Tampus, Queenie Ann M.

BSN IV
Section I
NCM 104 10:00 – 12:40

“Do You Prefer One Shock or Three?”

The Changing Role of Defibrillation in Cardiopulmonary Resuscitation

By Rod Brouhard, About.com Guide
Updated January 15, 2007

Shocking a stopped heart to get it started again is a technological example

of life-saving medical care that can be administered by almost anyone.
The American Heart Association is constantly amending the guidelines for
cardiopulmonary resuscitation (CPR) and emergency cardiac care. After years of
placing the focus of cardiac arrest resuscitation on defibrillation, the association
restructured its guidelines in 2005 to put the focus back on CPR. Defibrillation
still happens, but not as often.

2005 Changes to Defibrillation Guidelines:

• Perform CPR for about two minutes prior to defibrillation on all unwitnessed
cardiac arrest victims
• One initial shock instead of three
• No assessment after shock - begin CPR immediately
• Two minutes of CPR between shocks instead of one

Research has shown that performing CPR on a cardiac arrest victim prior to
shocking makes the heart much more likely to respond. The only exception to
this rule is if the defibrillator is with the victim when the heart stops.
Research also indicates that cardiac arrest victims are unlikely to respond
to a second or third successive shock if the first doesn't work. They are, in fact,
much more likely to respond to a repeat shock after two minutes of CPR.
CPR supplies oxygen to the brain as well as the heart muscle. Dfibrillation,
if successful, simply lets the heart start beating again. Once restarted, the heart
often needs a minute or two to adequately begin pumping blood. CPR gives the
heart a little boost while it gets back into the rhythm (pun intended).
http://firstaid.about.com/od/cpr/a/07_Less_Shocks.htm

“ automated exter nal defibrillators (AEDs) ”

Experts say the findings, reported in the New England Journal of Medicine,
(AEDs) more widely available for laypeople to use.
Cardiac arrest is a medical emergency that is quickly fatal without prompt
treatment. Most cases occur when the heart goes into ventricular fibrillation
(VF), a heart-rhythm disturbance in which the heart begins to quiver chaotically
and can no longer pump blood to the body.
An electrical shock from a defibrillator can restore the heart's normal
rhythm and reverse cardiac arrest. AEDs are a portable, layperson-friendly
version of the devices that automatically analyze the heart's rhythm and, if
needed, instruct the user to deliver a shock.
SOURCE: The New England Journal of Medicine, March 18, 2010.

“Defibrillator shock may signal future trouble”

NEW YORK — A lifesaving shock from an implanted heart defibrillator
provides relief that a crisis was avoided, but new research suggests it can also
be a sign that more trouble is ahead.
A study found that heart failure patients were far more likely to die within
four years after their defibrillator zapped the heart into beating normally than
those who got no shock.
"We need to think about everything else we possibly could do to make them as
healthy as they can be," said the study's lead author, Dr. Jeanne Poole of the
University of Washington.
The findings are in Thursday's New England Journal of Medicine, along with
another study that concluded that having an implanted defibrillator doesn't
appear to diminish one's quality of life.
The new government-funded reports show that a defibrillator prolongs
"survival in patients with heart failure, with relatively little compromise in the
quality of life," wrote Drs. Jeff Healey and Stuart Connolly of McMaster University
in Hamilton, Ontario, in a journal editorial. But they added: "It is somewhat
disturbing to realize that actually receiving a shock is such an important
predictor of death."
In the study, about a third of the 811 patients with defibrillators were
shocked during nearly four years of follow-up. Data recorded by the devices
shows whether the shock corrected a life-threatening irregularity or was
inappropriately fired by another problem, such as an abnormal rhythm in the
heart's upper chambers.
The researchers found that those who needed a shock were more than 5
times more likely to die over the next 4 years than those who didn't require
one. Even people who didn't seem to need a shock but got one had double the
risk of dying.
Dr. N.A. Mark Estes, president of the Heart Rhythm Society, noted that the
defibrillators used in the study are a generation-old, and that newer devices can
often correct a high heartbeat through painless pacing techniques, before a
shock would be needed.
A patient at Duke, John McKinnon, said he was initially reluctant to get a
defibrillator about two years but has had no concerns since. Months ago, the 65-
year-old pastor got a shock, which he described as a strong kick. Since then he's
had a procedure to treat an abnormal heartbeat.
http://www.msnbc.msn.com/id/26530845/