Sudden cardiac death is caused by the abrupt loss of heart function. The victim may or may not have diagnosed heart disease. The American Heart Association supports implementing the "chain of survival" to rescue people who suffer a cardiac arrest in the community.
Dianne Atkins, MD, pediatric cardiologist at University of Iowa Children's Hospital, talks about implementing a "chain of survival" that includes onsite automated external defibrillators:
What causes the heart to abruptly lose function and stop?
Sudden cardiac death is usually caused by an abnormal heart rhythm. A very common one is something called ventricular fibrillation. This can be caused because the patient has underlying coronary artery disease and ventricular fibrillation occurs during the process of a heart attack. But it also can be related to abnormalities of the:
- Heart muscle
- Heart's electrical system of the heart
Those are often inherited problems, but not always.
Who is more likely to suffer from a sudden cardiac death?
One of the consequences of getting older is that your risk of sudden cardiac death increases. As you get older, your risk increases. There is a huge difference between the risk in young children versus older people. The University of Iowa was involved in a study which looked at this on a nation-wide basis. The risk in older people is around 127 events per year for every 100,000 people. That risk is only about eight per 100,000 in children under the age of 18.
When a child or young adult has a cardiac arrest/death, is heart disease always the cause?
Yes, it very, very frequently is an underlying cause. There are a few exceptions to that. If young children receive a very sudden and very forceful blow to the chest area right over the heart at a very particular time in the cardiac cycle; it can cause ventricular fibrillation. But generally there is some type of heart disease underlying it as a cause.
What is meant by public access defibrillation program?
If you have ventricular fibrillation, the two things you need immediately are cardiopulmonary resuscitation—or CPR—and very rapid defibrillation of the heart. This is application of the shock directly through the chest to convert the abnormal heart rhythm back to normal. We know that time is of the essence and for every one minute that goes by, the survival declines by 10 percent. So by 10 minutes, virtually no one will survive.
The goal is to put defibrillators in areas where cardiac arrest may occur—like a sports arena— where there are people trained to do CPR and use the device. There's a program to maintain the device because the batteries have to be replaced along with the pads that attach the patient to the defibrillator. The program not only gets and maintains the defibrillators, but also recruits the people who know how to use it.
Can someone witnessing a cardiac arrest do something to prevent a death from occurring? What steps should they take?
Absolutely. In fact, the new recommendations from the American Heart Association are that if you witness an arrest, if somebody drops in front of you, and you don't detect any signs of life, then:
- Call 9-1-1
- Immediately start chest compressions
We know that in the event of sudden cardiac arrest—which is very abrupt, very sudden—that people have a lot of oxygen already in their body. What they need right away is chest compressions. Absolutely—and it's very important—it's one of the predictors of survival of sudden cardiac arrest. So even if you haven't been trained, you can start chest compressions just like you see on TV. For the first five to seven minutes, it's not necessary to do the mouth to mouth.
Do the general public who work or go to school in a building where an AED is located need to be trained to use the device?
The devices themselves are actually very easy to use. They take about three steps and there are voice prompts in all of the devices directing somebody who has never used it. Even if you've never used it and have never been trained, I would still recommend that you try. It's very unlikely that you would hurt yourself. However, training can be accomplished in probably about an hour or two. There are a lot of classes in our area given by both the American Heart Association and the American Red Cross on how to use these devices.
What is the cost of an AED unit?
The defibrillators are not inexpensive. They usually cost on the order of a $1,000 to $1,500 to purchase. You need to have training and the defibrillator needs ongoing maintenance. One of the down sides of public access defibrillation programs is that people purchase the device and then forget about the training six months later as well as replacing the pads and replacing the batteries. There is a cost related to these. It can be amortized over several years, but the initial cost of the device is the biggest cost.
We would like to have CPR as a requirement in all schools, both in middle school and high school. You can't hurt somebody—they have already died. The only thing that you can do is make the situation better. We encourage everybody to learn and to do CPR if it's necessary. |
