Herzschrittmachertherapie & Elektrophysiologie
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Herzschrittmacherther Elektrophysiol · Jun 2005
Review[Resuscitation in ventricular fibrillation: what is essential?].
Prognosis of prehospital cardiac arrest due to ventricular fibrillation is dependent on the first minutes, as survival decreases by 10% for each minute by which resuscitation attempts are delayed. Thus, early defibrillation plays a key role in improving outcome of cardiac arrest victims. ⋯ Whereas the use of intravenous antiarrhythmic drugs, particularly amiodarone, remains controversial, new data support the use of vasopressine instead of epinephrine as vasopressor drug in cardiac arrest patients. The present review aims to focus on the above mentioned aspects as well as on the changes to the present ILCOR guidelines which have led to modification of the resuscitation guidelines of the European Resuscitation Council (ERC).
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Herzschrittmacherther Elektrophysiol · Jun 2005
Review Comparative Study[Technical requirements for early defibrillation: what are the capabilities of automated external defibrillators].
Modern automated external defibrillators (AEDs) offer a variety of technical improvements which increase the efficacy of early defibrillation, facilitate the application by not or minimally trained persons and improve safety. The development of biphasic shocks allows better myocardial protection, the use of lithium batteries, and a marked decrease of AEDs, in size. Microprocessors realize complex acoustic and visual prompts which lead the user through all steps of cardiopulmonary resuscitation (CPR) according to current guidelines. ⋯ The ability to perform CPR after defibrillation guided by the AED depends primarily on the clarity of acoustic prompts which have to consider the terms and abbreviations of the respective language. Currently available AEDs surpass performance goals of the AHA. However, all devices exhibit advantages and disadvantages which will be discussed in this review.
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Herzschrittmacherther Elektrophysiol · Jun 2005
Review Comparative Study[First responder defibrillation in the USA, Europe and Germany--prerequisites, experiences, perspectives].
Sudden out-of-hospital cardiac arrest is a leading cause of death and only 5-8% of patients survive such event. Defibrillation is the mose effective treatment and should performed within 5 minutes; however, its effectiveness diminishes with each passing minute. "Early defibrillation" is the use of automated external defibrillators (AEDs) by trained public-safety personnal ("first responder"), whereas "public access" defibrillation describes AED use by persons who have no specific AED training. Several studies in the US and in Europe show that first responder defibrillation will increase the number of survivors of out-of-hospital cardiac arrest compared to paramedics. ⋯ In Germany, there are only few AED programs with promising results. At the present time, placement of automated external defibrillators in public places frequented by a large number of susceptible people will increase overall survival. However, placement of AEDs in all public places is still debatable and further studies are necessary to estimate the potential impact of publicc access defibrillators.
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Herzschrittmacherther Elektrophysiol · Jun 2005
Review[Automated external defibrillators: perspectives and outlook].
In Germany about 80.000 patients die of sudden cardiac death each year with enormous human, social and economic consequences. Most cases of sudden cardiac death are caused by ischemia-triggered ventricular fibrillation. A precondition for survival of the victims is an optimally and fast reacting "chain of survival". ⋯ It has been convincingly demonstrated, that these devices not only are safe and efficacious in the hands of rescue personnel of different qualification degrees but also in the hands of minimally trained "first responders" and even in the hands of untrained lay people. This story of success was paralleled by the development of a new generation of biphasic defibrillators, which have a superior efficacy, are lightweight and are even cheaper than conventional devices. It must however kept in mind, that progress offered by these new opportunities will only translate in better resuscitation results, when programmes are thoroughly planned, will stay under continuous quality control with regard to performance of devices and rescuers and if new knowledge in resuscitation is adequately incorporated in action protocols.
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Herzschrittmacherther Elektrophysiol · Jun 2005
Clinical Trial[First responder defibrillation in the LAGO-die Therme--results and experiences].
The use of automated external defibrillator (AED) by persons other than paramedics and emergency medical technicians is advocated by several US- and European organizations. However, at the present time it is still unclear to identify public places with a high incidence of out-of-hospital cardiac arrest. There are few data on the potential impact of public access defibrillators on survival after out-of-hospital cardiac arrest in sporting arenas or water parks. ⋯ In addition, in 2004, AED was noticed by 480 visitors (83%) and 277 visitors (48%) did more sporting activities. There were no significant differences between 2002 and 2004 (p=ns). Despite no out-of-hospital cardiac arrest in the waterpark during the 3 year follow- up, it seems reasonable to install AED in sporting places with thousands of visitors per year.