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Does Your Family Defibrillate?

It's been almost exactly a year since I wrote about Rita and Richard Helgeson, whose 18-year-old son Andrew, an accomplished athlete at Montgomery Blair High School in Silver Spring, died in his home after suffering a sudden cardiac arrest in May 2005.

The Helgesons channeled their grief by mounting a successful campaign for a state law requiring every public high school to have an AED, or automated external defibrillator. AEDs are easy-to-use devices that correct the abnormal heart rhythm, or ventricular fibrillation, that's the most common cause of sudden cardiac arrest. AEDs have been shown to save lives when they're readily available in public places such as airports and shopping malls. Putting them in schools is a great idea, and the Helgesons should be proud of their accomplishment.

If AEDs save lives in public settings, how about at home? A study published online April 1 in the New England Journal of Medicine shows that home AEDs did a good job of keeping heart-attack victims alive till they could get professional help.

But the same study showed that good old low-tech CPR did an equally good job.

A home-model AED costs between $1,200 and $2,000. CPR training (which usually includes guidance on how to use an AED) for the whole family costs a few hundred dollars, tops. Once you're trained, you carry that training everywhere you go.

New "Hands-Only" CPR guidelines this month by the American Heart Association make CPR a lot easier to learn and execute: Call 911. Then start pressing hard and fast on the center of the chest. No more mouth-to-mouth breathing.

Experts maintain that AEDs are valuable tools. For now, though, my household's relying on my CPR skills and those of my husband; there are a thousand bills that need to be paid before an AED is in our budget.

How about you? Do you have a home AED? Have you had to use it?

And is your CPR training up to date? If not, here's a list of upcoming training sessions.

By Jennifer LaRue Huget  |  April 8, 2008; 7:00 AM ET
Categories:  Family Health  
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Comments

Home AEDs? This sounds like a not-so-subtle campaign by Philips and Medtronic to sell more AEDs. They are great devices when medically necessary, but only work on a limited number of arrhythmias. My sense is that basic CPR skills are nearly as valuable, especially in the metro DC area where ALS professionals are typically minutes away after dialing 911 (not sure whether this would be true for the District).

I did, however, see remanufactured AEDs for under $600 if you feel so inclined to have one.

Posted by: Mike Sorce | April 8, 2008 10:22 AM | Report abuse

You gotta be kidding. You must have no young children digging through your closets and finding a defibulator to test on the pussy cat or their friends. Then there's the issue of spending $1,200 to $2,000 on a device which you may or may not remember you have, but can't find in an emergency. Better to spend your time calling the rescue squad than wasting time trying to find and operate a defibulator. This column is a godsend for manufacturers, but is truly silly.

Posted by: edward | April 8, 2008 11:15 AM | Report abuse

I agree largely with what edward wrote. Much like having a firearm in the house, a defibrillator would probably be more likely to do more harm than good.

Posted by: Wolfcastle | April 8, 2008 11:31 AM | Report abuse

I have been through the workplace training twice. As soon as I can afford it I will get a home unit. I think under $500 is my target price.

Posted by: Gary E. Masters | April 8, 2008 11:41 AM | Report abuse

Just read the otner comments. Inform yourselves. The units evaluate the signals and sens a surge only when needed. Not at will.

Posted by: Gary E. Masters | April 8, 2008 11:42 AM | Report abuse

In terms of the risks, I think they are smaller than people may think. An AED, as opposed to a defibrillator in a hospital, will only shock in appropriate situations. It won't shock kitty or the neighbor's kid-- so long as his heart is beating. If I was higher risk, I might think about getting one.

Posted by: Alfredo | April 8, 2008 11:46 AM | Report abuse

After losing my father 4 years ago from a heart arrhythmia, my family has talked a lot about whether having an AED would have made a difference. I believe it would have and he would be here today as opposed to dead at age 60. I have been trained on AEDs in all of my jobs and they are easy to use,they do not shock unless a shock is needed, and they also are a great source of information for the EMT's when they arrive.

Posted by: Amy | April 8, 2008 12:08 PM | Report abuse

As a trained and certified First Responder here are my thoughts.

Having an AED in public places is useful and the information that they can record for EMTs and then later for the hospital can be wonderful for the accurate diagnosis and quick treatment of a heart condition. My concern is about people buying them in mass and not being properly trained in their use, while they are designed not to shock someone unless the heart rhythm is abnormal there is always the possibility of a malfunction or misuse.

On the topic of hands-only CPR, it can and does save lives, but if improperly done it can severe trauma to the patient. The chest compressions done during CPR need to be timed correctly, to allow the heart to fully re-inflate with blood, to simulate a beating heart. Having untrained persons performing a medical technique are always dangerous, and I for one am against untrained people being encouraged to perform CPR.

That being said, you can probably get CPR training and instruction on how to and when to use the AED from the local fire station or community college.

Posted by: Art | April 8, 2008 12:47 PM | Report abuse

With a little training you will learn that these units are very safe. At the very least get the CPR trainig. Although you are pushing the AHA program, American Red Cross has had the compresion only program for some time and it would have been nice to see them get equal time.

Posted by: Randy | April 8, 2008 12:47 PM | Report abuse

You say that it's a good idea that schools are now required to have AEDs, but then you say that CPR is just as good. So, why is it so great that schools are now required to spend some of their precious budgets on these expensive pieces of equipment? It seems to me that every school has a nurse trained in CPR who would be just as accessible as an AED. At my high school, every student received CPR training in PE class. I'm sure that the closest student is more accessible than the AED. It seems like a better idea to spend school money on something else if, as you say, CPR is just as good.

Posted by: erik | April 8, 2008 12:48 PM | Report abuse

AED's save lives. Period. CPR is nice but unless you get one of us obese baby boomers to an AED or a hospital that has an AED, quite soon you will be compressing dead flesh.

I tried to get our condo association to install AED's but ran up against fear of lawyers. The Galt Mile Condo in Florida has AED's but things come slowly to Alexandria.

And these are idiot-proof, too. Good Samaritan laws, both Va. State and Federal should quell the litigious fears but they don't. And sudden cardiac arrest is one the most likely if not the most likely killer.
Thump-thump. Thump-thump.

Posted by: Paul Mazzuca | April 8, 2008 12:51 PM | Report abuse

Just 2 weeks ago I was at the gym when a mid-40 YO male fell over in obvious distress. Less than 3 minutes later, his heart stopped beating. The gym staff and others were very tentative at starting CPR, but did eventually. However, it was the AED that we got out that saved his life. It worked exactly as intended, and I stood there in awe as the flat line on the monitor began to show a pulse again. All the same, I don't think it makes sense to have one in every home. Every place where there are a large concentration of people, yes. But the odds of a 3-6 person household needing one make a home AED hard to justify.

Posted by: witness to aed | April 8, 2008 1:03 PM | Report abuse

why don't people spend the money on learning English so when they get a Mortgage they'll be ablt to read. and not cry foul in regards to an adjustable rate mortgage.

Posted by: jim | April 8, 2008 1:03 PM | Report abuse

If families want to have an AED around, and are willing to pay for them, then it is fine with me, rather like putting a sprinkler system in your house, just to be safe----not because you are going to burn it down.

Posted by: George11 | April 8, 2008 1:24 PM | Report abuse

If you read the study, it says "As a result of these factors, the trial had substantially less power than initially projected. These effects were so profound that even a doubling in the population size would not have been sufficient to show an overall mortality benefit with home AED therapy".

The sample size was too small to support any conclusion. It should never have been published, much less cited. It is typical of much medical research which makes claims either positive or negative with no scientific basis.

Posted by: Marc | April 8, 2008 1:34 PM | Report abuse

It may make sense in certain cases. What about an elderly couple where they are too frail to do the job of CPR? Or some other physical reason why CPR may not be effective? I agree with a previous post that for $500 I'd consider it.

Posted by: d3 | April 8, 2008 1:59 PM | Report abuse

Does your family have a smokefree home?

Secondhand smoke causes heart attacks. We now have five independent studies that show this.

How does the effectiveness or cost effectiveness of having defibrillators in the home compare with smokefree homes? I bet in lives saved, and in dollars per life saved, smokefree homes is well ahead.

Expensive dangerous devices for amateur use in a crisis probably doesn't do nearly as well as prevention that's known to work -- and has the side effect of also preventing other heart disease, lung disease, and cancer.

Fancy medical devices are more flashy. Prevention is usually quiet -- but safe and effective.

Posted by: Jon | April 8, 2008 2:07 PM | Report abuse

Art says: "Having untrained persons performing a medical technique are always dangerous, and I for one am against untrained people being encouraged to perform CPR."

Better to have someone who is not fully trained and doing their best than to have nobody at all.

There are few downsides to CPR, considering that the victim's heart is stopped. Would it better to wait for someone certified to come along? Of course not.

Posted by: Bill Smith | April 8, 2008 2:09 PM | Report abuse

If you've been to a CPR class, you know that you have to be willing to break the victim's ribs (literally). Between your hands and the victim's heart, there are ribs, muscle and fat in the way, and sometimes you've really got to push HARD to get the heart moving. Some studies suggest that up to 30% of cardiac arrest victims have broken ribs as a result of CPR. Now, in the case of a 60-year-old heart attack victim who is otherwise going to die, some broken ribs may be the least of his worries. But if your victim survives, it would be nice for him/her not to have to heal from that as well.

I am not a medical professional and I do not work for a device company, just someone with a history of arrhythmia. I can tell you that the reason this device is legally available without a prescription is that it can't shock you if your heart is beating and has minimal potential for abuse. You may choose not to buy one because the expense doesn't make sense for your family, given your risk profile, but please don't spread inaccurate information about these lifesaving devices.

Posted by: NH08 | April 8, 2008 2:15 PM | Report abuse

The research cited concludes "a home AED did not significantly improve overall survival".

Yes, there is context, and the context matters. To get the full picture you'll have to read the study.

But from what's in this study, I can make my previous comment a little stronger.

There are five or more studies that provide support for concluding that smokefree air saves lives. Every one of those studies provides stronger support for that conclusion, than this study provides for the conclusion that home AEDs save lives.

In short, the evidence is telling us that smokefree homes are more effective and more cost effective than home AEDs for saving lives from heart attack.

Now: millions of Americans are exposed to secondhand smoke in the home every day. It's very clear how to win big here. Instead of putting the money into fancy medical devices of unproven benefit, we could put the money into education and public awareness campaigns that get people to change behavior to achieve safe air in millions of homes.

Posted by: Jon | April 8, 2008 2:26 PM | Report abuse

To, Bill Smith:

As NH08 stated, even when properly done CRP can break ribs. If improperly done, say with the compressions being done too low, it can cause severe internal bleeding from driving the xiphoid process into various parts of the abdomen; or if done too fast it has a negligible effect as the heart doesn't have enough time to refill with blood.

That being said, I agree with you completely about not waiting for someone who is certified, just that people know the risks that they take before attempting CPR.

My concern is from the various videos I've seen that have advertised this have not shown proper CPR, and I would like for people to at least see how to properly perform CPR before they attempt it.

Posted by: Art | April 8, 2008 3:03 PM | Report abuse

Art:

Of course I agree that people should avail themselves of proper training, as I was fortunate enough to receive from my employer (could use a refresher though).

But what are the real risks of incomplete training or someone trying their best? Failure to perform CPR means the victim dies. You can't damage the person more than letting them die before you.

Also, an unstated point in this debate is the significantly poor rate of success when CPR is offered, with good training or not. More often than not, the victim is done. Still, it should be attempted on the off chance it works even while breaking ribs or worse.

The proliferation of AEDs in public and work spaces has helped considerably, as this technology works far better than CPR.

Posted by: Bill Smith | April 8, 2008 4:52 PM | Report abuse

The comments to this entry are closed.

 
 
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