CPR/AED - Sudden Cardiac Arrest Awareness

October is National Sudden Cardiac Arrest Awareness Month

As part of the National Cardiac Arrest Collaborative, The Parent Heart Watch and the Sudden Cardiac Arrest Foundation have initiated a campaign that educates people about the importance of the first three links of the chain of survival :

Call - Push - Shock

1) CALL - Call 911 and follow instructions of the emergency dispatcher
2) PUSH - Start CPR immediately by pushing hard and fast (approximately two compressions per second!).
   Remember that the victim is unconscious and not able to experience any pain while chest compressions are applied.
3) SHOCK - as soon as an AED becomes available, apply pads and follow instructions given by the AED

The probability of witnessing a sudden cardiac arrest might be low but with more than 350,000 out-of-hospital cardiac arrests (OHCA) per year in the USA ( Heart Disease and Stroke Statistics - 2018 Update ), it is high enough to invest a small amount of time and effort to learn CPR and how to use an AED. Approximately seven out of ten sudden cardiac arrests occur at home, which means that the victim could be a close member of your family. The American Heart Association (AHA) recommends basic life support (BLS) training for every citizen, including school children and teenagers, because application of immediate CPR and defibrillation has great potential to improve the survival rate of only ten percent (one out of ten) for out of hospital cardiac arrest (OHCA). It is estimated that immediate CPR including AED can double or triple the chance of survival.

Basic life support (BLS) training is provided by many organizations such as the American Heart Association, the American Red Cross, and others. Many parts of the BLS training can be done online, however, BLS has a practical part which involves learning and practicing how to perform high quality CPR and how to apply AED pads and execute an electrical shock.

All 50 states and the District of Columbia include the emergency use of an AED as part of their Good Samaritan laws which protect a bystander from civil liability for voluntarily helping a victim of sudden cardiac arrest. Even though modern AEDs are designed to be operated by an untrained layperson, it is better to learn the necessary skills ahead of time. It is recommended to refresh the CPR/AED knowledge and skills every year.


You can perform this short five-question test to assess your current knowledge about CPR and AED:

1) When should the AED be used for witnessed adult cardiac arrest?

a) AED should only be used after a 1-2 min period of CPR (chest compression)
b) AED should be used as soon as possible if immediately available
c) There is no need to apply CPR before arrival of the AED

2) What should the untrained lay rescuer do first when witnessing adult cardiac arrest?

a) Run and find the nearest AED
b) Call 911 or ask bystanders to call 911
c) Immediately provide compression-only (Hands-Only) CPR

3) Should the lay rescuer check the victim's pulse?

a) To correctly recognize a cardiac arrest the lay rescuer should check for a pulse first
b) The lay rescuer should not check for a pulse. A cardiac arrest can be assumed when an adult suddenly collapses or an unresponsive victim is not breathing normally.

4) Can adult AED pads be used in children 1-8 years of age?

a) Yes
b) No

5) Is it ok to use an AED on a victim's chest that is wet?

a) It is ok, however, wet clothing and excessive water should be removed as much as possible
b) It is not ok, because water on the chest always creates a short circuit between the defibrillation pads

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Home AED

For some people it may make sense to purchase a home AED because of the individual's risk of sudden cardiac arrest. Here are some key points to consider:

• Living alone or to live with somebody who cannot act quickly to operate an AED means that an AED at home would not be useful.

• The overall cost to purchase, install and maintain an AED at home can be high. Health insurance companies do not normally pay for an AED.

• High risk of sudden cardiac death (sudden cardiac death)
If you have a heart condition that comes with a high risk of sudden cardiac death you are more likely to have an implantable cardioverter-defibrillator (ICD) implanted than using an AED at home. Sometimes, a wearable cardioverter-defibrillator (AED vest) is a temporary solution.

• It is not advisable to keep an AED at home if your health condition has reached a stage where resuscitation from sudden cardiac arrest would not be helpful. Sometimes the very personal decision not to prolong life because of an incurable or painful condition can be a reason not to allow resuscitation anymore.

In case the decision has been made to install an AED at home, it is important to inform family, friends and visitors about its presence, location and usage. Ideally, everybody involved should learn how to use it. In addition, an AED, like any technical device, requires some technical knowledge and maintenance. It is good practice to register the AED with the manufacturer to receive safety alerts and recall notices.


Correct answers and comments:

1b: It is reasonable to assume a shockable rhythm for a witnessed adult cardiac arrest. After calling 911, the lone rescuer should retrieve the AED if it is nearby and easily accessible. Otherwise, it is better to immediately start and continue CPR until help arrives.

2b: The first three links of the chain of survival describe three actions in the following order: Call 911 - Start CPR - Use AED. The first step for a lay rescuer is always to call for help. The second step is hands-only CPR.

3b: Usually, untrained lay rescuers have difficulties to check for a pulse. In a victim that is unresponsive and not breathing normally, it is better to immediately start CPR.

4a: Even though young children are less likely to have a shockable rhythm, it is acceptable to apply adult defibrillation pads to a young child's chest if pediatric electrodes are not available. The AED will then detect whether a shockable rhythm is present. Especially for small children, the adult size AED pads should be placed on the front center of chest and in the middle of the child's back. Pediatric size AED pads must not be used in adults!

5a: After removing clothing, ideally the chest should be clean and dry to enable good contact of the adhesive defibrillation pads with the chest. Some AED kits come with a towel for removal of water.