instruct the rescuer on what to do. The voice prompts the rescuer to place the pads into position on the chest and these then detect if a shock is needed by reading activity in the heart.

Defibrillation should never be seen as an alternative to to CPR, which can help buy time before defibrillation is needed. The British Heart Foundation state that if more GP surgeries were equipped with defibrillators that survival could be increased by up to 60 per cent if the patient is treated immediately after entering cardiac arrest.

AED’s are often placed in highly visible areas and it is not recommended that these should be placed in locked or code restricted cabinets as this makes them inaccessible in time of emergency where the time taken is of essence. AED’s are often brightly coloured, and are often encased in protective cases. When these protective cases are opened nearby staff are alerted by a buzzer.

 
See on www.blog4safety.com

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Automated External Defibrillators and the Urban myths

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Sudden Cardiac Arrest (SCA) is a life-threatening condition that must be treated within minutes if the victim is to survive. The only therapy which can treat the life-threatening arrhythmia that occur during SCA is defibrillation; the earlier the better. Various studies have determined that for every minute defibrillation is delayed survival falls rapidly. In one study it was determined that this fall in survival was around 7 to 10% while the British Heart Foundation (BHF) have concluded that the fall in survival percentage is 14%.

Defibrillation for the SCA victim needs to be part of the ‘pattern of care’; a well-establish process – the Chain of Survival – assists the rescuer in giving the victim the best chance of survival; call for help, early CPR, early defibrillation and advanced life support.

Automated External Defibrillators (AEDS) are designed specifically to enable non-medical rescuers to treat SCA victims as they are safe, easy to use and effective.

There are, however,  a number of myths and mis-information around the whole issue of SCA and the use of an AED.

Lay persons are often confused between a heart attack and a sudden cardiac arrest. These are two separate medical conditions and although the first can lead to the second, an AED is designed to treat the unresponsive, not breathing victim the indications for SCA and the use of an AED.

Clinically, defibrillation does not ‘jump’ start the heart. Delivery of a biphasic electrical current depolarises the heart cells allowing the organ’s natural ‘pacemaker cells’ to re-start and the heart to return to normal electrical activity or sinus rhythm. During SCA the heart is exhibiting ventricular fibrillation (VF) ; a chaotic discharge of electrical current that prevents oxygenated blood from circulating or pulseless ventricular tachycardia (VT) which while more regular is still too fast to again allow the effective circulation of blood thus denying the brain of oxygen.

People often ask about the ‘danger’ of rescuers or bystanders receiving a shock if they are touching the victim of SCA during defibrillation. While we have adopted the historical warning ‘stand clear’ from the use of manual defibrillators, studies show that current leakage from a defibrillation device using adhesive pads is actually minimal. The majority of current delivered being discharged into the chest and heart. The actual amount of current leakage recorded in one study measured this as well below 2,500 microamps, the international standard relating to this threshold. To put this into layman’s terms this equates to the current from a standard nine volt battery. The European Resuscitation Council (ERC) Guidelines (2010) describes 29 instances of death or harm from a manual defibrillator, however this is a different type of device, produced for professional rescuers, utilising metal paddles (although some are available with adhesive defibrillation pads.

All in all, AEDs are safe, effective and easy to use so why would you not want to place these in your workplace or public area?
See on stejey.blogspot.co.uk

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Villagers turn old phone box into mini A&E with life-saving machine

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A DEFIBRILLATOR has been installed in a rural red call box after locals bought the kiosk from BT for a pound.

AN old phone box has been transformed into a potential lifesaver after being purchased by villagers for £1.

A defibrillator, which gives the heart an electric shock in some cases of cardiac arrest, has been installed in the red call box.

And as the nearest accident and emergency department is 20 minutes’ drive away, the machine could mean the difference between life and death.

The call box in Arnprior, Stirlingshire, was bought by the community from British Telecom under the company’s Adopt a Kiosk scheme.

Funding for the defibrillator came from various organisations, including Stirling Council and the Sandpiper Trust, who aim to provide Scotland’s rural doctors and nurses with emergency medical equipment.

A BT spokesman said: “We’re very pleased to hear that the villagers of Arnprior have found a new lease of life for one of our old, rarely used boxes.

“Over the years, many people have described their local phone box as a lifeline. Now that everyone has a phone at home or a mobile, that’s no longer true.

“But kiosks fitted with defibrillator machines could be real life savers for the community in the future.”

The Scottish Ambulance Service and the Community Heartbeat Trust, a charity dedicated to the provision of defibrillation services to local communities, gave their help to the project.

Backing also came from the community council and Stirling Council’s Community Pride fund. Villagers were given advice and training on how to use the defribillator.

And children from the local primary school will be on hand to help open the lifesaving installation on Monday.

A spokesman for the Sandpiper Trust said they were delighted to have been involved in the Arnprior project.

He said: “It has become increasingly clear over the past decade since the trust was set up that working together with all these organisations is what saves lives.

“We are also pleased that the children of Arnprior School have been involved in this project.”

More than 100 traditional red kiosks in Scotland have been adopted by their local communities for £1.

Arnprior is the second community in Scotland to have a defibrillator fitted in their call box.

Glendaruel Village, Argyll, was the first in 2011.
See on www.dailyrecord.co.uk

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How a health club’s AEDs saved 100 lives

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David Lloyd Leisure’s health clubs do business throughout Europe; the company has 80 sites in the UK alone. With more than 440,000 members the company gets 25 million club visits a year. Since 1998, the David Lloyd Leisure staff has used AEDs to save the lives of more than 100 people.

There’s no legal requirement in the UK for fitness clubs to have automated external defibrillators (AEDs) on the premises. But the health and safety experts at David Lloyd Leisure insist on having AEDs readily accessible at every one of their busy clubs. This policy, along with staff training in AED use, has made a world of difference. Since 1999, David Lloyd Leisure has saved more than 100 lives.

“Our feeling is every fitness facility should have an AED, even if there’s no legal requirement,” says Caleb Brown, of the health and safety office at David Lloyd Leisure. “AEDs have become so affordable, and the response element is something which is really easy for a health club to do — they’ve already got team members available.”

One of Europe’s largest health and fitness businesses, David Lloyd Leisure started its AED program in 1998. At first, this simply meant ensuring that the reception desk at every facility had a defibrillator at hand.

A staff member from David Lloyd Leisure Brooklands with their Powerheart AED. Staff at the club used the AED to revive a member in 2010.

The return on investment in terms of lives saved was immediate, and the company nurtured the AED program. Brown, who joined the company in 2000, has been involved in the development of the company’s AED training program as part of overall safety training. Today, an AED is brought immediately to the scene of any health incident at one of the clubs.

While the survival rate for people who suffer outside-of-hospital sudden cardiac arrest in the United Kingdom is less than 20 percent, the survival rate for someone who suffers cardiac arrest or another serious health incident at one of the David Lloyd Leisure clubs reached 88 percent in 2012.

How They Chose Powerheart AEDs

All David Lloyd Leisure clubs are equipped with at least one AED, and one large, six-story site has two defibrillators on the premises. All the AEDs — with the exception of devices at clubs recently acquired from other companies — are Cardiac Science Powerheart AED G3s. The Powerheart AEDs were chosen because they’re highly portable and easy to use, with long-lasting medical-grade batteries and Rescue-Ready technology that conducts an automatic self-check of the main components (battery, hardware, software, and pads) every day. When it’s nearing time to replace a battery, a Rescue Ready indicator on the AED turns red and sounds an alert.

“The Powerhearts are so easy to look after, and the maintenance system is brilliant,” Brown says.

In the aftermath of any incident in which an AED was required, the club replaces the used pads with a set of spares. Brown, or one of his health and safety team colleagues, then visits the club to download data from the AED for hospital use, write up an incident report, and supply a new set of spare pads.

Training: Key to a Successful AED Program

Brown, who took on a leadership role in the AED program in 2006, has designed training for club employees that enables them to respond with maximum speed and efficiency when a cardiac incident occurs.

“Because of the voice prompts, even an untrained bystander can use an AED,” Brown points out. “With a training program, you give people the ability to react faster in an event, which is going to increase chances of survival.”

Ambulance response time in urban areas in the UK is usually under 8 minutes, Brown noted, but for a sudden cardiac arrest victim that is often too late. Brown’s goal has been to train David Lloyd Leisure staff to get the AED to the victim, and the defibrillator pads on the victim’s chest, within 1 minute.

Once the pads are attached, the AED can diagnose the heart rhythm, and, if appropriate, administer a shock. The AED’s voice prompts coach the team through every step of the process, including administering CPR. The AEDs are programmed in accordance with the latest resuscitation guidelines, and David Lloyd Leisure bases its training on those same guidelines.

“I believe that some businesses overestimate the amount of training that is required for a successful AED program,” Brown says. “Our training is only two hours for an employee, once a year. With just that basic training, in the vast majority of incidents requiring an AED, we are able to get the pads onto the chest in less than a minute.”

In 2012, the company’s survival rate for incidents in which an AED was deployed reached 88 percent.

Case Study: Saving a Life at the Health Club

“I would not be alive now had it not been for the quick intervention of Paul, Laura,and others and their ability to resuscitate me,” a 45-year-old businessman wrote in a letter to David Lloyd Leisure. “I have been advised by doctors that if I had been anywhere else, in particularly where there was no defibrillator, I would not have survived.”

The man had collapsed while using a rowing machine at the North London club. Bystanders alerted the club’s team straightaway, and one of the team immediately started CPR. The AED was brought to the area and the pads put on immediately. The AED diagnosed a shockable heart rhythm and it administered one shock.

“By the time the ambulance crew arrived, the man was breathing and talking,” Caleb Brown, part of the company’s health and safety team, said. “He went on to make a complete recovery, went back to work, and he’s back at the club.”

Two members of the David Lloyd Leisure staff were directly involved in the rescue. One delivered CPR and the other used the AED. A half dozen others assisted, clearing members from the area and making sure there was access for the ambulance crew.

“The training I received in using the AED enabled me to use the AED with confidence and the clear voice prompts helped to keep me calm,” one of the rescuers reported after the incident. “It’s an amazing feeling to know that the actions I took resulted in a life being saved.”
See on www.cardiacscience.com

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Doctor’s plea for defibrillators to be in all public buildings

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Dr Aseem Malhotra, from Manchester, a cardiology specialist registrar at the Royal Free Hospital in London, says the machines could save thousands of lives.

Former footballer Fabrice Muamba’s life was saved as medics used a defibrillator when he suffered a heart attack on the pitch

A cardiologist has called for defibrillators to be placed in all public buildings in a bid to improve the  low survival rates for cardiac arrest victims.

About 60,000 cardiac arrests happen outside of hospitals in Britain each year – but the survival rate is between just two per cent and 12pc.

Dr Aseem Malhotra, from Manchester , a cardiology specialist registrar at the Royal Free Hospital in London, says the machines could save thousands of lives.

The former Manchester Grammar pupil said: “There should be defibrillators in all public buildings. They should be there like you have fire extinguishers.

“We know that, with defibrillation, the chances of survival increase to 75 pc. They are simple, computerised, tell you what to do, and it analyses the heart rhythm for you, shocking patients out of the abnormal rhythm.”

Dr Aseem and colleague Roby Rakhit, consultant cardiologist and clinical director at the hospital, have written an article in the British Medical Journal which says scientific evidence to support early defibrillation is overwhelming.

Dr Aseem Malhotra

They say lessons can also be learned from Seattle in the US, which has the world’s highest rate of survival for cardiac arrests. Children in Seattle are taught CPR in schools.

They say there should be more CPR training in Britain and steps should also be taken to ensure that patients are sent to the right hospitals where they can be treated by specialist cardiologists.

The call for more machines also comes after the Bolton Wanderers footballer Fabrice Muamba nearly died during a match but was saved thanks to prompt treatment and the use of a defibrillator.

Surveys have revealed that only one in 13 people in Britain feel confident enough to carry out emergency first aid.

Campaigners including leading doctors, health experts and MPs have written to the prime minister asking him to consider changing the law to make the life-saving machines compulsory in every community.
See on www.manchestereveningnews.co.uk

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‘OK Glass, Save A Life.’ The Application Of Google Glass In Sudden Cardiac Death

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Google Glass has made its way into healthcare.  Its use in the operating room and in medical education has been profiled here.  Yet the magic of Glass will be found in the applications that can make this “technology” into real-world solutions for health and medicine.  It’s a bit like the smart phone and how its realization is a function of the countless apps that bring the device to life.

Inside The Operating Room

Christian Assad, MD has taken the next step with Glass and developing a practical app that can turn Glass into a real life-saver. He recently profiles this application on his blog and I believe it’s an important turn of events that showcase just how technology can be applied to medicine and public health issues.  Here’s how it presents the concept in his blog–Google Glass and augmented CPR:

THE CPRGLASS SCENARIO

1)   Person walking, witnesses someone passing out (syncope)

2)   Individual says “OK GLASS, CPRGLASS”
A) Instructions appear ABC (Assess Airway, Breathing and Circulation)
B) “OK GLASS, No Pulse!”      (An algorithm developed by Hao-Yu Wu et al at MIT demonstrate how a normal camera can detect a pulse in a person with strong accuracy.) We are looking incorporate such algorithm aka (which will be open source) ”Eulerian video magnification” to CPRGLASS for 2 reasons;
1) Will help as an innovative method to assess if the compressions are adequate
2) Will be able to tell us if patient has regained pulse if we stop compressions, possibly, instead of even having to look for a pulse

3)   This triggers the following algorithm
A) Staying Alive Music starts which will guide you to do the compressions at a rate of 100/min.
B) Gyroscope tells you if compressions are adequate enough by moving
C) Tracks TIME of CPR initiation and number of compressions given
D) Calls 911 with your GPS based location
E) Via GPS will try to find nearest AED which information is being obtained by crowdsourcing. Ex AED4US
F) Sends Txt Msg to nearest hospital with information regarding ungoing CPR for them to get prepared

Dr. Assad combines science, technology and popular culture to create a platform that is as simple as it is important.  From the scientific underpinning to the driving musical beat, he’s part of a generation of clinicians ushering in digital health and the interesting and evolving role of Google Glass.
See on www.forbes.com

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