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Just over a decade ago, hospitals around the country began spending millions of dollars to buy automated defibrillators to save the lives of more patients who go into sudden cardiac arrest. The purchases were spurred by a recommendation from an American Heart Association committee that decided the new equipment would bring patients speedier emergency medical help.
Courtesy of Lilly Fowler / Fair Warning
A dual-mode defibrillator, capable of automated or manual operations.
But today the costly equipment switchover increasingly seems to have been a mistake. The latest, most extensive research suggests that the new gear, now found in nearly all U.S. hospitals, saves fewer lives than the old, lower-tech defibrillators.
By one estimate, the shortcomings of the automated equipment mean that close to 1,000 more hospital cardiac arrest patients die every year in the U.S.
A FairWarning review of the decision that prompted the switch reveals that the pivotal committee recommendation was made without clinical research answering a crucial question: Did the new devices, when used in hospitals, produce better results than the old equipment?
Instead, committee members endorsed automated defibrillators largely on the unproven theory that they would improve response times because even less-skilled hospital staffers could operate them.
“I think they jumped the gun,” said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic in Ohio. “Why would we want to dumb things down to a level of having a machine do the thinking for us?”
Or, as Dr. Roger D. White, who was on a heart association subcommittee that provided expert advice on automated defibrillators in 2000, put it: "We just assumed that we were going to make a difference."
White, an anesthesiologist at the Mayo Clinic in Rochester, Minn., added, “What we thought would work, hasn't worked so far."
What’s more, more than a quarter of the members of the heart association committee that recommended the automated defibrillators had business ties with manufacturers of the devices.
The heart association said its policies in place at the time “prevented undue industry influence on its guidelines recommendations.” A science editor for the heart association, Mary Fran Hazinski, who was a member of the key decision-making committee in 2000, added that the recommendation was “very carefully considered and based on the evidence available at the time.”
Move made sense, in theory
In theory, getting the new defibrillators made sense. Committee members were alarmed about the amount of time it took at many hospitals to provide shocks to patients who went into cardiac arrest. A big part of the problem was that, although critical care nurses typically knew how to work the traditional defibrillators, many nurses in general wards did not. The devices, using pads placed on a patient’s chest, deliver a shock that can restore a heart’s normal rhythm.
The new equipment, which provides step-by-step voice instructions, figured to be easier for more people to operate.
And the cost was modest, by hospital equipment standards. The basic models of the automated devices begin at around $1,600. The dual mode equipment -- which can run automated or manually, like the older generation devices – can cost more than $10,000.
In crafting the recommendation in 2000, the committee itself acknowledged that research had not yet proven that the new devices improved survival rates for hospital patients. Instead, committee members said, they acted based largely on evidence that the simpler version of the new devices – often known as automated external defibrillators, or AEDs – saved lives in non-hospital settings such as airports.
In its recommendation, the committee scolded hospital administrators for failing to stock up on the new generation of defibrillators. “An unacceptably high percentage of hospitals,” the heart association’s 2000 guidelines read, “have not made significant attempts to improve the availability” of automated defibrillators.
Purchases of the devices zoomed after those guidelines were released. U.S. hospitals bought close to 100,000 of the basic automated models between 2000 and 2010, according to the consulting firm Frost & Sullivan.
The firm projects that sales of those basic models to hospitals will keep rising 9 percent to 12 percent annually through 2013.
Soon after the recommendation came out, however, product quality flaws began to emerge, a major problem even if it wasn’t the biggest issue hospitals faced with the defibrillators.
An assessment published in August in the Annals of Emergency Medicine found that more than 1,000 cardiac arrest deaths between 1993 and 2008 were connected to the failure of the automated devices in hospitals and other settings. In many instances, the devices failed to turn on, or they turned off unexpectedly. Manufacturers have recalled tens of thousands of the devices.
An industry group, the Advanced Medical Technology Association, said that companies are working with the U.S. Food and Drug Administration to improve the safety of the devices. But it added that the agency “continues to advocate the use of external defibrillators and is not recommending any change to current use practices for these devices.”
Related story: Bad batteries in defibrillators tied to cardiac deaths
For hospitals, an even worse problem than the equipment failures is that automated defibrillators often appear to be poorly suited for many of their patients. That issue was spotlighted by a broad analysis completed last year by Dr. Paul S. Chan, a cardiologist with St. Luke’s Health System in Kansas City, Mo.
His critical study, funded by the heart association and published in the Journal of the American Medical Association, tracked 11,695 patients in 204 hospitals who suffered cardiac arrest between 2000 and 2008.
Cardiac arrest causes the body’s electrical pump, the heart, to abruptly lose function, much like a house that suddenly loses power when struck by lightning. In the population at large, an electrical shock, or defibrillation, often is the only cure.
Monitoring crucial for in hospital use
But Chan noted that hospital patients who suffer cardiac arrest tend to be sicker than the average victim, and may have complex medical problems that are interfering with their heart. They are more apt to suffer “non-shockable” cardiac arrest – in other words, episodes that can’t be fixed with the electrical shock delivered by a defibrillator.
To treat those patients, a defibrillator still may be needed to provide readings on how a patient is responding to CPR. Ordinarily, CPR is applied, and then periodically interrupted so that the defibrillators can provide those crucial readings.
A big drawback to the automated machines is that they require longer interruptions – or “hands off” periods – to make those readings, and the lost seconds of CPR can make the difference between life and death in some cases.
On top of that, Chan said, statistics show that hospitals equipped with the new defibrillators have failed to achieve one of the major aims of buying the equipment – delivering the first shock to patients in cardiac arrest more quickly. The hospitals failed to foresee that many less-skilled nurses apparently find it intimidating to operate defibrillators, and balk at using even the simpler, newer machines.
They have "psychological and emotional” barriers, said John Stewart, a Seattle-area nurse and resuscitation specialist.
All told, Chan calculated that cardiac arrest patients treated at hospitals with automated defibrillators survived only 16.3 percent of the time. By comparison, the survival rate was 19.3 percent over the same time period when hospitals used manual equipment to shock patients.
Given that automated defibrillator equipment is used in about one in six of the approximately 200,000 annual cases of cardiac arrest in hospitals, the lower survival rate would translate into about “965 fewer patients potentially who may be alive” every year in the U.S., Chan said.
For Dr. Gordon Guyatt, a health policy expert at McMaster University in Hamilton, Ontario, the bottom line is clear: “It is extremely unwise to be spending all this money on intervention that may not prove to be of benefit, and may actually be doing more harm than good.”
Manufacturers and others counter that research shows that patients at individual hospitals, particularly those with a shortage of staffers with the training to use manual defibrillators, benefit from the automated devices. They say that the advantages of automated devices will grow as new, faster-working versions come out.
“I think it would be a mistake to throw out a blanket statement hospitals shouldn’t be using an AED,” said Dr. Dana Edelson, a board member of the nonprofit Sudden Cardiac Arrest Foundation and an assistant professor at University of Chicago Medical Center. “It depends who is there in the middle of the night.”
Interviews and documents show that at least three people on the 11-member committee that recommended the in-hospital use of automated defibrillators had ties to device manufacturers:
- Dr. Richard E. Kerber, chair of the committee and currently a University of Iowa medical school professor, said in an interview that, at the time, he was receiving defibrillator research support from Agilent Technologies, which used to make the devices.
- Dr. Peter J. Kudenchuck, committee vice chair and a medical school professor at the University of Washington, disclosed at the time that he had conducted research for Medtronic.
- Dr. Richard O. Cummins, a science editor for the committee and a professor of emergency medicine at the University of Washington, said in a 1995 article published in the Annals of Emergency Medicine that he had received research support from Physio-Control, Zoll and other makers of automated defibrillators. He also disclosed he had received honoraria and travel and accommodation compensation from automated defibrillator manufacturers for participating in conferences. Cummins was also compensated for testifying for Laerdal Medical Corp., another automated defibrillator maker, in a federal court trial.
Kerber and Cummins said they no longer have records indicating how much money they received from the industry, and Kudenchuck failed to respond to repeated email and telephone requests for comment.
In an email, Cummins dismissed the idea that financial considerations could have influenced his thinking. "Certainly didn't occur with me ," he said, adding that "I still endorse the idea."
Most of the financial support for the heart association’s 2000 emergency cardiac care conferences also came from makers of automated defibrillators. The association declined to indicate how much it received from the companies.
Committee members, however, say the impetus for recommending the automated defibrillators stemmed from the sometimes prolonged delays in reaching cardiac arrest victims, documented by a 1995 analysis, as well as other studies showing that more nurses could be trained to use the automated devices.
The heart association, which updates its guidelines every five years, will have the chance to revisit the issue in 2015. The association isn’t offering any clues on whether its posture will change, but indicated that it doesn’t consider the Chan study persuasive enough by itself to warrant revisiting the issue.
“Guidelines,” the association said, “are based on the entire body of evidence.”
FairWarning is a nonprofit, online news organization focused on safety and health issues.
Leave a Comment:
I understand the theory, but with all the recalls I would be very leery if hospitals used these machines to replace people monitoring a patient because of budget cuts. I know and have experienced malfunctioning auto blood pressure machines practically crushing my arm because it was either malfunctioning or was not placed correctly on my arm. It will keep squeezing my arm until my pulse stops, but if it is placed wrong, it won't take an accurate reading.
If they (nurses) can't set up that simple machine correctly, a defibrillator will cost someone's life if it is set up wrong. So hospitals spends $10,000 instead of paying for a few nurses to save money, and people die as a result. That is just plain wrong no matter how you look at it.
These machines are dangerous.
Give me a well-trained doctor/nurse and just the simple old-style defibrillator any day.
.
YOUR STATEMENT IS DANGEROUS! Here are the facts... without AED's as a part of early response treatment (within 6-10 minutes of cardiac event), most individuals don't make it to emergency rooms.
Get your facts straight before you spout-off on a national forum like this!
@Dennis in OC:
Actually your statement is the dangerous one. The controversy is not over the use of AEDs by bystanders in outpatient Cardiac Arrest. The question here is whether AEDs have a use in HOSPITAL settings where patients in Cardiac Arrest have a much more complicated spectrum of co-morbidities than out of hospital cardiac arrrest victims.
Nowhere in the article is it stated that AEDs are of no use on the PROPER SETTING.
"Get your facts straight before you spout-off on a national forum" is excellent advice.
Thanks Doc, nice of you to generate the reasoned, well thought out, courteous response to 'Mike'
Dennis, please learn to read before commenting on a forum and wasting other's time. THE ARTICLE IS ABOUT A HOSPITAL ENVIRONMENT! Speaking as Field Paramedic, the old fashion defibrilators are far more effective as they allow greater control by the user, if they know what they are doing. AED's are dumbed down so that the average person can use them, which is great when necessary, but disruptive and time consuming when not. I do not understand the logic that went into this decision.
So.... Is you're cup half empty or half full?
The above stated facts are:
-100,000 new AED have been purchased.
-200,000 annual cases of cardiac arrest in hospitals.
Therefore an AED has been used in 16.9% or 33,800 arrests and has saved the lives of 16.3% or 5,509 people.
You have a problem with this because ?
Thank Goodness ObamaCare will save us all. More electronic defibs and less doctors! I guess you can train a PA to do a doctors job......
Hardlyhear -
Interesting "factoids", but they have nothing to do with the study.
From the study data...
110,132 Total patients
- 78,294 Excluded (ICU, ED, OR, non-patient care area)
- 14,185 Excluded (No AEDs in hospital at all)
- 5,958 Excluded (No AED implemented yet)
11,695 Included in the study.
Of those...
Using AED 734/4,515 = 16.3% survived
Not using AED 1,383/7,180 = 19.3% survived
In other words, survival with the AED was 15.5% WORSE than without.
This finding was p
What this study is highlighting without actually putting into words is that evidenced based practice in healthcare is seriously lacking. There are so many things that are done in the hospital and other healthcare settings because it sounds good to the uneducated consumer. It looks good to throw good money after illconcieved plans, because, after all, people want to see where their healthcare dollars are going even if the things that are being done make the original problems worse.
The lack of evidenced based practice is expensive, time consuming, and deadly. Demand eveidenced based practice for your care!
As a certfied Biomedical Equipment Technician, I have had conmcerns over AED's since they were introduced. The AED relies on information it recives through its patient transducers (usualy the defribilator paddles or pads themselves) to decide wether or not delivering a shock to the patient is advisable. The first problem with this is that the information provided to the machine can be faulty due to bad/degraded cables, poor contact with the patient, and any number of unforseen real-life issues. Second, there is no way to simulate every possible patient condition to verify that the devices algorythm is in fact reacting appropriately to the information it is receving from the patient. Thirdly, as the operator now is likely an unskilled or semi-skilled individual, they are not in a position to make a judgement about wether or not the machines reccomendation is valid or not. Are these devices usefull in places like malls and airpoirts where we cannot expect ACLS (Advnaced Cardiac Life Support) personnel to be available? Absolutley. They are not aceptable in a hospital environment. Nothing replaces well-trained HUMAN medical staff.
Health care in America - it's all about the money.
Damed if you do.. damed if you don't..
Of course, there's also substantial research that automated ECGs do a better job than cardiologists, so there couldn't possibly be an old-boys reactionist thing going on here, could there.
Eerything in the USA is all about cooporate greed!
not only in the USA, but here it goes uncontrolled...very little oversight, lots of conflict of interest!
Have any of you people been to Europe? You can't even file a product liability suit in Germany--no lawyer will take it. Or how about England just deciding to "forget" the colossal misdoings of Westland because its industrial returns were in the national interest. "Poof". Criminals--hard-core corporate thugs--go free and are free to act with impunity.
Learn a bit about the world before you start trashing your home. The US is just not that bad.
Yeah, let's spend money! We are in America and can waste as much as we want since there is no control in place. What a country!
cynic,
any evidence for your outrageous claim that automated reading of an EKG is better than a CARDIOLOGIST? Thats laughable and plain dumb. I correct those readings all day long
Show me that study--i doubt it exists
yellow journalism at it's finest
every RN at the hospital I work at is required to have current ACLS certification, and must know how to operate a BIPHASIC defibrillator - not an AED as described above. my hospital does not even own AEDs - but they do have about fifty Heartstart XL devices, that cost $30,000 each. there is no cost savings going on here - just the highest quality of emergency defibrillator technology available. don't like the changing economics of healthcare? you are welcome to move to Canada.
good for you and your hospital, but according to a study in the Nov. 17 issue of the Journal of the American Medical Association (Vol. 304, No.19, Nov. 17, 2010)...
pubs.ama-assn.org/media/2010jer/1115.dtl#1
Wow, so you're saying that since your situation is different than the majorities, that they are full of it? That does not speak highly of your ability to have abstract thought.
If you read the study design, this was done in NON-CRITICAL CARE AREAS ONLY (no ICU's, ED/ERs, ORs, etc. - these areas were excluded). This was also an observational "cohort study" from a registry - one of the weakest forms of clinical studies. The authors admit this...
Automated External Defibrillators and Survival After In-Hospital Cardiac Arrest
JAMA. 2010; 204(19): 2129-2136.
This is what happens when you think you have a good (maybe even great) change in care (in this case' a medical device).
This is the reason for "blinded" (to the analyzer") randomized controlled trials - conventional treatment vs. proposed treatment (to remove the effect of "confounding" by design). This is not "unethical" IF the Investigator believes that the two treatments could be equally effective. (This is called "equipoise") Randomized controlled trials are expensive, and often difficult to do. In this case, it would have been unethical to try this in the same hospital, but perhaps not in multiple hospitals where patients can me "matched" for risk factors (case-control study), or in the same hospital with a "cross-over" study.
In the history of medicine, there have been hundreds (thousands) of "reasonable" treatments that have been abandoned as they were ineffective or downright harmful. (Here's one from the end of the 18th through well into the 20th century - X-ray treatments to the neck and upper chest for an "enlarged" thymus gland (part of the immune system) in small children ("status thymolymphaticus') thought to interfere with breathing. This was found to be a perfectly normal finding on chest X-rays in small children. As a result, there was a huge spike in thyroid cancers as a result. The pratice was abandoned.)
Bottom line - do NOT overgeneralize more than you actually know (a very common problem in cases like this where a "paper" hits the "media" in sound- or word-bites.
Correction - 19th through well into the 20th century...
Better stick to what you're good at heart doc, and not commenting on news articles. It's hard to make out your point in that rambling mess. So the economics of healthcare are changing? Seems like it's more of the same to me. Accelerating health care costs have been the norm for decades.
I agree. We got more cost with these and nothing additional in return. Sounds like par for the course when talking about health care. Maybe not all hospitals used them but as a whole you can see the results for those that did. Once again greed, and I'd say conflict of interest, won out over common sense. Maybe someday we can reverse this trend....It is time.
It is time: We got...? Wow. Glad you can string a sentence together properly when commenting on a medical article that you probably didn't even fully understand.
ug1 -
He's a heart doc, and clearly standards at his hospital
are not the usual. ACLS is Advanced Cardiovascular Life Support. The standard at his hospital exceeds the minimum requirement from the Joint Commision.
We are entitled to "comment on news articles" when the "news" comes from a "peer-reviewed" medical journal article and the "sound-bite" conclusions are taken out-of-context.
Read the article yourself (it's free, and I mean the WHOLE article). Google PUBMED and enter the reference:
JAMA. 2010; 204(19): 2129-2136
(BTW - PUBMED is your tax dollars at work)
maeg - thank you grammar police. Your right, let some slang, poor grammer in there I apologize. "We have..." better now??? Now can you actually comment on or reply to my comment? Did you understand the article? Anything beside the grammar remark? I sometimes may get into it a little bit with others, possibly be a little harsh (though I try to save it for only the most ignorant and what I feel are deserving comments), and sometimes keep my comments short, but never the less they are how I see it, they are my opinion, I do try to be respectful to others, and I'm open to a respectable debate on the subject, which I enjoy. With that being said.....
My comment was relating to the point that ug1 made about it seeming to be more of the same, increasing [health care] costs vs little to no additional return. Which I noted in my comment had you actually tried to comment on what I said rather than my grammar. Maybe I'm not 100% on with the article as a whole but I was focused on the point in the article about the added costs these machines created with supposed values that were based on initial findings that appear to not have been as accurate or truthful as they were projected. Further more, to the point that the findings the values were based on may have been skewed or biased because those involved in the initial findings had financial gain at stake depending on which way the findings were reported. In addition to the fact that secondary studies or outside peer review was not done to what one could call a satisfactory level. There are other thoughts I have there but that's it for now. That was my point, and if you want to go down to a simple summary it was, as I stated, greed over all else and once again we, the average Joe American, get to pay for it; in this case with increased health care costs that we all see and are continuing to rise with serious questions as to what we are really paying for. Now maybe the greed part is is not the case here and the point the author made was wrong, (like one responder alludes to towards the end of the article) but as everything sits today, it wouldn't surprise me in the least. Otherwise I wasn't specifically questioning the procedures that some hospitals may have in place that could make some of the topics in the article and that I listed irrelevant. Nor do I have any bias against the author and what was written or how it was written.
Ok, now that I clarified and have provided more insight to my thoughts and comments feel free to respond...specifically you maeg...I'm waiting.
Well I believe that just because a person benefits from the purchase of a device does not mean that they wouldn't still recommend that device if they were not receiving any benefits from it's purchase. I think that the idea behind the device could be useful for a person who is untrained on this process but, as the article said, they jumped the gun on using this particular one before it was tested to it's fullest extent to make sure that everything would work in any situation. I also think that this device might not be the best thing to solely equip a hospital with but to carry in case someone needed to act quickly and had not yet been trained using the standard equipment. I could see this particular piece of equipment useful in other locations where such incidents occur that require the use of it that didn't have a person trained with the standard equipment. The first thing they should do though is work out all of the bugs with it so that it won't randomly shut off or not turn on when it's needed.
maeg - Thank you for the reply. See now that wasn't so bad. Isn't it a lot more stimulating to engage a respectful debate?
I agree with all you said. Your first point is very true and when I said what I did is wasn't to say that is always the case, just in this instance it seems that could be a factor. However, as we both posted in one way or another additional testing was needed and should have been done. These machines likely have a purpose and value it just that both those items should have been better defined and understood. Anyone can be a Monday morning quarterback on a decision that was made but if those who make the decsion don't do the required homework then the Monday morning quarterback's call is going to look that much more valid.
Once again, the AHA shows that it more interested in the profit-driven industry of cardiac care than actually saving lives. Remember they fought legislation that would encourage exercise. To make a leap of this magnitude without any empirical data is inexcusable and their status as a non-profit charity should bequestioned.
I wonder how many people would have died if there wasn't the AED to begin with?
Things that make you go hmmm.
I wonder, as well.
The FairWarning study seems to be comparing survival rates of AED patients to cardiac-arrest patients who receive timely defibrillation with a manual defibrillator. The whole point of the AHA recommendation was that cardiac arrest patients in most American hospitals were not receiving timely defibrillation because the only trained staff were in the critical/intensive care unit and had to travel, with their equipment, to the wards.
OK - the horse has left the barn. Seems like more training might show some improvement in the use of these devices.
They neglected to mention who the manufactures of these devices were until the end....they neglected to mention that GE is also heavily entrenched in this market.
What does the manufacturer have to do with the use of AEDs? It comes down to an issue of. If the floor isn't trained to use the device and uses it, well therein lies your issue.
Is the AED an amazing system without it's issues? No. Just like all other technology, it's only as good as the end user and is, of course, susceptible to mistakes.
Emanuelle....it comes down to the rush to get a market for these devices. Who is connected to who in the medical decision making world and the AMA. Payoffs and favors. It is part of the reason why medical costs continue a steep rise....
Well if you look at the devices, most of them do have a manual override, including the GE one you seemed most offended by.
Emanuelle....I am not offended by the devices...I am offended that it seems, based on the story, that the need for the devices was pushed without proper consideration or study....I am offended that it seems many made a profit on funding that could have gone to equipment that would have better served patient need.
Perry -
Actually, the issue was the response time of the "Code Blue" team from the ICU/ED/etc. who would take over from the ward staff.
The wards have a "crash cart" with the equipment already there (Sears used to sell a lot of red Craftsman car-tool wheeled carts to contain drugs and equipment until the "modern ones" at many times the price came along...). The question is who feels comfortable in using it.
What is the AHA's purpose? Science or advertising? Recommendations for sale: machines, drugs, even diet.
"What’s more, more than a quarter of the members of the heart association committee that recommended the automated defibrillators had business ties with manufacturers of the devices."
Who would have guessed?
Vlad: Good point. I don't know if the company that made the equipment is public or not, but it would be interesting to find out if any of the members of the Heart Association purchased stock in the companies that made the equipment, prior to making their recommendation. Just a thought.
ug1, maybe you're not too good at reading comprehension; heart doc is right. Training of staff is key to successful use of any medical device. Of course, this article will probably get the attention of every ambulance chaser in America and the class action lawsuits will fly. Could that be the reason healthcare is America is so costly? Hmmmm...
Sara there are lots of reasons the cost are high but i don't see anyone anywhere trying to get them down.. no new laws to stop the law suits or the cost... just more money threw at the problem that isn't any way to fix the problem... i see the government is giving one billion dollars to help health care.... my wife and daughter both went to school and got degrees in nursing and both do fine... why would the government need to mess this up to...
It's the lack of evidenced based practice. Anytime it is even broached as a subject for reigning in healthcare costs someone screams, "death panels!". People don't want to hear that a treatment has a greater probability of doing harm or making no appreciable difference. They want to see these neat little boxes stuck to walls everywhere and think that any Joe Bloe can save their life by following the preprogrammed voice.
The truth is that it takes highly trained professionals to successfully revive someone in cardiac arrest and it's more than the AHA corrupting the process. Hospital boards want to cut costs and one of the first places that happens is through cuts in staffing and staff inservice trainings translating into more nurses and other hospital personnel that are uncomfortable using well studied, effective equipment.
I was an American Red Cross CPR/First aid instructor for years when the American Heart Association and the AMA told us we had to stop training people to understand how the body works and what to do to save lives. We were to make it as simple as possible because they argued a poor attempt is better than no attempt at all. In conjunction with that, they marketed cheap mannequins and expensive machines so that any not so bright person could save lives.
I felt like an old codger when I refused to take part in the marketing sham and quit being a volunteer teacher. It looks like the "Train as many people as possible and put computers everywhere to do the thinking for them" plan may not have been the panacea they envisioned. They made a bundle of cash, though. It's the new American way; get used to it.
Now they are training healthcare prefessionals to stop checking for a pulse when when approaching an unresponsive patient. Just jump right into chest compressions and resuce breaths once you determine the patient is nonresponsive. In the latest update I got this spring all of us nurses were shocked to skip that step and they said, "yeah, it's too time consuming, costing people precious moments for 'people' to check for a pulse". This was the CPR refresher for healthcare PROFESSIONALS.
This not the way to start the day. Another machine that is supposed to save lives and the cost is very high. Prices soar, people can't even pay the high costs to stay alive. Is this companies still filled with Greed, that holy dollar but killing in the process. Instead of moving forwards in the medical fields we go backwards. Now who is going to feel better when we see one of these hanging on a wall? Will this one work.? We have cold medicines pulled off the market after being used for many years then causing 2 maybe 3 deaths, then we have stories of this causing thousands to die. WHATS THE DEAL? WHAT TOOK SO LING FOR THIS STORY..COVER UPS? THEY HAVENTDE THEIR BILLION DOLLOR QUOTA YET? This is what our great BIG DRUG BUSINESSES HAVE GONE TO...CUT WITH THEIR TESTING OR NONE AT ALL, USING CHEAP MATERIALS YOU NAME IT JUST FOR THE BIG BIG MONEY. THEY HAVE TO KEEP THE SUPER RICH AND STOCK HOLDERS HAPPY DON'T THEY...NO MATTER HOW MANY OF US THEY KILL IN THE PROCESS. But as Newt G. says people should suffer, let the rich enjoy their money. This is what they have turned our country into, it isn't a pretty picture.
I blame Obama.
Just another way of contolling the apparently spiralling population, hey!
As an old friend was fond of saying: there goes another perfectly good theory runied by the facts.
"We just assumed that we were going to make a difference." said the good doctor. If they would just make doctors take a few science and statistics classes this kind of nonsense would stop. Witch doctors.
Did anyone actually read this story? It seems to be typical "the sky is falling" sensationalism with a one-sided slant. As someone else asked – how many lives were saved because of these devices?
Regarding the untrained staff not using the devices, we live in a litigious society and hospital personnel are high profile targets of lawsuits. If I was a low-level hospital employee, I'd be a bit nervous about using this device and probably opt to wait for a trained person to arrive.
Finally, these devices are popping up everywhere (I work in the construction industry and we have them in our offices). After this slanted story, I wonder how many organizations will opt to remove the devices for fear of lawsuits. And how many lives might be lost because of their decision.
I work in Safety, do not let a slanted story change your mind, the AED is a viable device, and if kept maintained as any other piece of equipement should be, it will work as required when needed, but the key words are "Checked and Maintained" per the manufacturers instructions.
Some aren't the best at seeing both sides to any discussion; likely, sadly, some will be removed and/or not purchased because they will buy 'the sky is falling'.
When I worked as a polysomnographist, we had some stand alone sleep labs and the AED was mandatory (bout 2003). I never had to use one, but DID have to test it every night at labs prior to patient arrival, ensuring it worked. Paper was printed out as to calibration, and put in the nightly folder.
This was better than nothing, and testing helped ensure it would work properly. I'm sure cost factors in as in '03 the co. I worked for was paying six to eight hundred per unit, which wasn't bad at all. BLS certs were still required yearly, and most nurses I knew at the main hospital I worked at had to be trained on AED as well, so not sure about these mentioned in the article.
Seems it's time to step on health care again....
3rd Gen, YOU did not understand the story! The story has nothing todo with the sky!!!
The latest, most extensive research suggests that the new gear, now found in nearly all U.S. hospitals, saves fewer lives than the old, lower-tech defibrillators.
Has nothing to do with how many lifes have been saved...it says it should have been better, because of newer equipment being advocated and installed because of wrong assumptions!
Bottom line, without any form of technology or medical help these people would be dead. It's just nit picking at this point. There's no conclusive way to say why the person coded and was unresponsive. Absent any data to suggest where they got the viewpoint to begin with, it's going into the crock of @!$%# pile.
@ 3rd Gen I have read the article, and unfortunately, you do not understand the thrust of the article, to wit:
The use of Automated External Defibrillators (AEDs) in an out of hospital scenario IS NOT in question, and not the point of the article.
What is in question is the use of AEDs in a HOSPITAL setting where the patients have much more complicated medical problems than the average out of hospital Cardiac Arrest victim.
AEDs in the community setting save lives.
Doctors and Nurses applying proper training and judgemen in the HOSPITAL Setting appear to be able to outperform automaterd devices.
Thank goodness the Construction company where you work has the decency, and forethought to give cardiac arrest victims an opportunity to surve.
Training with the proven equipment you have can be just as effective. If nurses in various hospitals don't know how to properly use a new piece of equipment make sure they are trained before they are put in a position to cost someone their life. Just "thinking" a device will work better than really "knowing" can easily turn into disaster.
Trainings cost money and lots of it. Hospitals don't want to pay for staff to be trained to use its equipment confidently. Staff are more costly in the initial investment and upkeep that an inanimate box that works only when prompted.
Well! as a CBET (Certified Biomedical Equipment Technician), i can tell you that Nurses and other staff members at many hospitals aren't as familiar with cardiac care equipment as they should be. Furthermore, AEDs' go unchecked and unserviced at many locations outside of hospitals. Thus being the cause of most problems with AEDs'. Battery cost is also an issue.
I know that I have A-Fib and the new machine did not get my heart into a normal rythem.Maybe it was the new machine.I wonder if with a procedure with the old machine might have worked?
Dano,
Defibrillators are not meant to treat benign conditions like atrial fibrillation. They are meant to treat cardiac arrest due to ventricular fibrillation or unstable ventricular tachycardia. A patient with atrial fibrillation may undergo a medical procedure called a cardioversion, in which a defibrillator is used to administer a shock to try to interrupt the atrial arrythmia, but cardioversion is rarely effective in the long term as a stand-alone therapy for atrial arrythmias. The machine that was used on you has nothing to do with your chronic atrial fibrillation.
not exactly true,
defibrillators are used to cardiovert patients (just hit sync). Not the automated ones, though, and that may be what you meant
Cardioversion is also more than "rarely effective"--at least 25% of the time, and much higher if used in conjuction with anti-arrythmics
Hospitals are one thing and probably nothing is better for the patient than trained doctors and nurses using good equipment. But AEDs ae everywhere, at the mall, at the office, in the restaurant, at the health club, and hundreds of thousands of volunteers have taken CPR/AED training and may be the difference between living and dying for tens of thousands of cardiac arrest victims who are not in the hospital ER when the attack occurs.
In case you missed his point. It was that the manuel difibrillator with training is the best course of action.
I've been a Paramedic for 25 years & have recert'd in ACLS (required) 14 times. The "old days" ways of resusitation were cut & dried. You saw a rhythm on the monitor and there was a very specific drug & dosage to treat that rhythm. Now, fewer rhythms are taught, and treatments (and drug therapies) are "suggested". The main treatment is "pump hard---pump fast. In the ABC of resusitation, Airway is Number One. My last recert, I never even picked up a laryngascope!!!! WTF?? I can agree with blood circulation and early intervention as being key points, but don't depend on some machine hanging on a wall with dried-up pads and a dead battery as being the decision of destination--the ER or the morgue!
"Airway first" sounds good, but when a cardiac arrest occurs, there is already oxygen circulating in the person's blood, enough to keep them alive for several minutes, if it's being pumped around.
So the priority should be fast and hard chest compressions, not setting up an airway. That's why current CPR recommendations have changed recently to focus on chest compressions, not mouth-to-mouth breathing.
@ttmadison: Don't confuse procedures used in basic CPR for lay people with what is taught to trained professionals like paramedics who require certification in ACLS.
Basic CPR is targeted towards the easiest way that the average Joe Citizen can be effective when cardiac arrest happens. ACLS provides the most effective way to stabilize a patient, which is usually far from easy and requires quite a bit more training than basic CPR.
Mitchell
When you say "patients die", you really mean "failed to be resuscitated", right?
Let's get something perfectly clear, people in cardiac arrest are already dead, even if they are resuscitated they face a world of problems including clotting, infarction neuro deficiencies and the condition that caused the cardiac arrest in the first place.
I agree this could have worked better, and the testing should have been metric based, rather than theoretical (there are studies out there, by the way, that show less human thinking delivers better results when dealing with Cardiac events), but let's put this all in perspective - If you have a condition that warrants a cardiac arrest in the first place, being "saved" is a luxury, not an expectation.
It's simple to slant something; most that aren't in a particular field will buy either the cherry picked citations or the few that support the view. Healthcare, especially now, is coming back under fire as election time draws closer.
I've often thought, too, that sometimes authors will put forth varied toned articles just to see how many that take time to repond, respond in the way they'd hoped. The majority of people for various reasons will turn to the media for information rather than research; other times, the media is all we have for some information. In many cases, the facts themselves don't create enough of an interest so articles are presented with some sort of 'riling' factor which is unfortunate. News facts should be just that; we have enough other media outlets for entertainment.
In other words, Health Care workers are becoming stupider and less competent, so to compensate, machines that do their thinking for them have been introduced in an attempt to bridge the gap between required and available skills. Sort of like the cash registers in McDonalds that have pictures of the items on the keys rather than numbers. All of the reminds me of the movie "Idiocracy", a dystopian fantasy about a future world so incompetent that artificial intelligence substitutes for lost human ability. That's where we are heading, folks.
You are exactly right. Over automation is not necessarily a good thing. Look at some articles from the airline industry, they are already addressing this. It looks to be a major factor in the Air France crash a few years ago. Their concern is that everything in a plane is so automated now that if the electronics fail, the pilots aren't prepared to manually handle an emergency.
Same thing is starting to happen in health care. Except its not just the electronics, so many protocols are being implemented that physicians are encouraged not to think outside a predefined box. Even delivery of care is becoming automated. Why do we need to have physicians if they don't need to think? Why have nurses, we can have medication delivery techs?
Mike, I actually think that it's the other way around. I think that new technology is developed, people think that the technology will eliminate the element of human error, and they substitute the new technology for training. The result is that healthcare workers learn to rely on machinery and technology, and therefore never learn and practice the skills that used to be a basic part of their training.
I can say from experience (many years as a critical care nurse working in a large urban teaching hospital) that cardiac arrest in a hospital setting (i.e. not in the emergency room) is rare enough that many nurses never have an opportunity to participate in a resuscitation attempt. It's an extremely stressful situation, and even the most seasoned nurses and doctors become flustered and can make mistakes. The automated machines were intended to help minimize the potential for these types of mistakes, but I think the research is showing that the automated machines are no more reliable than a freaked-out novice nurse or first-year resident.
This one strikes close to home. About two months ago, my life was saved by a defibrillator. From what I was told later on, however, it was done manually. Four stents later, I'm back to my normal self (except for the diet).
I think the operative statement in the article..... which is kind of glossed over... is "I think they jumped the gun,” said Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic in Ohio. “Why would we want to dumb things down to a level of having a machine do the thinking for us?”
Uh, answer is simple. Hospitals don`t want to spend the money on trained nursees but rather have nursing techs (notice how they throw that word in nursing in there when they really are not nurses or even close to it). Some articles the last few years even show them going below licensed vocational nurses.
We are in the hospital for far more complicated problems then ever before (since the less complicated ones are in and out same day surgery type). Yet we are going to the lowest skilled labor possible to take care of us. In some cases you don`t even get much of that unless a family member stays with you to provide it. Thus you have to dumb down all the equipment in the hospital so that the untrained can use it when needed. No surprise when that philosophy does not work and you have more deaths than expected.