Defibrillators
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PRODUCT NAMES AND MANUFACTURER
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HeartStart OnSite and FR2+ Defibrillators—Philips Medical Systems, 3000 Minuteman Road, Andover, Mass. 01810-1099, 1-978-687-1501, "www.medical.philips.com/dental" (received ADA Seal of Acceptance in January 2004)
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SUMMARY
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Sudden cardiac arrest can strike anyone, anywhere and at any time, often without warning. Reported survival rates for cardiac arrest with ventricular fibrillation are low: from 3 to 10 percent.1–6 Studies have shown that rapid defibrillation after out-of-hospital cardiac arrest with ventricular fibrillation is the most important determinant of survival.1–5 That is why training people to use automated external defibrillators, or AEDs, in public places can double the odds that a person in cardiac arrest will survive.7
The ADA recently awarded the Seal of Acceptance to HeartStart OnSite and FR2+ defibrillators. HeartStart defibrillators are
- – easy to use. HeartStart defibrillators are designed specifically for the lay responder. They provide clear, easy-to-follow voice instructions and a simple user interface to guide the responder through an emergency.
- – reliable. HeartStart defibrillators perform comprehensive daily, weekly and monthly self-tests to help ensure readiness. A highly visible status indicator shows at a glance that the device is ready for use.
- – safe. HeartStart defibrillators have an innovative design that makes it virtually impossible to shock someone who is not in cardiac arrest. The heart rhythm first is analyzed to ensure that a shock is needed. The device will not allow the user to deliver a shock that the analysis determines is unnecessary.
Philips offers two defibrillator models for the dental office: the HeartStart OnSite Defibrillator and the HeartStart FR2+ Defibrillator. The HeartStart OnSite Defibrillator is intended to be easy to use for responders in an office setting. It provides step-by-step verbal instructions on how to perform cardiopulmonary resuscitation, or CPR. The HeartStart FR2+ Defibrillator is designed for first responders, such as flight attendants, nurses, police officers and designated workplace responders who participate in regular training.
Each HeartStart defibrillator comes with a nonrechargeable long-life battery, two sets of adult pads and complete instructions for use.
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CONSIDERATIONS FOR ACCEPTANCE/EFFICACY AND SAFETY DATA
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The American Heart Association Committee on Emergency Cardiovascular Care conducted an evidence-based review of the literature documenting the outcomes of transthoracic defibrillation using a low-energy biphasic waveform shock (like that delivered by Philips’ HeartStart defibrillators).8 The committee endorsed the conclusion that "positive evidence supports a statement that initial low-energy, nonprogressive, impedance-adjusted biphasic waveform shocks for patients in out-of-hospital ventricular fibrillation arrest are safe, acceptable, and clinically effective."
A review of the literature published in JAMA in 2001 analyzed the results of more than 100 journal articles in an effort to examine the impact of AEDs on time to defibrillation and survival, and the future role of AEDs in improving survival after sudden cardiac arrest.9 The authors concluded that the AED is an efficient method for safely and effectively delivering defibrillation to people in cardiac arrest outside of the hospital.
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INDICATIONS FOR USE
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HeartStart AEDs are indicated for use with people in sudden cardiac arrest who are unresponsive and not breathing normally. The user should have received training at a recognized course in CPR and AED use such as those offered by the American Heart Association or the American Red Cross, or be certified in basic life support, advanced life support or other physician-authorized emergency medical response.
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RESOURCES
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To learn more about Philips’ HeartStart defibrillators, visit "www.medical.philips.com/dental".
The ADA Seminar Series offers courses on medical emergencies in the dental setting. For more information, visit "www.ada.org/members/ed/seminar/ScheduledSeminars.asp" or call 1-312-440-2908 or the toll-free number on the back of your membership card and ask for Ext. 2908. For a complete list of continuing education courses on the subject, visit "www.ada.org/members/ed/courselisting/courseinfosearch.asp".
Visit the American Heart Association online at "www.americanheart.org" to find CPR and emergency cardiovascular care classes in your area.
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FOOTNOTES
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PREPARED BY THE ADA DIVISION OF SCIENCE ON BEHALF OF THE ADA COUNCIL ON SCIENTIFIC AFFAIRS
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REFERENCES
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- White RD, Asplin BR, Bugliosi TF, Hankins DG. High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med 1996;28:480–5.[Medline]
- White RD, Hankins DG, Atkinson EJ. Patient outcomes following defibrillation with a low energy biphasic truncated exponential waveform in out-of-hospital cardiac arrest. Resuscitation 2001;49:9–14.[Medline]
- White RD, Hankins DG, Bugliosi TF. Seven years’ experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation 1998;39:145–51.[Medline]
- Eisenberg MS, Mengert TJ. Cardiac resuscitation. N Engl J Med 2001;334:1304–13.
- Kellermann AL, Hackman BB, Somes G, Kreth TK, Nail L, Dobyns P. Impact of first-responder defibrillation in an urban emergency medical services system. JAMA 1993;270:1708–13.[Abstract]
- Lombardi G, Gallagher EJ, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA 1994;271:678–83.[Abstract]
- Ornato JP. Presentation at: American Heart Association Scientific Sessions 2003, Plenary Session III, Late-Breaking Clinical Trials; Nov. 11, 2003; Orlando, Fla.
- Cummins RO, Hazinski MF, Kerber RE, et al. Low-energy biphasic waveform defibrillation: evidence-based review applied to emergency cardiovascular care guidelines—a statement for healthcare professionals from the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation. Circulation 1998;97:1654–67.[Free Full Text]
- Marenco JP, Wang PJ, Link MS, Homoud MK, Estes NA 3rd. Improving survival from sudden cardiac arrest: the role of the automated external defibrillator. JAMA 2001;285:1193–200.[Abstract/Free Full Text]
How to prepare yourself for an office emergency
The ADA Council on Scientific Affairs published a report in 2002 on office emergencies and emergency kits.1 This report makes the recommendation that dentists should consider obtaining an automated external defibrillator, or AED, for the dental office. Support for public access to AEDs also is growing. Public defibrillators ranked third on the American Heart Association’s 2003 list for major gains in heart disease and stroke research, following encouraging results in a study that looked at improved survival after cardiac arrest when AEDs were made available in public places.2
Although they are rare, life-threatening medical emergencies can and do occur in the dental environment. Preparedness to recognize and appropriately manage medical emergencies in the dental environment includes the following3:
- – current basic life support certification for all office staff;
- – didactic and clinical courses in emergency medicine;
- – periodic office emergency drills;
- – telephone numbers of emergency medical services or other appropriately trained health care providers;
- – emergency drug kit and equipment (including at least injectable epinephrine 1:1,000, injectable histamine-blocker, oxygen with positive-pressure administration capability, nitroglycerin and asthma inhaler) and the knowledge to properly use all items.
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REFERENCES
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- ADA Council on Scientific Affairs. Office emergencies and emergency kits. JADA 2002;133:364–5.[Medline]
- Ornato JP. Presentation at: American Heart Association Scientific Sessions 2003, Plenary Session III, Late-Breaking Clinical Trials; Nov. 11, 2003; Orlando, Fla.
- White RD, Hankins DG, Bugliosi TF. Seven years’ experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation 1998;39(3):145–51.[Medline]
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PRODUCT NAMES AND MANUFACTURER
SUMMARY
