Unless you’ve been living under a rock you have probably seen television shows where doctors revived a patient whose heart had stopped. If you’re old enough, you probably even know people who have suffered a sudden cardiac arrest. My grandfather had one, but I know of numerous others. Something they all have in common is they’re all dead. About 85 to 90 percent of people who suffer a sudden cardiac arrest do not survive, because they don’t get help in time. According to The New York Times:
…minutes count when reviving someone in cardiac arrest. For every one-minute delay in resuscitation, the likelihood of survival falls by up to 10 percent.
It’s actually worse than that. Once your heart stops irreversible brain damage occurs within three to six minutes, with death occurring soon afterward. The American Heart Association reports brain damage is very common in cardiac arrest patients who’ve been resuscitated.
The majority of cardiac arrest survivors have some degree of brain injury and impaired consciousness. Some remain in a persistent vegetative state. Determining the survivor’s prognosis and deciding whether to treat or withdraw care is complicated and based on many variables (many of which haven’t been thoroughly studied).
The difference between death, disability and a return to normal life is generally how fast your heart begins beating again. Mouth-to-mouth resuscitation is not enough if someone’s heart stops for more than a couple minutes. Mouth-to-mouth buys time, it doesn’t restart the heart. In addition, if mouth-to-mouth is not started immediately, the defibrillator won’t work either, according to the Sudden Cardiac Arrest Foundation. A defibrillator needs to be used immediately. That is why a lot of public places have defibrillators available. These include airports, schools, malls, grocery stores, fire stations and numerous other places. However, you can buy a personal defibrillator to keep at home. These smart devices are easy to use, require no training and are highly effective if used immediately.
One problem with home defibrillators is they cost $1,000. Another is once in the home they are unlikely to be used. A third reason, which I will get to below, is they’re often not used quickly enough.
The price is not the only thing that gives some specialists pause. The odds are so stacked against a dramatic save that it has proved impossible to show that personal A.E.D.’s make a difference.
An estimated 1,000 people a day in the U.S. have sudden cardiac arrests, in which the heart stops beating and the person is technically dead. But that represents a minuscule portion of the American population.
A large research study of 7,001 people, who had previously had heart attacks, were randomly assigned AEDs or to a control group. Despite being a elevated risk population, and a relatively large study group, it was difficult to find evidence that the AEDs made a difference. Having an AED available didn’t always help because sudden cardiac arrests didn’t always happen at home or happened when nobody else was around to witness them. The New York Times talked to the co-founder of the Sudden Cardiac Arrest Foundation, which promotes awareness of the condition. She owns an AED but when her mother collapsed in the bathroom while on vacation nobody noticed she was missing until it was too late. Interestingly, many of the cases of sudden cardiac arrest that I’m aware of involved a bathroom. It’s a natural place to go if you’re feeling sick. It’s also the last place friends, family and relatives are likely to barge in if you don’t reappear quickly.
One comparison is to think of a personal defibrillator like a fire extinguisher. You hope to never need one but it’s nice to have when you do. The New York Times spoke with Dr. Abella, who owns an AED:
But think of an A.E.D. like a fire extinguisher, said Dr. Benjamin Abella, an emergency medicine specialist at the University of Pennsylvania. You might never use it, but having one might one day save a life.
We have a fire extinguisher at home, but I’d be hard pressed to find it in a hurry. The other day I came across it while installing a new filter on our water system. I had forgotten we owned one. The problem with the fire extinguisher analogy is that an AED requires two people, the one having the sudden cardiac arrest and another person to witness the arrest. Sudden cardiac arrests are rare but when they occur it’s not always while you’re at home sitting with your wife watching television. Sometimes you’re out running errands. Maybe you’re in the back yard pulling weeds. Maybe you’re in the bathroom after getting up feeling sick at night while your wife is in bed asleep. Or maybe you’re in your upstairs office while your wife is in her office downstairs. You may even be on vacation and didn’t want to pack a 9” by 11”, 3.4 inch thick, seven-pound device in your luggage.
Small defibrillators made for home use are not particularly expensive but also not a trivial expense either. Experts can’t really point to convincing evidence you should own one. But by all means, ask your doctor whether a personal, automated external defibrillator (AED) is right for you. It probably isn’t though.