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Journalism of Courage
A 50-year-old woman from Pune recently experienced chest pain while on a pilgrim trek. Unable to breathe properly, she stopped walking and almost collapsed as she went into a cardiac arrest. Fortunately, the Maharashtra Emergency Medical Services (MEMS) personnel accompanying the 21-day pilgrimage responded on time and revived her. In such situations, an automated external defibrillator (AED), the lightweight, portable device, becomes a life-saver as it delivers an electric shock through the chest to the heart when it detects an abnormal rhythm and changes it back to normal. With an increase in cases of sudden cardiac arrest as Indians become more prone to cardiovascular issues, we need AEDs in our public places and basic training to use them, says a Lancet Commission investigating sudden cardiac deaths.
“AEDs save lives. A person’s chance of surviving drops by seven per cent to 10 per cent every minute a normal heartbeat isn’t restored. So immediate CPR (cardio-pulmonary resuscitation) and AED use can double or triple the person’s chance of survival. AEDs are intended for use by the general public (lay responders) and can make a difference at hotels, playgrounds, shopping malls and other public places. Usually, non-medical personnel, such as police, firefighters, flight attendants and security guards are trained to use AEDs,” says Dr Dnyaneshwar Shelke, Chief Operating Officer, BVG-MEMS. In fact, the new Lancet Commission of 30 international experts has suggested maximum access to and awareness of AEDs in public places as part of their recommendations on a multidisciplinary strategy to avoid sudden cardiac arrests and deaths. The estimated annual burden of sudden cardiac deaths worldwide is currently about five million cases every year. This amounts to more than half of all cardiac deaths and could account for up to 20 per cent of overall mortality.
What is sudden cardiac death?
Conventionally, the most frequently used definition for SCD is an out-of-hospital, sudden natural death presumed to be a result of underlying cardiac causes and disturbances in heart rhythms. Its onset is rapid, with the affected person collapsing within an hour of reporting discomfort. The word sudden in SCD or SCA refers to a mode of death rather than a specific cardiac disease and the triggers are usually a supposed high rate of arrhythmic origin, say Eloi Marijon (chair) and Kumar Narayanan (deputy chair), from the Paris Sudden Death Expertise Center (Paris-SDEC), Paris, France and Medicover Hospitals, Hyderabad, who are among the 30 international experts in the Lancet Commission that did the study.
Why are life-saving devices vital in cardiac arrests?
Getting a portable defibrillator can make a difference between life and death. “Any case with cardiac arrest has a shockable or non-shockable rhythm. Thus, identifying the right rhythm and providing the immediate first line of treatment is of utmost importance. An AED provides automatic commands identifying the appropriate rhythm in case of shockable or non-shockable. Anyone can use it in cardiac arrest situations and help the victim by following the commands provided by the machine,” Dr Shelke says. AEDs can be placed at all public areas, even in schools and colleges and can be used by older kids and teachers.
Survival after sudden cardiac arrests is lower than 10 per cent
The Lancet Commission found the less than 10 per cent survival rate from sudden cardiac arrest in most parts of the world to be unacceptable. “Sports-related cases have a survival rate of up to 70 per cent given the swift interventions but there are huge disparities in survival rates between geographical locations,” say experts. That’s why Dr Prasad Rajhans, chief intensivist and pioneer of emergency medical services in Maharashtra, says training in CPR should be introduced at the school level from Class VIII. He has been instrumental along with Symbiosis International university to start a post-graduate diploma in emergency medical services that focusses on life saving skills and knowledge of pre-hospital care. “We even train non-medical personnel and it is important to train police, autorickshaw drivers among others who usually are the first responders,” he adds.
But availability, cost can be a concern
However, according to cardiac surgeon Dr Vijay Natarajan, while AEDs installed at airports have been used to save lives, there should be maximum access to AED devices in public places with awareness about their availability. “Smaller hospitals and nursing homes must also be regulated for availability of advanced cardiac life support facilities. The equipment is expensive, costing upwards of Rs 60,000 and single-use AED chest pads are expensive. However, on the brighter side, AED prompts are also being developed in local languages for easier applications,” he says.
Meanwhile, Lancet Commission experts feel there has been little innovation in AED devices to the point that their communication and tracking technology is outperformed by most mobile phones, toys, and everyday household appliances. Public-access defibrillator programmes are dependent on manual steps to locate the devices, keep track of when they are moved, and check whether they are ready for use (sufficient battery, pads within expiration date, etc). Important resuscitation data from these AEDs are often not stored, and when theoretically available, the data are difficult to extract and convert to uniform formats. Public-access defibrillation programmes should be complemented with public awareness campaigns, CPR cum AED training and AED maps linked to EMS for telecommunicators to direct lay responders to the nearest AEDs, suggest experts.
