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Defibrillators and Sudden Cardiac Arrest

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Oct. 18, 1999 (Atlanta) -- Every year more than 350,000 people suddenly go into cardiac arrest, making heart failure the leading cause of death in the western world. It can happen in any stadium or any airport -- or anywhere -- and if there's an automatic defibrillator nearby, even a sixth grader could save a life, according to a study in the Oct. 20 issue of Circulation: The Journal of the American Heart Association.

Defibrillators, which are increasingly being installed in public places, can detect abnormal heart rhythms and shock the heart back into action.

"Given the magnitude of the cardiac arrest problem, it's an important issue," author Gust H. Bardy, MD, at the University of Washington Medical Center, tells WebMD in an interview. "Nothing comes close to the problem of cardiac arrest in mortality in the U.S."

In a mock cardiac arrest scenario, the study measured how quickly 15 untrained children could respond in a crisis situation and put the defibrillator to use. The results were compared to response time of 22 trained emergency medical technicians and paramedics. 'Resusci-Annie' -- a mannequin used in emergency response training -- served as the 'victim.'

All children had their time one-on-one with the mannequin; none were allowed to watch the others, says Bardy. The equipment 'talked' each child through the procedure.

"When you open the case of the automated emergency defibrillator, you push an 'on' button, and it starts telling you what to do, where to put the pads, in a soothing yet authoritative voice," says Bardy. The devices, which are used worldwide, can be programmed for any language. A visual diagram also shows where pads should be applied. While the sixth graders averaged 90 seconds 'time to defibrillation,' the trained EMT/paramedic group averaged 67 seconds.

"We realized that [using children] was an extreme circumstance, but we wanted to show that anyone who could reach these devices [could use them] with no formal training," he says. "Of course, you can never make it as real as a real cardiac arrest."

"We've had three-year-olds call 911. My four-year-old can build complicated Lego constructions. Applying a pad and pushing a button are not very complicated," Bardy says. "It's hard to misuse these devices. They are very smart. They are able to figure out true cardiac arrest from stroke or fainting spells. It can replace CPR in many cases if applied early, but if a person has been down for a long time, it gets more complicated."

The study challenges the FDA requirement that only trained staff be allowed to use defibrillators. Right now, the FDA recognizes them as controlled devices, but emergency medicine experts are spearheading training efforts and pushing to have them installed in high-traffic public and private places, just like fire extinguishers.

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