Reprinted from Hartford Courant May 6,
2004
Put A Defibrillator In Every School
May 6, 2004
Karen Zott
There were obvious signs that my young patient
was a lively adolescent. She still had her summer tan; strong, defined muscles
reflected her athletic nature; nicely manicured (blue) toenails indicated
she could be a girlie girl. She could have been anyone's daughter.
Contrasting this picture were the IVs in her arms and the respirator keeping
her alive. While playing basketball, my patient became a victim of sudden
cardiac arrest. Although she received CPR at the scene, she nevertheless
suffered significant brain damage.
I often wonder what the outcome would have been if an automatic external
defibrillator had been immediately available. Would immediate defibrillation
have improved her outcome? What is confirmed by a recent study done by the
National Institutes of Health is that the chances of surviving sudden cardiac
arrest are doubled where AEDs are placed in public places and ordinary people
are trained to use them.
Sudden cardiac arrest accounts for approximately 250,000 deaths annually
in the United States; 10,000 of these deaths are children. In adults, an
estimated 40 percent to 60 percent of all sudden cardiac arrests are a result
of ventricular fibrillation or pulseless ventricular tachycardia. Both VF
and VT cause a rapid and chaotic quivering of the heart muscle, interrupting
blood flow to the brain. This interruption can lead to brain death in as
little as four minutes. Children also suffer; the American Heart Association
estimates that 15 percent of all pediatric cardiac arrests are a result of
VF or pulseless VT.
For victims of cardiac arrest, the single most important factor determining
survival is the time between onset and the first defibrillation. For each
minute a victim waits for defibrillation, the chance of survival drops as
much as 10 percent.
With defibrillation, a shock is delivered to the chest wall and transmitted
to the heart. The hope is that this shock resets the electricity of the heart
to normal, allowing it to resume pumping properly. AEDs are designed to be
used by people who have very little medical training. These small units contain
computer chips that analyze a victim's heart rate and rhythm. If the AED
determines that the rhythm needs to be shocked, the user - through synthesized
voice prompts - will be instructed how to proceed.
Although AEDs are in many public places, they are by no means in every location
where there is a high potential for cardiac arrest. Initially, school-site
AED programs began as a grass-roots effort, usually in response to a student
death. However, these grass-roots programs are now increasingly becoming state-mandated,
although not necessarily state-funded. The Jackson County, W.Va., school
system was among the first to have a comprehensive AED program in place,
prompted by a 16-year-old who suffered from sudden cardiac arrest while playing
baseball. Two years ago, a Long Island teenager died from cardiac arrest
after being hit in the chest by a lacrosse ball (he had been wearing a chest
plate). After that tragedy, the teenager's parents developed a foundation
to promote early defibrillation programs in schools. Last May, the New York
legislature passed a bill that required every public school (grades K-12)
in the state to acquire AEDs and train people to use them. Illinois, New Jersey
and Massachusetts are working on similar legislation.
One may wonder why these devices are being put in schools, where the incidence
of cardiac arrest is low. It may be low, but it is not insignificant. Some
1 in 100 children will be born with a congenital heart defect. With the advent
of complex surgical techniques, many more of these children are surviving
into young adulthood - and many of them will die of disorders that could be
prevented with defibrillation.
The standard of care should be no different for children than it is for adults.
Next time, my patient could be anyone's daughter.
Karen Zott is a registered nurse in the pediatric intensive care unit
at Connecticut Children's Medical Center in Hartford.
If you want other stories on this topic,
search the Archives at ctnow.com/archives.