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Current Opinion in Critical Care Jun 2023The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. (Review)
Review
PURPOSE OF REVIEW
The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation.
RECENT FINDINGS
Defibrillation with on-site automated external defibrillators (AEDs) has been the conventional approach for public access defibrillation. This strategy is highly effective in cardiac arrests occurring in close proximity to on-site AEDs; however, only a few cardiac arrests will be covered by this strategy. During the last decades, additional strategies for public access defibrillation have developed, including volunteer responder programmes and drone assisted AED-delivery. These programs have increased chances of early defibrillation within a greater radius, which remains an important factor for survival after out-of-hospital cardiac arrest.
SUMMARY
Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
Topics: Humans; Defibrillators; Emergency Medical Services; Out-of-Hospital Cardiac Arrest; Registries; Cardiopulmonary Resuscitation; Electric Countershock
PubMed: 37093002
DOI: 10.1097/MCC.0000000000001051 -
Journal of the American Heart... Apr 2014
Topics: Computers, Handheld; Defibrillators, Implantable; Electric Countershock; Electromagnetic Fields; Equipment Failure; Humans
PubMed: 24755157
DOI: 10.1161/JAHA.114.000947 -
Revue Medicale de Liege Oct 2022Sudden cardiac death affects close to half a million people a year in Europe and accounts for 50 % of cardiovascular deaths. Unfortunately, only a minority of these...
Sudden cardiac death affects close to half a million people a year in Europe and accounts for 50 % of cardiovascular deaths. Unfortunately, only a minority of these events occur in front of witnesses, which reduces the chances of survival. In order to limit this risk, an internal automatic defibrillator can be implanted in patients at risk of sudden cardiac death. However, there are circumstances when the patient is at risk of sudden cardiac death and this device cannot be implanted. In order to limit this risk, certain patients can be equipped with a wearable defibrillator.
Topics: Death, Sudden, Cardiac; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Humans; Wearable Electronic Devices
PubMed: 36226391
DOI: No ID Found -
Heart Rhythm Mar 2007Intravascular ventricular defibrillation and intravascular atrial defibrillation have many similarities. An important factor influencing the outcome of the shock is the... (Review)
Review
Intravascular ventricular defibrillation and intravascular atrial defibrillation have many similarities. An important factor influencing the outcome of the shock is the potential gradient field created throughout the ventricles or the atria by the shock. A minimum potential gradient is required throughout the ventricles and probably the atria in order to defibrillate. The value of this minimum potential gradient is affected by several factors, including the duration, tilt, and number of phases of the waveform. For shock strengths near the defibrillation threshold, earliest activation following failed shocks arises in a region in which the potential gradient is low. The defibrillation threshold energy can be decreased by adding a third and even a fourth defibrillation electrode in regions where the shock potential gradient is low for the shock field created by the first two defibrillation electrodes and giving two sequential shocks, each through a different set of electrodes. However, the addition of more electrodes and sequential shocks complicates both the device and its implantation. Because patients are conscious when the atrial defibrillation shock is given, they experience pain during the shock, which is one of the main drawbacks of intravascular atrial defibrillation. Unfortunately, the pain threshold for defibrillation shocks is so low that a shock less than 1 J is uncomfortable and is not much less painful than shocks several times stronger. Therefore, even though electrode configurations exist that have lower atrial defibrillation threshold energy requirements than the atrial defibrillation threshold with standard defibrillation electrode configurations used in implantable cardioverter-defibrillators (ICDs) for ventricular defibrillation, they are not clinically practical because their shocks are almost as painful as with the standard ICD electrode configurations. Such electrode configurations would make the ICD more complicated, leading to greater difficulty and longer time required for implantation.
Topics: Analgesics; Animals; Anti-Arrhythmia Agents; Atrial Fibrillation; Defibrillators, Implantable; Electric Countershock; Equipment Design; Heart Conduction System; Humans; Hypnotics and Sedatives; Pain; Pain Threshold; Treatment Outcome; Ventricular Fibrillation
PubMed: 17336885
DOI: 10.1016/j.hrthm.2006.12.030 -
Circulation Feb 2019This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular... (Review)
Review
This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular pacemakers, mechanical circulatory support, and transplantation with a focus on utilization, efficacy/clinical effectiveness, adverse events, and controversies. One will learn about the controversies regarding efficacy/clinical effectiveness of implantable cardioverter defibrillators and understand why these devices should be implanted in women even if there are sex differences in appropriate shocks. Individuals will learn about the sex differences with biventricular pacemakers with respect to ventricular remodeling and reduction in heart failure hospitalizations/mortality, as well as, possible mechanisms. We will demonstrate sex differences in heart transplantation and waitlist survival. Despite similar survival for women and men with left ventricular assist devices, there are sex differences in adverse events. These devices do successfully bridge women and men to transplant, yet women are less likely than men to have a left ventricular assist at time of listing and time of transplantation. Finally, one will learn about the concerns regarding poor outcome for men who receive female donor hearts and discover this may not be due to sex, but rather size. More research is needed to better understand sex differences and further improve advanced heart failure therapy for both women and men.
Topics: Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Defibrillators, Implantable; Electric Countershock; Extracorporeal Circulation; Female; Health Status Disparities; Healthcare Disparities; Heart Failure; Heart Transplantation; Humans; Male; Risk Factors; Sex Factors; Treatment Outcome
PubMed: 30779645
DOI: 10.1161/CIRCULATIONAHA.118.037369 -
Archives of Cardiovascular Diseases Apr 2014The increase in number of implanted cardiac medical devices and the announced decrease in number of cardiologists have led to remote monitoring being considered as a... (Review)
Review
The increase in number of implanted cardiac medical devices and the announced decrease in number of cardiologists have led to remote monitoring being considered as a pivotal tool for patient follow-up. For 10 years, remote monitoring has been the subject of multiple clinical studies. In these studies, reliability and clinical efficacy have been demonstrated, but the use of remote monitoring remains quite limited in France compared with other countries. To explain this delay in uptake, some organizational difficulties and the lack of reimbursement of remote monitoring are often mentioned. The results of medico-economic studies might provide answers about the value of remote monitoring and enable the supervisory authorities to define how its use will be financed. This review provides a global view of remote monitoring in France, and covers the principle, clinical efficacy, organizational and regulatory aspects, and medico-economic data.
Topics: Cardiac Pacing, Artificial; Cost-Benefit Analysis; Defibrillators, Implantable; Delivery of Health Care; Electric Countershock; Equipment Design; France; Health Care Costs; Heart Diseases; Humans; Organizational Objectives; Pacemaker, Artificial; Predictive Value of Tests; Telemedicine; Telemetry; Time Factors; Treatment Outcome
PubMed: 24709285
DOI: 10.1016/j.acvd.2014.02.004 -
Circulation Research Jun 2015The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to... (Review)
Review
The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and prevention of reperfusion injury, as this holds the promise of restoring life to many patients for whom our current therapies fail.
Topics: Calcium Signaling; Cardiopulmonary Resuscitation; Cardiovascular Agents; Chest Wall Oscillation; Combined Modality Therapy; Defibrillators; Defibrillators, Implantable; Drug Therapy, Combination; Electric Countershock; Equipment Design; Heart Arrest; Humans; Mitochondria, Heart; Models, Cardiovascular; Myocardial Contraction; Myocardial Reperfusion; Myocardial Reperfusion Injury; Survival Rate; Treatment Outcome; Ventricular Fibrillation
PubMed: 26044255
DOI: 10.1161/CIRCRESAHA.116.304495 -
Lakartidningen Oct 2018
Topics: Checklist; Critical Pathways; Defibrillators; Electric Countershock; Heart Arrest; Humans; Tachycardia
PubMed: 30672681
DOI: No ID Found -
Hong Kong Medical Journal = Xianggang... Dec 2017
Topics: Defibrillators; Electric Countershock; Health Services Accessibility; Hong Kong; Humans; Out-of-Hospital Cardiac Arrest; Public Facilities
PubMed: 29226830
DOI: 10.12809/hkmj175074 -
Trends in Cardiovascular Medicine Aug 2016With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In... (Review)
Review
With increasing indications and access to cardiac implantable electronic devices (CIEDs) worldwide, the number of patients needing CIED follow-up continues to rise. In parallel, the technology available for managing these devices has advanced considerably. In this setting, remote monitoring (RM) has emerged as a complement to routine in-office care. Rigorous studies, randomized and otherwise, have demonstrated advantages to patient with CIED management systems, which incorporates RM resulting in authoritative guidelines from relevant professional societies recommending RM for all eligible patients. In addition to clinical benefits, CIED management programs that include RM have been shown to be cost effective and associated with high patient satisfaction. Finally, RM programs hold promise for the future of CIED research in light of the massive data collected through RM databases converging with unprecedented computational capability. This review outlines the available data associated with clinical outcomes in patients managed with RM with an emphasis on randomized trials; the impact of RM on patient satisfaction, cost-effectiveness, and healthcare utilization; and possible future directions for the use of RM in clinical practice and research.
Topics: Cardiac Pacing, Artificial; Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Defibrillators, Implantable; Electric Countershock; Heart Diseases; Humans; Pacemaker, Artificial; Patient Participation; Physician's Role; Practice Guidelines as Topic; Predictive Value of Tests; Prosthesis Design; Prosthesis Failure; Remote Sensing Technology; Risk Factors; Signal Processing, Computer-Assisted; Telemetry; Treatment Outcome
PubMed: 27134007
DOI: 10.1016/j.tcm.2016.03.012