Introduction
A defibrillator is a device used in acute and emergency medicine, which is designed to stop the heart by means of a directed current surge. Contrary to what is often assumed, the defibrillator only leads to heart stimulation in a secondary way. The defibrillator is used when a patient is in life-threatening ventricular fibrillation.
Ventricular fibrillation is defined as a too rapid and irregular contraction (fibrillation) of the heart muscle. This muscle movement is not sufficient to supply the body with oxygen-rich blood. Ventricular fibrillation is a life-threatening condition that must be treated as soon as possible.
The defibrillator sends a current surge through the tip of the heart. To do this, two paddles are applied to the tip of the heart and the roof of the heart and then the current surge is triggered. The electrical impulse interrupts the fibrillation and immobilizes the heart.
A few seconds later the heart starts beating again at its own rhythm. A defibrillator is a box equipped with a high-performance battery, a monitor and two paddles. It is part of all emergency medical equipment and can be found especially in the intensive care unit.
The first stationary defibrillation devices were developed after the Second World War to treat electrical accidents. In 1976 the first early defibrillators came onto the market. In 1977, the first defibrillation device was already transferred to the non-medical emergency service, as there was no comprehensive emergency doctor system in Germany at that time.
However, this innovative measure was blocked at that time by politicians and doctors’ associations because early defibrillation was considered very critical by laypersons. The use of fully automatic defibrillators (AEDs), which are still frequently seen in public today, is still very low because many non-medical practitioners do not dare defibrillate for fear of making mistakes. Numerous campaigns, such as the fight against cardiac death etc., should and should ensure that fear of this important first measure is taken away.
What do you need him for?
The defibrillator is always used when a flickering heart needs to be brought to a standstill so that its own rhythm can be restored. It is a very vital instrument, especially in acute and emergency medicine. It is used for life-threatening ventricular fibrillation or ventricular flutter as well as for severe cardiac arrhythmia. Even during cardiac surgery on a standing heart, a defibrillator, which is applied directly to the heart muscle, ensures that the rapidly flickering heart (clinically equivalent to cardiac arrest) comes to a complete stop so that it can start beating again by its own rhythm.
Can you buy a defibrillator?
In principle, any medical equipment can also be purchased. No special medical training is required for this. Whether one may also use certain equipment as a non-medical person is another question.
Although the classic defibrillator can also be purchased by non-medical personnel, its use without training should be avoided. Furthermore, the exact reason why one should buy a defibrillator should be considered. If a family member has a serious heart condition, the purchase of a defibrillator is more justified than if there is no increased risk of severe cardiac arrhythmia or cardiac arrest.
In any case, if you do, you should consider buying a fully automatic defibrillator, which is also available in public buildings. This device, also known as an AED, is easy to operate even without medical training, as a computer program guides the user through the steps to be taken. In the meantime, there are state-of-the-art defibrillators from different manufacturers and at different price levels.
Fully automatic, so-called AEDs, which are now available in large public buildings, are priced between 400 and 2000 euros. The stationary defibrillators available in hospitals, which also have more functions (e.g. monophasic and biphasic current output can be controlled manually with these devices), are many times more expensive but not suitable for everyday emergencies, especially for the untrained physician or the medical layman. There are also defibrillators that are implanted and which only deliver an electric shock when the heart exceeds a certain pause in its beat, i.e. when either the pulse is so low that the maintenance of circulation is no longer guaranteed, or when whole heartbeats fail.
The implanted defibrillator corresponds to a pacemaker with defibrillator function. A distinction is made between a single-chamber and a dual-chamber defibrillator. The implantation is carried out through an approx.
5 cm incision below the left collarbone, sometimes also below the right collarbone. The left side is preferred for a possible defibrillation because of the better blood distribution. The electrodes are advanced to the heart through a superficial vein or through the clavicle vein.
This is done under X-ray control. Once the catheter with the electrodes has reached the heart, it is fixed to the tip of the heart in the right chamber. The electrode consists of two different parts.
The tip serves as a monitor module, i.e. this part monitors its own ventricular rhythm and gives an alarm as soon as the heart falls below a certain, previously set frequency or when one or even several beats stop and long pauses occur. Above this monitor module there are coils which, in this case, generate a strong current and then release it into the tip of the heart. In the meantime, there is not only the all-or-nothing defibrillation, but also multi-chamber combinations of pacemaker and defibrillators, i.e. with the most modern defibrillators, even previously set rhythms can be maintained by giving light impulses.
After the operation, a test shock should be triggered to see whether the electrodes are in the correct position. For this purpose, the heart is first artificially set into such a strong cardiac dysrhythmia that the implanted defibrillator should trigger. If it does not, the patient is released from the arrhythmia with a defibrillator permanently installed in the operating room. In this case, additional electrodes must be attached to the heart to ensure a regular heartbeat. This ensures that a severe cardiac arrhythmia arising in everyday life can be successfully corrected by defibrillation.
