A shock to the system
By David Martin, www.timesonline.co.uk
August 1st, 2005
A defibrillator designed for home use is so simple
that a child could operate it. But will it save the
lives of those at risk from heart problems?
IT’S LATE AT night, and the patient’s
heart has stopped beating. Cue George Clooney, who
races in, grabs two alarming-looking paddles and,
with a grave “stand clear”, zaps the patient’s
chest with an electric shock to re-establish a regular
heartbeat. It looks so easy in the television world
of ER.
Now comes your chance to stand in for George with
the real thing, and perhaps save the life of a loved
one lying unconscious in your living room. For Philips
has recently introduced the UK’s first defibrillator
for use in the home and, it says, anyone can learn
to operate it.
The HeartStart Home Defibrillator is designed specifically
for people suffering from a Sudden Cardiac Arrest
(SCA), a condition in which the electrical signal
that regulates heart rhythm misfires, causing the
heart to stop beating and to quiver unproductively.
An SCA can result in death within minutes and those
with a history of heart trouble are most at risk.
SCA causes 80,000 deaths a year, says the UK Resuscitation
Council. Nearly 70 per cent of out-of-hospital SCAs
occur in the home, and once SCA has begun, chances
of survival decrease by about 14 per cent a minute
without treatment — the survival rate in such
cases is around 5 per cent.
Gert van Santen, a Philips spokesman, says: “The
home defibrillator can bridge the gap between SCA
and ambulance. You must call the ambulance first,
then defibrillate, then perform cardiopulmonary resuscitation
(CPR). Early defibrillation is key to survival.”
The HeartStart Home Defibrillator sounds like something
that every hypochondriac, let alone heart patient,
will want. In fact, according to Van Santen, the kit
is aimed “primarily at high-risk categories:
those with a history of heart trouble, those with
type 2 diabetes. But later we can imagine a wider
appeal.”
For £1,295 the buyer gets the unit itself —
about the size of a large hardback book and a little
heavier — and a voucher for a personal training
session in the home.
The defibrillator can be used only in the case of
SCA: this is not to be confused with a heart attack,
where a crushing pain is felt in the chest because
the heart is being starved of oxygen. A heart attack
can often precipitate SCA, but the two conditions
are separate. In SCA, the patient will suddenly become
unconscious, breathing will stop, and there will be
no pulse. The condition — medical name ventricular
fibrillation — can be reversed only by an electric
shock meant to defibrillate the heart.
The defibrillator is worked by first pulling the
handle to activate a voice-recording that issues instructions.
Two adhesive pads are removed from the unit and stuck
to the patient’s bare chest. The defibrillator
then automatically analyses the heart rhythm to ascertain
if ventricular fibrillation is occurring. If it is,
the operator is told to press a button to administer
an electric shock. The patient will jerk suddenly.
The unit will then announce that it is safe to touch
the patient and will talk you through CPR. There are
two interchangeable sets of adhesive pads, one for
adults and one for children under 8.
It’s easy to use, I find, when I practise on
a forlorn life-size cut-out torso provided for training
purposes (Philips says that children as young as 10
can use the defibrillator after completing the standard
training). The unit’s voice reminds me of a
lift I often use, only rather more urgent; Philips
apparently experimented with a range of voices but
settled on a deep male with a neutral accent because,
it say s, he sounds most authoritative. But even in
these surreal circumstances, when the defibrillator
instructs me to shock I feel a kind of trepidation
before I push the button. A certain instinct resists
the idea of giving a person (or paper torso) an electric
shock. So amid the distress in a real case, would
the layman really be able to manage it?
Dr Anthony Handley, a defibrillator specialist and
member of the UK Resuscitation Council, suggests that
people talk to their doctor before buying a home-use
defibrillator. “Some people surprise themselves
and do well in these situations, after the right training.”
But isn’t there a chance that you could harm
the patient if you, or the machine, get it wrong?
“These machines only allow a shock if one is
necessary,” Handley says. “The chances
of it indicating a shock when none is required are
so low as to be negligible. They are extremely safe.”
His main reservation about the machine — apart
from the considerable cost — is the psychological
implication of ownership. “Are you going to
worry, for instance, if you go somewhere and can’t
take it with you? Potential buyers need to think carefully
about what ownership will mean. But my view is that
there’s a place for these devices, particularly
among high-risk groups.”
The Resuscitation Council is not directly recommending
the use of home defibrillators until more data exists
to prove that they save lives.
And Katherine Peel, head of Emergency Life Support
for the British Heart Foundation, remains cautious:
“We are awaiting with interest the results of
ongoing trials of home-use defibrillators. For the
present at least, any national endorsement is premature.”
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