Sept. 19, 2000 — The headlines are everywhere: Flight Attendant Saves Life of Man Having Heart Attack at 30,000 Feet … Policeman Uses Device to Save Grandmother From Cardiac Arrest … But the favorite story of Bill Brown, president of the National Registry of Emergency Medical Technicians, is this one. Brown tells WebMD, “These devices, called automated external defibrillators, are found in most casinos. At a casino in Las Vegas, casino attendants used one on a man playing the slots who apparently suffered a heart attack. After they resuscitated him and had him on the stretcher to take to the hospital, he argued with them about going. He said, ‘This is the first time I’ve won anything at a casino. I’m alive, aren’t I? Let me go back to my machine!'”
There’s no question that these defibrillators saved the lives of people in these circumstances, but do these success stories mean the devices should be placed in more public places? Organizations such as the American Red Cross and the American Heart Association (AHA) say yes, but a debate on the issue rages on the pages of this week’s Journal of the American Medical Association.
The need for more accessible defibrillators is clear. According to the AHA, sudden cardiac death or cardiac arrest strikes about 350,000 Americans each year — nearly 1,000 per day. Most die before reaching the hospital. A lethal, irregular heartbeat is the most common culprit. Death usually follows unless responders are able to shock — or defibrillate — the heart into a normal heart rhythm within five to seven minutes. The AHA estimates that 100,000 or more deaths could be prevented if defibrillators were more widely available to first-line emergency responders such as police officers and fire department personnel.
Mickey Eisenberg, MD, PhD, author of one of the new articles, argues that a similar declaration was made about CPR — cardiopulmonary resuscitation — when its tremendous life-saving possibilities were recognized in the 1940s and 1950s. “When CPR was first developed, it was limited to [use in] the operating room and only physicians practiced it,” Eisenberg tells WebMD. “As it became apparent that the technique both saved lives and was easy to perform, more and more people were trained in it and it became a lay technique.
“The same thing is happening with automated external defibrillators. … As the devices are getting smaller and simpler to use, someone can successfully operate one with about an hour or less of training,” he said. In fact, a study released last year suggests that even children can learn to use the technique after proper training.
The devices of today are practically foolproof. Here’s how it works: If a person is unresponsive and not breathing, a trained person puts the electrode pads on the chest. Since the device uses voice prompts, assesses the heart beat itself, and then delivers a shock, there’s little chance that they will be used inappropriately, says Eisenberg, professor of emergency medicine at the University of Washington Medical Center in Seattle.
Because of this, Eisenberg says the FDA should deregulate the devices and allow them to be sold directly to consumers. He says this would bring the cost of the devices down and develop a kind of natural experiment, where the impact of defibrillators could be assessed.
Arthur Kellerman, MD, MPH, co-authored the dissenting opinion. “I think [defibrillators] are wonderful devices. However, their marketing has gotten way ahead of the scientific data related to their effectiveness. … As far as putting them into the home is concerned, at this point there’s simply no good reason to do so,” Kellerman tells WebMD.
Kellerman points to a current study looking at the impact of defibrillators in public places. “In my mind, it makes all the sense in the world to wait and look at [the results of] a study like this before communities and individuals all across the country purchase these devices to stick in closets and under the couch. It’s also worth emphasizing that the best strategy for avoiding deaths from heart attacks is not to have one. Prevention is still the best medicine,” says Kellerman, who is professor and chairman of the department of emergency medicine at Emory University in Atlanta.
Brown agrees with Kellerman, saying, “I want to see more research before the American public puts [defibrillators] everywhere, which is likely to be very expensive and will no doubt exceed their value once maintenance costs are figured in and balanced against lives saved. I think there is a place for them in airplanes, casinos, police cars, and fire trucks, but its just speculation at this point that defibrillators will help save lives if they are placed in office buildings and the like.”