Automated External Defibrillators (AEDs)

The following information supplements the October 2006 CRA Newsletter

Features

Continuation of chart from Newsletter with additional information on features and accessories:

AED 10	AED Plus	HeartStart OnSite

Welch Allyn 8500 SW Creek Side Place Beaverton, OR 97008 800-289-2501 503-530-7500 www.welchallyn.com	Zoll Medical Corp. 269 Mill Road Chelmsford, MA 01824 800-348-9011 978-421-9655 www.zoll.com	Philips Medical Systems www.philips.com Distributed by: HealthFirst Corp. 22316 70th Ave W, Unit A Mountlake Terrace, WA 98043 800-331-1984 425-771-5733 www.healthfirst.com
Useful Accessories: It is recommended that a spare battery & set of pads be kept with the unit at all times. $26 Prep Kit Includes: 2 pair gloves, CPR face shield, scissors, razor, 4X4s, biohazard bag.	Useful Accessories: It is recommended that a spare set of batteries & spare pad be kept with the unit at all times. (Disposable prep kit with 1 pair gloves, CPR face shield, scissors, razor, towel, & antimicrobial wipe is included with each CPR-D Padz)	Useful Accessories: It is recommended that a spare battery & set of pads be kept with the unit at all times. $41 Fast Response Kit Includes: 2 pair gloves, CPR mask, scissors, razor, towel.
Use With Children: $95 Infant/Child Energy Reducer. Energy reducer plugs into pads connector & reduces energy output to level suitable for children. Use with regular adult pads. Convenient storage pouch built into case.	Use With Children: $89 Pedi Padz (2-piece). AED auto-detects child pads & reduces energy output to level suitable for children.	Use With Children: $85 Infant/Child SMART Pads (2-piece). AED auto-detects child pads which reduce energy output to level suitable for children.
Training Supplies: $449 Trainer AED. $26 Training pads (reusable). Trainer has multiple scenarios for simulating various conditions & responses.	Training Supplies: $150 Simulator. $119 Training pads (reusable). AED auto-detects simulator & enters training mode. Simulator has multiple scenarios for simulating various conditions & responses. $379 Trainer AED also available.	Training Supplies: $75 Adult training pads (reusable). AED auto-detects training pads & enters built-in training mode with multiple scenarios for simulating various conditions & responses.
Size: (in case) 11 X 13 X 4 in (27 X 33 X 10 cm) 5.0 lb (2.3 kg)	Size: (in case) 12 X 10.5 X 8.5 in (30 X 27 X 22 cm) 7.5 lb (3.4 kg)	Size: (in case) 9 X 9.5 X 5.5 in (22 X 24 X 14 cm) 4.5 lb (2.0 kg)
Controls: On/off button. Two soft buttons for user programming. Shock button.	Controls: On/off button. Shock button.	Controls: On/off button or pull handle Information button. Shock button.
Example Voice Prompts: Apply defibrillation pads to patient's bare chest. Connect cable. Analyzing heart rhythm, do not touch the patient. Shock advised, stand clear. Shock now, press the red button now. Shock delivered. It is safe to touch the patient. Begin CPR. (CPR pacing with beeps) Stop CPR. Analyzing heart rhythm...	Example Voice Prompts: Unit OK. Adult pads. Stay calm! Check responsiveness. Call for help. Open airway. Check breathing, give two breaths. Attach defib pads to patient's bare chest. Don't touch patient, analyzing. Shock advised. Press flashing shock button. Shock delivered. Start CPR. (CPR pacing with beeps & compression feedback) Stop CPR. Don't touch patient, analyzing...	Example Voice Prompts: Begin by removing all clothing from the patient's chest... Remove protective cover and take out white adhesive pads. Place pads exactly as shown in the picture. Press firmly to patient's bare skin. No one should touch the patient, analyzing. Shock advised. Stay clear of patient. Press the flashing orange button now. Shock delivered. Be sure EMS has been called. It is safe to touch the patient. Check airway, check breathing, check circulation. If needed, begin CPR. (CPR pacing with beeps & optional instructions) Stop CPR. No one should touch the patient, analyzing...
Status Indicator: Indicator visible through window of case.	Status Indicator: Indicator visible through window on front of unit.	Status Indicator: Blinking LED visible through window of case.
Software: SmartLink Lite. SmartLink Event Pro. Infrared Communications Kit. Software allows user to download event data, review ECG traces, generate reports, etc. Software mainly useful for hospital or medical setting with frequent AED use.	Software: Zoll Administration Software RescueNet Code Review Software. IrDA PC Adapter (infrared port). Software allows user to change AED settings, download event data, review ECG traces, generate reports, etc. Software mainly useful for hospital or medical setting with frequent AED use.	Software: HeartStart Event Review 3.0 Infrared data cable. Software allows user to change AED settings, download event data, clear AED memory, review data, etc. Software mainly useful for hospital or medical setting with frequent AED use.
Manuals: Quick Reference Card, CD-ROM with user manual & inservice training video.	Manuals: Operator's guide quick reference sheet, CD-ROM with operator's guide & administrator's guide, CD-ROM training video.	Manuals: Quick reference card, user manual.
Infection Control: Clean with soft cloth & non-abrasive cleaners. Do not use strong solvents. Do not immerse or sterilize. use: Fantastik Formula 409 Hydrogen Peroxide solution INCIDIN Liquid Soap T.B.Q. Warm water Wex-cide Windex Do not use: Acetone Ammonia Benzene Butyl alcohol Denatured ethanol Enviroquat Ether Freon Glutaraldehyde Isopropyl alcohol Chlorine bleach solution Misty Staphene Trichloroethane Vesphene II	Infection Control: Clean with soft cloth & 90% isopropyl alcohol, or soap & water, or chlorine bleach solution. Do not immerse or sterilize. Do not use: Ketones (MEK, acetone, etc.) Abrasives (paper towel) on LCD window	Infection Control: Clean with soft cloth & soapy water, or chlorine bleach solution, or ammonia based cleaners. Do not immerse or sterilize. Do not use: Isopropyl alcoho Strong solvents (acetone) Abrasive cleaners Enzymatic cleaners
Evaluation Team's Favorite Features: Programmable: User can easily change shock sequence & power as well as CPR timing to match current recommendations without requiring service call. Simplicity!	Evaluation Team's Favorite Features: New disposable prep kit comes with each set of pads. Attention to detail: every aspect is well thought out & perfectly executed, from the location of expiration date tags to the long shelf life of the pads!	Evaluation Team's Favorite Features: Built-in training program: Training pads cartridge is all that's required to perform training routines; no need for a separate unit. CPR metronome "gong" sound is really cool!

Locating the AED In Your Facility

The AED should be located in an obvious place in plain sight where it can easily be accessed for use or regular checks. Wall mount brackets are available from each manufacturer.

Wall mount cabinets (with door alarms) are available if AED is to be located in the public area of a building.

Staying Current with CPR/AED Guidelines

The American Heart Association revised its guidelines for CPR & AEDs in late 2005 & changes went into effect mid-2006. The prior guidelines had been effective since 2000. Although new guidelines do not mean that old protocols are ineffective, they do show progress in research & experience that lead to more successful resuscitations & improved survival rate.

Some key changes were:

Compression to breath ratio of 30:2, verses 15:2 under the old guidelines.
AED delivery of 1 shock followed immediately by 2 minutes of CPR before stopping to re-analyze the heart, verses 3 sequential shocks & 1 minute of CPR under the old guidelines.
Elimination of AED prompts that delay or interrupt the delivery of CPR.

AEDs using old guidelines may still be used, but they will no longer match current rescue training. Upgrading your AED to new guidelines could be as simple as re-programming the unit yourself, or as expensive as sending it in for a complete electronics overhaul, depending on the brand & model.

Other AED Brands Available

Many AED brands & models are available. A useful resource CRA has identified is the AED Superstore at: www.aedsuperstore.com or 877-233-7828 (877-AED-STAT).

Coordinating With Local EMS

It has been recommended that you "register" your AED with your local EMS to help your community's efforts to provide public access to defibrillation. Check with your local EMS.

It has also been suggested that you purchase the same brand AED as used by your local EMS so that when they arrive they can simply unplug the connector from your AED & plug it into theirs without removing the pads from the patient or putting new ones on. It is not yet known if this provides a true advantage or not. Many of the more advanced defibrillators with pacemaking use pads with more leads. In addition, the pads may need to be placed in different locations for different functions. Again, check with your local EMS.

Evaluation Team's Experience: CRA researchers visited their local fire station & spoke with rescue paramedics. Their engine was equipped with a LIFEPAK 500 by Medtronics. The ambulance had a more advanced model using 12-lead electrodes. They were not concerned that we use the same brand, nor were they concerned that we "register" our AED with them. They were friendly & did not hesitate to show us their equipment.

CPR/AED Training

In preparation for this evaluation, a CRA researcher took the class "CPR for the Professional Rescuer" from the local chapter of the American Red Cross, which included AED assisted rescue training. The class cost $60 & was taught in two 4-hour evening sessions. CPR protocol followed the 2000 guidelines since the Red Cross was not updating to the 2005 guidelines until January 2007. The AED portion was brief but adequate to know how & when to use an AED.

In addition to receiving certified CPR/AED training, dental clinicians should purchase training materials along with their AED so that they & their team can practice simulated rescues using their specific AED model.

AED Survey

In July, 2006, CRA surveyed its Clinical Evaluators regarding AEDs. Of 106 respondents, 83 had access to an AED. (Percents may add to more than 100 because some clinicians had access to multiple units.)

Location of AED:

86% In the practice.
18% Accessible in the building.

Models & brands:

22.9% HeartStart OnSite (Philips)
16.9% Power Heart AED G3 (Criticare)
16.9% AED Plus (Zoll)
14.5% clinician did not know model or brand
8.4% LIFEPAK 500 (Medtronics)
7.2% AED 10 (Welch Allyn)
4.8% Samaritan AED (Heartsine)
3.6% Lifeline (Defibtech)
2.4% HeartStart FR2 (Philips)
1.2% Code Master (Hewlett Packard)
1.2% HeartStart F1 (Philips)

Questions asked by Evaluators. Answers are based on the best information CRA had available in Oct. 2006.

Why do they cost so much?
AEDs require extensive testing to meet FDA guidelines for medical products. Critical components must be proven & certified.
Are AEDs safe?
Yes, they are simple to operate, the shock delivery is rescuer controlled, & their ECG analysis algorithms have proven very effective at correctly interpreting the heart's condition.
What is the battery life? Is there a low battery warning?
Typical disposable batteries have a ten year shelf life (stored as a back-up). Batteries in the AED are typically good for 4 - 5 years. If the AED's periodic self-check finds any problem, including low batteries, it will give a visual & audible warning that it should be serviced.
Do they require periodic testing?
Not really. A periodic glance at the status indicator is sufficient. Perhaps once a year, when training is reviewed & expiration dates are checked, a more extensive power-up test could be performed. Frequent testing should be avoided because it wastes battery charge.
Do they improve survival rate over CPR only?
Yes. CPR temporarily treats the condition, but cannot solve the underlying problem. AEDs potentially solve the problem by resetting an ineffective heart rhythm. Bear in mind that resuscitation is rarely successful & only some conditions are treatable by AEDs. Furthermore, a successful resuscitation does not guarantee survival to hospital discharge. However, studies of AED treatable cases show that AEDs are successful 15 - 74% of the time. This is a significant improvement & makes a tremendous difference for the victim & their loved ones. It is estimated that access to AEDs could save an additional 40 - 50,000 lives a year in the U.S. alone!
What is the liability if misused or owned?
CRA does not know the full legal implications of owning an AED. Certainly, the decision to purchase an AED requires a higher level of commitment to both training & response in the event of an emergency. This commitment goes hand-in-hand with the clinician's desire to provide the best care possible using the most up-to-date knowledge & equipment available. AEDs should not be operated by untrained persons. The Good Samaritan Act protects lay people who attempt to help others when acting on their best judgment & within the scope of their training. This Act has made possible the proliferation of AEDs in the public sector, & their use by trained rescuers who are nonetheless, not certified medical professionals.
Can anyone use them?
Yes, with appropriate training in CPR/AED rescue technique anyone can operate one.
Are they easy to use with female patients?
Yes, pads are placed above the right breast & below the left breast, the same as for males. Diagrams on the pads make placement fast & easy.
Why do the pads expire?
The conductive gel-adhesive can dry out over time, especially if the sealed pouch is punctured. The FDA regulates the shelf-life of pads.
Is certification necessary?
AEDs may now be purchased without a prescription. FDA regulations specify that the AED must be registered with the manufacturer for tracking purposes, & that users should have certified CPR/AED training by an approved agency. The federal "Public Access to Defibrillation" (PAD) program also encourages purchasers to register their AED with their local EMS to help meet their community's goals for defibrillation.
When will they be required legally?
Currently, Florida is the only state specifying AEDs in all dental facilities. Other states have legislation specifying AEDs for certain procedures, & in certain types of facilities. It is not known how soon they may be required in all dental practices.
Is it necessary to use pediatric pads?
No. Children are seldom affected by sudden cardiac arrest. When they are, the cause is usually asphyxiation due to other factors. The AED may temporarily resuscitate them, but seldom changes the outcome. If no pediatric pads are available, adults pads should still be used on a child/infant. Standard of care practice is to keep a set of pediatric pads on hand if a significant number of children are routinely treated at a facility. However, adult pads should still be the ones pre-attached to the AED or in the "ready" position.
What is the lifespan of an AED? Are they reliable?
Unfortunately, a large number of AEDs have been recalled in recent years. Not all recalls are due to failure, just for potential for failure. Changes in recommendations for shock treatment are also cause for recalls. Lifespan is unknown. Choose a reputable company with an established history of defibrillator products.
Do the benefits out weigh the costs & risks?
Until AEDs are required by law, each clinician must decide this for themselves. They are now considered standard of care.
Are they necessary if local EMS are nearby?
Yes. National studies show a typical EMS response time of 9 minutes. V-fib seldom lasts longer than 5 minutes before deteriorating to asystole. Early defibrillation is a key link in the cardiac chain of survival.