In January 1974, my father, who was then 65 years old, died suddenly. He had had a silent myocardial infarction five years previously, followed by mild angina easily controlled. My mother witnessed the death and immediately called emergency medical services but the response time was prolonged and my father could not be resuscitated.
My father was mild diabetic but otherwise healthy and vigorously active. He probably could have been saved had there been a prompt defibrillation. Who knows, he might still be alive. My mother is alive and well.
Several years ago I learned from Professor Michael ORourke in Sydney, Australia, that Quantas Airlines had inaugurated the use of defibrillators on all of their overseas flights. It is my understanding that several lives have been saved since that happened. A few American airlines, for example, Northwest, American, and Delta, are providing defibrillators for their airplanes. I applaud this decision and I suspect that several lives will be saved.
More recently I have learned that companies are now configuring defibrillators simple enough to be used by a person with minimal training. Recent breakthroughs in automatic external defibrillator technology have made this possible. These light-weight and relatively inexpensive devices are available now.
These companies are recommending that defibrillators be placed in the homes of patients who are at high risk for sudden cardiac death.
It seems to me that the spouse or close live-in relative of a patient with high risk for sudden cardiac death, for example, patients with ulna pectoris, recent myocardial infarction, patients on the cardiac transplant list, and so forth, could be easily acne to use an automatic external defibrillator.
It has been estimated that 1,000 persons per day die of sudden cardiac arrest. I assume that a fair percentage of these cardiac arrest victims could be resuscitated, since many of these patients have had previous symptoms and are known to be at high risk. In fact, it has been estimated that approximately 450-500 people per day who have had previous symptoms experience sudden cardiac death. It is estimated that among people who have had a previous heart attack, sudden cardiac arrest occurs at 4-6 times the rate of the general population. Patients diagnosed with heart failure are 6-9 times more likely to have a sudden cardiac arrest than the general population.
In order for an automatic external defibrillator to be problem free and used by a lay person, it must be designed so the abnormal rhythms can be recognized simply and the shock can be delivered for the appropriate rhythm abnormality, that is, ventricular fibrillation. The device must recognize other rhythms and indicate to the rescuer that a shock should not be delivered.
Those of us who have worked in cardiac catheterization and electrophysiologic laboratories recognize that the treatment of ventricular fibrillation is not cardiopulmonary resuscitation (CPR) but rather prompt defibrillation. CPR obviously needs to be performed until defibrillation can be accomplished, but should be of short duration.
I think the time is right to make the American Heart Associations concept of earlier defibrillation an attainable goal. The earlier the better.
I must admit that if I had an ischemic cardiac event, I would like to have one of these devices in my home and have my wife trained in its use. The President of the United States travels with a defibrillator. We pay his salary. If the concept is good for one of our employees, it should good enough for all of us. I believe the time has arrived to consider home defibrillation devices.
C. Richard Conti, M.D.