Automated External Defibrillation
Automated external defibrillators (AEDs) are commonly used to meet the need for early defibrillation, which is currently considered the most effective treatment for ventricular fibrillation (VF) and pulseless ventricular tachycardia. Some facilities now require an AED on every noncritical care unit. Their use is common in such public places as shopping malls, sports stadiums, and airplanes. Instruction in using the AED is required as part of both basic life support (BLS) and advanced cardiac life support (ACLS) training, pediatric advanced life support (PALS), and heartsaver AED courses. Studies have shown that attempts to resuscitate victims of sudden cardiac arrest resulting from VF using public defibrillation equipment and administered by laypeople trained to use an AED have a survival rate of 41% to 74% when cardiopulmonary resuscitation (CPR) is initiated immediately and defibrillation occurs within 3 to 5 minutes.1
The 2010 American Heart Association (AHA) guidelines for CPR and emergency cardiovascular care (ECC) recommend rapid integration of CPR with the use of an AED. These guidelines include the following:
Initiate CPR immediately, and then use the AED as soon as it’s available.
When two rescuers are available, one rescuer should begin CPR immediately while the second rescuer activates the emergency response system and prepares the defibrillator.
Coordinate CPR and defibrillation to minimize the time between stopping compressions and administering the shock.
First-responding personnel should receive AED training with the goal of delivering the first shock for any spontaneous cardiac arrest within 3 minutes of collapse.
An AED can be used for children ages 1 to 8; however, for this age group, an AED with a pediatric dose attenuator system should be used, if available. If one isn’t available, a standard AED can be used.
If pediatric pads aren’t available, adult pads can be used on a child. Place the pads at least 1 inch apart or use an anterior-posterior pad position.2
An AED shouldn’t be used for infants; instead, a manual defibrillator is preferred. However, if a manual defibrillator isn’t available, an AED with a pediatric dose attenuator system may be used. If neither defibrillator is available, an AED without a dose attenuator may be used as a last resort.1
AEDs provide early defibrillation, even when no health care provider is present. (See Understanding the AED.) The AED is equipped with a microcomputer that senses and analyzes a patient’s heart rhythm at the push of a button. Then it audibly or visually prompts the operator to deliver a shock. AED models all have the same basic function but offer different operating options. For example, all AEDs communicate display directions on a screen, give voice commands, or both. Some AEDs simultaneously display a patient’s heart rhythm.
All devices record the operator’s interactions with the patient during defibrillation, either on a cassette tape or in a solid-state memory module. Some AEDs have an integral printer for immediate event documentation. Facility policy determines who is responsible for reviewing all AED interactions; the patient’s
doctor always has that option. Local and state regulations govern who is responsible for collecting AED case data for reporting purposes.
doctor always has that option. Local and state regulations govern who is responsible for collecting AED case data for reporting purposes.
Equipment
AED ▪ two prepackaged, unopened AED electrodes ▪ gloves ▪ Optional: clippers.
Implementation
