Wednesday, April 2, 2008

Home AED Use for Precocious Geezers

As we precocious geezers contemplate the various ways we will someday exit this globe, one means looms large: cardiac death. Fortunately, this specter of heart disease can be exorcised somewhat by appropriate technology, such as coronary stents, cardiac pacemakers, and automated external defibrillators (AED). All of these devices have done a great deal to prevent some cardiac deaths.

I'm currently reasonably healthy, but remain a bit sensitized to this issue due to a friend having a cardiac arrest before my eyes at a dance last year. As I posted earlier this year, prompt CPR and a nearby AED got my friend's heart started again. My spouse and I now own a personal AED unit, and take it with us to dances and other events. We also keep it readily accessible at home.

Therefore, I read this article from the current issue of the New England Journal of Medicine with particular interest. It's titled Home Use of Automated External Defibrillators for Sudden Cardiac Arrest, and presents the findings from a randomized study of home AED use in 7,001 subjects with prior anterior-wall myocardial infarction (a specific variety of heart attack). The gist of the article:
For survivors of anterior-wall myocardial infarction who were not candidates for implantation of a cardioverter–defibrillator, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods.
These results are mildly disappointing if you own your own AED, as we do. They are even more disappointing if you are Philips corporation, who currently sells the only AED on the market that is FDA-approved for home use (and may have been hoping to use the results of this study to sell a zillion more home AED's).

The demographics of this study population don't extrapolate well to our house, since none of us have any prior history of cardiac disease. However, neither did the friend we helped to resuscitate last year. Furthermore, I take heart, so to speak, in the following details from the study:
AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge.
A simple analysis of these numbers: 4/14 (29%) of those who were shocked were long-term survivors. If there had been no AED available, this survival rate would have been much lower -- like zero. We won't be putting our AED on eBay anytime soon.

Other points of interest from this study: 83% of the subjects were men, and 88% of the rescuers were married to the subject.

Putting all of these factoids together, here's the Secret Master Plan™ I would suggest for surviving a home cardiac event:
  1. keep an AED around the house
  2. have a significant other
  3. be really, really nice to your S.O.
  4. make sure they know CPR
  5. make sure they know how to use your AED

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