Do you know where the nearest defibrillator is?
Seconds count if you or someone near you has a sudden cardiac arrest. It happens to roughly 1,000 Americans every day. Although it often accompanies a heart attack, sudden cardiac arrest can happen to young and seemingly healthy people, too, and 95 percent of victims die before emergency personnel arrive.
The odds improve dramatically if somebody on the scene can quickly start cardiopulmonary resuscitation, or CPR, to get blood flowing through the victim's heart and uses an automatic external defibrillator, or AED, to shock it back into normal rhythm. If you go into sudden cardiac arrest in a Chicago airport, where AEDs are plentiful, your chance of survival is greater than 50 percent. It's as high as 74 percent in casinos, where trained personnel are watching constantly.
Statistics like that are helping fuel the drive to put more AEDs in public places. Once only seen in hospitals and ambulances, defibrillators today come as small as laptops, cost as little as $1,300 and can be operated easily by untrained bystanders. All you have to do is follow the recorded instructions. The device itself determines if a shock is needed and delivers it, after telling bystanders to stand back.
Some states now require AEDs in schools; some require them in health clubs, shopping malls and golf courses. There's little uniformity; despite their foolproof nature, some businesses oppose them out of fear of being sued if something goes awry with an on-site AED. "I predict that 10 years from now, people will say, 'I'm not going to work in a building or stay in a hotel or eat in a restaurant that doesn't have an AED,'" says San Diego city-council member Jim Madaffer, who helped place nearly 5,000 AEDs in public facilities since 2001. They've saved 49 lives.
Schools have been a tough sell, too, largely because of cost. Some parents are raising money for AEDs themselves, often after a tragedy. Evelyn and Larry Pontbriant have donated 32 AEDs to Norwich, Conn., schools since last summer, when their 15-year-old son, an athlete with no known heart problems, suffered a fatal cardiac arrest during a running event in the local park. An AED arrived on the scene too late.
"It's a good investment to have on hand in your school," says Evelyn Pontbriant. "It benefits not just the athletes, but also the teachers, coaches, referees, grandparents and siblings."
AEDs are also available now for home use without a prescription. In April, a government-funded study found that the devices didn't significantly reduce the chances of death for people who had previous heart attacks. Still, "it's hard to make a case not to have one if you can afford it," says Gust H. Bardy, the Seattle electrophysiologist who led the study. "We almost never use a fire extinguisher or the flotation device on an airplane." Dr. Bardy, who says he has seen five people die for lack of access to an AED, personally has five of them - in his two homes, his two cars and his office.
People at high risk for sudden cardiac arrest may be candidates for an implantable cardioverter-defibrillator, or ICD, that continually monitors heart rhythm and delivers shocks as needed. But ICDs cost as much as $55,000 and have had a history of recalls. What's more, roughly 75 percent of people who have one never require a shock, and 70 percent of people who do have a sudden cardiac arrest don't fit the criteria to receive an ICD.
The National Institutes of Health is sponsoring a major study, which begins enrolling patients this week, to better understand who might benefit from an ICD. For now, assessing risk "is a very, very difficult thing. I can't look at you and say you have a 10 percent chance of dying from this," says lead investigator Jeffrey Olgin, chief of Cardiac Electrophysiology at the University of California-San Francisco.
There's no telling whether faster use of a defibrillator might have saved NBC's Tim Russert, who died of a heart attack June 13. His doctor said co-workers were about to use the office AED when paramedics arrived. They shocked his heart several times in vain.
Still, experts say his death underscores that cardiac arrest can strike unexpectedly, and that every workplace should have an AED - ideally less than three minutes' walk from anyone. Michael Sayre, a spokesman for the American Heart Association, says people should get over the idea that death is inevitable in sudden cardiac arrest. In many cases, "this is a treatable disease," he says. "We can do much better than we're doing today."
Stayin' alive
If someone collapses near you, follow these steps:
Call 911.
Push hard and fast on the center of the chest (mouth-to-mouth is no longer recommended).
Send someone to get an AED (if you are alone, get the AED before doing chest compressions).
Source: American Heart Association