Cardiac emergencies demand immediate action. When someone collapses from suspected cardiac arrest, bystanders often wonder how to help, especially if the person has a medical device. A common question arises regarding the use of Automated External Defibrillators (AEDs) on individuals with an implanted defibrillator. This article provides clear guidance for this situation, empowering responders and ensuring effective emergency care.
Understanding Automated External Defibrillators and Implanted Devices
Automated External Defibrillators (AEDs) are portable electronic devices designed to treat sudden cardiac arrest. An AED analyzes the heart’s electrical impulses and determines if a shock is needed to restore a normal rhythm. If a life-threatening abnormal rhythm, such as ventricular fibrillation, is detected, the AED instructs the user to deliver a controlled electrical shock. This helps reset the heart’s natural pacemaker, allowing it to resume effective pumping.
An Implantable Cardioverter-Defibrillator (ICD) is a small, battery-powered device surgically placed under the skin, often in the chest near the collarbone. Thin wires, called leads, connect the ICD to the heart, enabling constant heart rhythm monitoring. If the ICD detects a dangerously fast or irregular heartbeat, such as ventricular tachycardia or ventricular fibrillation, it can deliver internal electrical pulses or shocks to correct the rhythm. Unlike an AED, an ICD functions automatically within the body.
Administering AED Therapy When an Implanted Device Is Present
If someone with an implanted defibrillator experiences cardiac arrest, use an AED without hesitation. AEDs are designed for safe use even if an implanted device is present. The implanted device may have already delivered a shock, but if the person remains unresponsive and in cardiac arrest, external defibrillation is still necessary.
When applying AED pads to someone with an implanted device, avoid placing them directly over the visible lump or scar indicating the device’s location. This lump is typically found in the upper chest or shoulder. Position the pads at least one inch away from the implanted device to ensure safety and optimal energy delivery.
If standard pad placement (one pad on the upper right chest below the collarbone and the other on the lower left chest) would place a pad directly over the device, adjust placement slightly to the side or use an anterior-posterior configuration. For instance, one pad can be placed on the front of the chest, and the other on the back, between the shoulder blades. If precise alternative placement is difficult or delays the process, standard placement is still preferable to no AED use. Modern AEDs are designed to work effectively, and an ICD’s presence will not prevent the AED from delivering a life-saving shock.
Comprehensive Emergency Response
Responding to a cardiac arrest emergency involves several coordinated actions. The immediate first step is to call for emergency medical services, such as 911, as quickly as possible. This ensures professional medical help is en route while bystander interventions begin.
Initiate continuous chest compressions (CPR) immediately if the person is unresponsive and not breathing normally. High-quality chest compressions, performed at a rate of 100-120 per minute and to a depth of at least two inches, are important for maintaining blood flow to the brain and other organs. Continue CPR until an AED is available, emergency medical personnel arrive, or the person shows signs of life.
Even if the implanted device delivers a shock, the person may still require ongoing CPR and external defibrillation. Continue following the AED’s voice prompts, which guide rhythm analysis and shock delivery if needed. Stay with the individual and continue providing care until emergency responders take over, informing them about the implanted defibrillator.