Sudden cardiac death – in Germany alone, 100,000 people die this “quick” death each year. Most often, arrhythmias (ventricular fibrillation) are the reason, when the heart gets out of sync and beats so fast and disorderly that cardiovascular arrest is the result. In such a situation, only treatment with an electric shock to the heart (defibrillation) can help. And this should be done as early as possible, because with every minute the chance of survival of the affected person decreases by 10%. Electroshock therapy of the heart is usually performed by medical professionals. Usually by physicians, but in emergencies also by specially trained paramedics, paramedics, etc. Usually this is done in conjunction with cardiopulmonary resuscitation, but occasionally it is done to treat chronic arrhythmias.
With each passing minute, the survival rate decreases
But medical professionals are not always present when such an emergency occurs, and so vital minutes pass before the ambulance or emergency physician arrives. This is one reason to place the life-saving devices in public places and to make their operation so easy and safe that even medical laypersons can handle them. For this reason, semi-automatic defibrillators (AEDs = Automated External Defibrillators) have been available for some time for so-called early defibrillation in public buildings with high public traffic (e.g. in airports, official buildings, shopping centers, train stations). They are referred to as semi-automatic because the device automatically performs an ECG analysis after special electrodes are attached and then signals the rescuer what to do. They are usually located at information desks, etc., where trained personnel are immediately available. Special signs point out the AEDs.
How does an early defibrillator work?
Semi-automatic defibrillators are simple and safe to use: the rescuer is told all the necessary steps via voice control (voice recorder) and a text display: First, 2 surface electrodes are glued on. If ventricular fibrillation or ventricular tachycardia (a rhythm disorder in which the heartbeat is too fast) is present, the user is prompted to trigger an electric shock by pressing a button. Important: The impulse can only be triggered by a request from the device, not on the rescuer’s own initiative. Once a shock has been delivered, the device reanalyzes the ECG and may instruct the user to deliver another shock. AEDs are therefore not only safe to use, they also operate with a maintenance-free long-term battery and perform automatic self-tests to check their function. But who should/can actually perform early defibrillation? This question is still under discussion. Should only trained (!) first responders without medical background or also laymen be allowed to perform the first defibrillation?
Trained first responders…
The group of trained first aiders includes, for example, security guards or security personnel, personnel at information desks, stewardesses, police officers, firefighters. They have undergone special training to learn how to properly perform cardiopulmonary resuscitation and handle the semi-automatic defibrillator. There are currently no legal requirements for the use of these trained first aiders. However, various medical professional bodies have made recommendations for the education and training of this group of people.
…vs. untrained laypersons
However, there are already freely accessible defibrillators that are also available to untrained laypersons. However, this form of “lay help” is currently still hotly disputed. This is because the helpers are not legally protected and do not have any established knowledge of cardiopulmonary resuscitation. In an emergency, they can therefore only deliver the electric shock for ventricular fibrillation diagnosed by the device, but are not sufficiently trained in the basic measures of resuscitation (administering breaths, cardiac massage). Advocates of early defibrillation performed by untrained laypersons include, for example, the “Fight Cardiac Death” initiative, of which the German Heart Foundation is a member. It has already donated numerous defibrillators, for example at Münster/Osnabrück and Paderborn/Lippstadt airports.Proponents hope that the use of the “untrained” can at least save the victims, where the delivery of an electric shock allows the heart to spontaneously return to its normal rhythm. But also that the courageous lay help can bridge the important minutes until the arrival of the rescue service. Ina Mersch
