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Critical care medic here. Adult CPR at least has some evidence in its favor on a population level, but only as a bridge to using electricity. CPR alone is merel

Critical care medic here. Adult CPR at least has some evidence in its favor on a population level, but only as a bridge to using electricity. CPR alone is merely slowing deaths arrival. There is NO evidence to support any of the commonly used advanced cardiac life support drugs in terms of functioning brain leaving the hospital. Epinephrine (for arrest, not shock or anaphylaxis), atropine, lidocaine, amiodarone, procainamide, digitalis, etc. Its electricity or bust. Just one of many reviews on this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129833/

JumpCrisscross 3y ago
Would it make sense for households with those at risk of heart attack to invest in an AED?
- rdmirza 3y ago
  Even better is installing an implantable cardiac defibrillator (ICD) in those at high risk.
  - noughtme 3y ago
    > at high risk. Before an event? I’m not sure what insurance would cover this. I don’t really want open heart surgery before I need it.
    - Calavar 3y ago
      Plenty of insurance plans cover ICD implantation because it is recommended by the American College of Cardiology for specific situations: 1. moderately to severely reduced systolic function of the heart due to a heart attack that persists > 40 days after the heart attack 2. severely reduced systolic function of the heart of any cause that does not improve after 3 to 6 months of pharmacologic therapy 3. personal history of sudden cardiac death with a persistent risk factor ICD implantation is not open heart surgery. It is a relatively quick procedure that is done by a cardiologist rather than a cardiothoracic surgeon.
      - plugin-baby 3y ago
        > personal history of sudden cardiac death with a persistent risk factor Personal history, or family history? Maybe this is a technical term? As a non-medic I can’t imagine there are many people who have a history of sudden death AND a persistent risk of it happening again.
        Calavar 3y ago
        Personal history. "Many" is relative. We are talking about a fraction of a percent of the general population, but if you are looking specifically at the population of people who have some form of long standing heart disease, it's not terribly rare. I don't work in cardiology specifically, and even so I encounter one or two patients a year who have had an ICD placed for reason #3. Persistent risk factors include things like or overgrowth of muscular heart tissue (which has dozens of causes, but the most common is severe, long standing coronary artery disease) or scarring of the heart after a heart attack. Persistent risk factors are not rare at all. The thing is that most people who fall into bucket 3 also fall into buckets 1 or 2. So in an ideal world they would have already seen a cardiologist and had an ICD placed before they ever had an episode of SCD. And of course many of those who do have SCD don't survive long enough to have an ICD placed. If you are interested in reading more, you can search for "secondary prevention of sudden cardiac death" or "secondary prophylaxis of sudden cardisc death." There are some good review articles available online.
- robbiep 3y ago
  The most common cause of sudden cardiac death is blocked left anterior descending artery. Generally this is unknown until it happens. It kills 250,000 Americans every year. It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA. Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.
  - moffkalast 3y ago
    Well as long as it only kills Americans, then the simple solution is to emigrate /s
  - gerdesj 3y ago
    Quite a lot of people/families can find £500-1000 for something important. The more that can, the cheaper it will become. AEDs/Defibs are just an expensive battery powered thing, that we just don't bother to discuss. With around an hour or less training, you can expect to be at least 10x more effective than the best CPR. CPR is horrible to deploy and very complicated but I will if I have no choice.
    - robbiep 3y ago
      They’re not equivalent though! An AED means your heart muscle has been absolutely trashed and will never be the same again. Plus, there’s still the issue of who actually needs an AED in their house, and if you know that, they’ve probably got an IED. Whereas if you can for the same cost have a scan after being reviewed appropriately, you can avoid the heart muscle trashing. That is nothing short of a miracle in terms of the extension of lifespan available
      - Aeglaecia 3y ago
        can you provide sources for AED trashing the heart muscle ?
  - tomatocracy 3y ago
- ericd 3y ago
  At $1k, it’s not a no-brainer, but it’s also not that expensive in the context of the risk it counters.
- dreamcompiler 3y ago
  More important: Call 911 and start CPR. 911 will always bring a defibrillator.
- stbede 3y ago
  They are about $500 on the cheap end if I'm not mistaken.
- gerdesj 3y ago
  I would say yes. Some of the answers here are referring to population stats and you are worrying about your particular circumstances, which is different. If someone you come across (family, stranger, whatever) keels over you need to, without proper medical knowledge, diagnose the issue and then administer appropriate treatment. Oh and could you do it within a couple of minutes please. CPR should be a last resort - it can be rather barbaric. A defib has a way better chance of success and won't break your ribs. A defib costs around £1000 or so. Hopefully that money is wasted.
- jdietrich 3y ago
  Generally not, for two reasons. Firstly, the people most at risk of cardiac arrest are unlikely to regain any meaningful quality of life after resuscitation. An AED might bring a very elderly and/or very ill person back from the dead, but more often than not they'll be just barely alive afterwards, which is not an outcome that most people would choose for themselves. People who are close to the end of their natural lives would benefit much more from serious conversations about end-of-life care than expensive gadgets and false hope. Secondly, most of the risk of cardiac arrest in younger and relatively healthier people is preventable. If you're not a frail elderly person but you consider yourself at risk of cardiac arrest, it's very likely that you're at least one of: obese, sedentary, hypertensive, poorly-managed diabetic. Before you go out and buy an AED, give some serious thought to what kind of state you'd be in after surviving a cardiac arrest and to whether you'd rather take meaningful action to improve your health now. Some people with cardiac abnormalities might be good candidates for an at-home AED, but they'd generally be better candidates for an ICD. A young and otherwise healthy person with a condition like LQTS, Brugada or severe HCM is at very real risk of sudden cardiac arrest, but the most likely trigger for that arrest would be strenuous physical exercise - something that most of us don't do in our own homes.
w10-1 3y ago
"only as a bridge to using electricity" The key point is that the AED (automatic electric defibrillator) will tell you if you have a shockable rhythm. Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions. Once you know this, you'll start tracking the last one you saw, and you'll find them more ubiquitous than you realized (and start advocating for one in your office). (And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)
- bsder 3y ago
  > (And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.) The problem is that this advice is situational. If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.
  - 7a1c9427 3y ago
    > If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest. Can you provide a reference or citation to this claim and practice? It is always much better to give "conventional CPR" (breaths and chest compressions) if suitably trained.[1] If not suitably trained you are more likely to a) perform CPR and b) do it effectively if not providing mouth to mouth breathing.[2][3] You can argue about the nuance of particular patient groups where there is potentially a statistically significant benefit of providing conventional CPR over compression only. Under no circumstances are there benefits to providing rescue breaths without chest compressions (as your comment seems to recommend). [1]: https://pubmed.ncbi.nlm.nih.gov/21273279/ https://pubmed.ncbi.nlm.nih.gov/21273279/ [2]: https://pubmed.ncbi.nlm.nih.gov/7726702/ https://pubmed.ncbi.nlm.nih.gov/7726702/ [3]: https://pubmed.ncbi.nlm.nih.gov/17420082/ https://pubmed.ncbi.nlm.nih.gov/17420082/
dreamcompiler 3y ago
EMT here. I've had exactly one save in my career from CPR without external defibrillation. That save happened only because of epi, and the patient was disconnected the next day because of brain death. So yeah, CPR is great but if you don't also have an AED, it's just theater. Caveat: If you call 911 [in the USA] they will bring an AED! So don't let the fact that you don't own an AED stop you from starting CPR. Just be sure somebody calls 911 also.
- Daub 3y ago
  Glad you said this. I have delivered cpr twice: once to my lecturer at school, the other to a stranger in the street. Both times they died. The experience of seeing people freak out when they saw their loved one dying completely devastated me out. Still now the memories are painful. I told my father, who worked in medicine. He recommended that unless there was a defibrillator nearby, I walk away next time I see someone having a heart attack.
  - JshWright 3y ago
    Just to be clear, a "heart attack" commonly refers to a myocardial infarction (part of the hear tis being deprived of blood, generally due to an obstruction in a coronary artery). Someone in the early stages of a heart attack will generally (but not always) experience chest pain/etc, anxiety, shortness of breath, etc. A heart attack can lead to cardiac arrest, where the heart stops beating effectively and the patient loses consciousness. Cardiac arrest is the scenario you're talking about (where CPR is indicated)
    - Daub 3y ago
      Thanks for the clarification.
- sacnoradhq 3y ago
  TLDR: 1. AEDs should be everywhere. 2. CPR isn't perfect but it works sometimes. ----- 1. Get an AED if you can and keep it near your home and/or vehicle. 2. Just don't expect complete recovery miracle revivals like the movies.
FireBeyond 3y ago
Same here. And yup. Early effective compressions and early access to defibrillation.

JumpCrisscross 3y ago

Would it make sense for households with those at risk of heart attack to invest in an AED?

rdmirza 3y ago
Even better is installing an implantable cardiac defibrillator (ICD) in those at high risk.
- noughtme 3y ago
  > at high risk. Before an event? I’m not sure what insurance would cover this. I don’t really want open heart surgery before I need it.
  - Calavar 3y ago
    Plenty of insurance plans cover ICD implantation because it is recommended by the American College of Cardiology for specific situations: 1. moderately to severely reduced systolic function of the heart due to a heart attack that persists > 40 days after the heart attack 2. severely reduced systolic function of the heart of any cause that does not improve after 3 to 6 months of pharmacologic therapy 3. personal history of sudden cardiac death with a persistent risk factor ICD implantation is not open heart surgery. It is a relatively quick procedure that is done by a cardiologist rather than a cardiothoracic surgeon.
    - plugin-baby 3y ago
      > personal history of sudden cardiac death with a persistent risk factor Personal history, or family history? Maybe this is a technical term? As a non-medic I can’t imagine there are many people who have a history of sudden death AND a persistent risk of it happening again.
      - Calavar 3y ago
        Personal history. "Many" is relative. We are talking about a fraction of a percent of the general population, but if you are looking specifically at the population of people who have some form of long standing heart disease, it's not terribly rare. I don't work in cardiology specifically, and even so I encounter one or two patients a year who have had an ICD placed for reason #3. Persistent risk factors include things like or overgrowth of muscular heart tissue (which has dozens of causes, but the most common is severe, long standing coronary artery disease) or scarring of the heart after a heart attack. Persistent risk factors are not rare at all. The thing is that most people who fall into bucket 3 also fall into buckets 1 or 2. So in an ideal world they would have already seen a cardiologist and had an ICD placed before they ever had an episode of SCD. And of course many of those who do have SCD don't survive long enough to have an ICD placed. If you are interested in reading more, you can search for "secondary prevention of sudden cardiac death" or "secondary prophylaxis of sudden cardisc death." There are some good review articles available online.
robbiep 3y ago
The most common cause of sudden cardiac death is blocked left anterior descending artery. Generally this is unknown until it happens. It kills 250,000 Americans every year. It would make the most sense for people above 50 with a family history of heart disease to have a CT coronary angiogram or for those above 40 to have a Cardiac Calcium Score to risk stratify for future CTCA. Distributing AEDs is infrastructure heavy and indiscriminate because you don’t know who actually needs one.
- moffkalast 3y ago
  Well as long as it only kills Americans, then the simple solution is to emigrate /s
- gerdesj 3y ago
  Quite a lot of people/families can find £500-1000 for something important. The more that can, the cheaper it will become. AEDs/Defibs are just an expensive battery powered thing, that we just don't bother to discuss. With around an hour or less training, you can expect to be at least 10x more effective than the best CPR. CPR is horrible to deploy and very complicated but I will if I have no choice.
  - robbiep 3y ago
    They’re not equivalent though! An AED means your heart muscle has been absolutely trashed and will never be the same again. Plus, there’s still the issue of who actually needs an AED in their house, and if you know that, they’ve probably got an IED. Whereas if you can for the same cost have a scan after being reviewed appropriately, you can avoid the heart muscle trashing. That is nothing short of a miracle in terms of the extension of lifespan available
    - Aeglaecia 3y ago
      can you provide sources for AED trashing the heart muscle ?
- tomatocracy 3y ago
ericd 3y ago
At $1k, it’s not a no-brainer, but it’s also not that expensive in the context of the risk it counters.
dreamcompiler 3y ago
More important: Call 911 and start CPR. 911 will always bring a defibrillator.
stbede 3y ago
They are about $500 on the cheap end if I'm not mistaken.
gerdesj 3y ago
I would say yes. Some of the answers here are referring to population stats and you are worrying about your particular circumstances, which is different. If someone you come across (family, stranger, whatever) keels over you need to, without proper medical knowledge, diagnose the issue and then administer appropriate treatment. Oh and could you do it within a couple of minutes please. CPR should be a last resort - it can be rather barbaric. A defib has a way better chance of success and won't break your ribs. A defib costs around £1000 or so. Hopefully that money is wasted.
jdietrich 3y ago
Generally not, for two reasons. Firstly, the people most at risk of cardiac arrest are unlikely to regain any meaningful quality of life after resuscitation. An AED might bring a very elderly and/or very ill person back from the dead, but more often than not they'll be just barely alive afterwards, which is not an outcome that most people would choose for themselves. People who are close to the end of their natural lives would benefit much more from serious conversations about end-of-life care than expensive gadgets and false hope. Secondly, most of the risk of cardiac arrest in younger and relatively healthier people is preventable. If you're not a frail elderly person but you consider yourself at risk of cardiac arrest, it's very likely that you're at least one of: obese, sedentary, hypertensive, poorly-managed diabetic. Before you go out and buy an AED, give some serious thought to what kind of state you'd be in after surviving a cardiac arrest and to whether you'd rather take meaningful action to improve your health now. Some people with cardiac abnormalities might be good candidates for an at-home AED, but they'd generally be better candidates for an ICD. A young and otherwise healthy person with a condition like LQTS, Brugada or severe HCM is at very real risk of sudden cardiac arrest, but the most likely trigger for that arrest would be strenuous physical exercise - something that most of us don't do in our own homes.

w10-1 3y ago

"only as a bridge to using electricity" The key point is that the AED (automatic electric defibrillator) will tell you if you have a shockable rhythm. Many modern AED's can be used by untrained people, so if you see a cardiac arrest, find the nearest AED and deliver it and/or follow its (brief) instructions. Once you know this, you'll start tracking the last one you saw, and you'll find them more ubiquitous than you realized (and start advocating for one in your office). (And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.)

bsder 3y ago
> (And if you are doing CPR, the breathing part is less important than the chest compressions. Blood flow is more important than oxygenation. But always/only follow current guidelines/training.) The problem is that this advice is situational. If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest.
- 7a1c9427 3y ago
  > If electrocution is what caused the cardiac arrest, it is much better to give breaths than compressions. The heartbeat system resets itself before the respiratory system. The problem is then that the heart is back, uses up all its energy reserves, but there is no oxygen to replenish and the heart goes back into arrest. Can you provide a reference or citation to this claim and practice? It is always much better to give "conventional CPR" (breaths and chest compressions) if suitably trained.[1] If not suitably trained you are more likely to a) perform CPR and b) do it effectively if not providing mouth to mouth breathing.[2][3] You can argue about the nuance of particular patient groups where there is potentially a statistically significant benefit of providing conventional CPR over compression only. Under no circumstances are there benefits to providing rescue breaths without chest compressions (as your comment seems to recommend). [1]: https://pubmed.ncbi.nlm.nih.gov/21273279/ https://pubmed.ncbi.nlm.nih.gov/21273279/ [2]: https://pubmed.ncbi.nlm.nih.gov/7726702/ https://pubmed.ncbi.nlm.nih.gov/7726702/ [3]: https://pubmed.ncbi.nlm.nih.gov/17420082/ https://pubmed.ncbi.nlm.nih.gov/17420082/

dreamcompiler 3y ago

EMT here. I've had exactly one save in my career from CPR without external defibrillation. That save happened only because of epi, and the patient was disconnected the next day because of brain death. So yeah, CPR is great but if you don't also have an AED, it's just theater. Caveat: If you call 911 [in the USA] they will bring an AED! So don't let the fact that you don't own an AED stop you from starting CPR. Just be sure somebody calls 911 also.

Daub 3y ago
Glad you said this. I have delivered cpr twice: once to my lecturer at school, the other to a stranger in the street. Both times they died. The experience of seeing people freak out when they saw their loved one dying completely devastated me out. Still now the memories are painful. I told my father, who worked in medicine. He recommended that unless there was a defibrillator nearby, I walk away next time I see someone having a heart attack.
- JshWright 3y ago
  Just to be clear, a "heart attack" commonly refers to a myocardial infarction (part of the hear tis being deprived of blood, generally due to an obstruction in a coronary artery). Someone in the early stages of a heart attack will generally (but not always) experience chest pain/etc, anxiety, shortness of breath, etc. A heart attack can lead to cardiac arrest, where the heart stops beating effectively and the patient loses consciousness. Cardiac arrest is the scenario you're talking about (where CPR is indicated)
  - Daub 3y ago
    Thanks for the clarification.
sacnoradhq 3y ago
TLDR: 1. AEDs should be everywhere. 2. CPR isn't perfect but it works sometimes. ----- 1. Get an AED if you can and keep it near your home and/or vehicle. 2. Just don't expect complete recovery miracle revivals like the movies.

FireBeyond 3y ago

Same here. And yup. Early effective compressions and early access to defibrillation.