Early defibrillation: healing shock in sudden heart failure

Sudden cardiac death - in Germany alone, this "fast" death kills 100 000 people a year. Usually, arrhythmias (ventricular fibrillation) are the reason when the heart gets out of rhythm and beats so fast and disorderly that a cardiovascular standstill is the result. In such a situation, only treatment with cardiac shock (defibrillation) can help. And this should be done as early as possible, because with each minute the chance of survival of the person concerned drops by 10%. Electro shock therapy of the heart is usually performed by healthcare professionals. Usually by doctors, in an emergency, but also by specially trained paramedics, paramedics, etc. This usually happens in the context of a CPR, but occasionally also to treat chronic arrhythmia.

Every minute, the survival rate drops

However, medical professionals are not always present when such an emergency occurs and so vital minutes pass before the arrival of the ambulance or the emergency medical officer. A reason to place the life-saving devices in public places and to make the operation so easy and safe that also laymen can handle them.

Semi-automatic defibrillators (AEDs = Automated External Defibrillators) have been around for quite some time now for so-called early defibrillation in public buildings with high public traffic (eg in airports, official buildings, shopping centers, railway stations). They are referred to as semi-automatic, because the device automatically creates an ECG analysis after sticking on special electrodes and then signals the helper what he has to do. Most of them are housed at information desks, etc., where immediately trained staff is available. Special signs point to the AEDs.

How does a premature defibrillator work?

Semi-automatic defibrillators are easy and safe to use: The helper is informed via voice control (voice recorder) and a text display of all necessary steps: First, 2 surface electrodes are glued. With their help, the device can completely independently analyze the heart rhythm of the patient. If a ventricular fibrillation or a ventricular tachycardia (arrhythmia with too rapid heart rhythm) before, the user receives the request by pressing a button to trigger a surge.

Important: The power surge can only be triggered when prompted by the device, not on the initiative of the helper. If a current pulse is triggered, the device will re-analyze the ECG and may issue the instruction to re-deliver the shock. Not only are AEDs safe to handle, they also work with a maintenance-free long-life battery and perform automatic self-tests for functional testing.

But who should / should actually perform an early defibrillation? This question is still being discussed. Should only trained (!) First responders without a medical background or laymen be allowed to carry out the first defibrillation?

Trained first responders ...

The group of trained first-aiders includes, for example, security guards or security personnel, information desk personnel, stewardesses, police officers and firefighters. They have learned in a special training to perform the cardiopulmonary resuscitation and the handling of the semi-automatic defibrillator properly. There are currently no legal requirements for the use of these trained first-aiders. However, several specialist medical committees have issued recommendations for the education and training of this group of persons.

... against untrained laymen

But there are also freely accessible defibrillators that are available to untrained laymen. This form of "lay help" is currently still hotly debated. Because the helpers are not legally secured and do not have solid knowledge in the heart-lung-resuscitation. Thus, in an emergency, you can only deliver the electroshock for a ventricular fibrillation diagnosed by the device, but you are not adequately trained in the basic measures of resuscitation (respiratory donation, cardiac pressure massage).

Proponents of early defibrillation carried out by untrained laypeople include, for example, the initiative "Kampf die Herztod", which also includes the German Heart Foundation. She has already donated numerous defibrillators, for example in the airports Münster / Osnabrück and Paderborn / Lippstadt. The proponents hope that the use of the "untrained" will at least be able to save those affected, in whom the delivery of an electric shock spontaneously returns the heart to its normal rhythm. But also that the brave lay help can bridge the important minutes until the arrival of the rescue service. Ina Mersch

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