Summary
Modern automated external defibrillators (AEDs) offer a variety of technical improvements which increase the efficacy of early defibrillation, facilitate the application by not or minimally trained persons and improve safety. The development of biphasic shocks allows better myocardial protection, the use of lithium batteries, and a marked decrease of AEDs, in size. Microprocessors realize complex acoustic and visual prompts which lead the user through all steps of cardiopulmonary resuscitation (CPR) according to current guidelines. The design of AEDs has been simplified; many devices provide only a single button which can be used for all active processes. Memory functions record the whole CPR with all details which can be transferred to other computers and analyzed off-line. The introduction of AEDs has reduced the delay between collapse and defibrillation to less than 4 min in several studies thus increasing the success of CPR and the proportion of patients dismissed from hospital alive and without neurological deficit. Up to 93% of untrained volunteers were able to successfully complete defibrillation with the use of an AED, sixth-form pupils without experience in CPR were only few sec slower with an AED than staff of emergency medical services. The ability to perform CPR after defibrillation guided by the AED depends primarily on the clarity of acoustic prompts which have to consider the terms and abbreviations of the respective language. Currently available AEDs surpass performance goals of the AHA. However, all devices exhibit advantages and disadvantages which will be discussed in this review.
Zusammenfassung
Moderne automatisierte externe Defibrillatoren (AEDs) verfügen über eine Vielzahl von technischen Neuerungen, die die Effektivität verbessern, die Anwendung durch nicht oder nur minimal trainierte Personen ermöglichen und den Einsatz für Patienten und Anwender sicherer machen. Die Entwicklung biphasischer Schockformen erlaubt schonendere Energieabgaben, die Nutzung von Lithium-Batterien und eine hochgradige Verkleinerung der Geräte. Moderne Mikroprozessoren ermöglichen komplexe akustische und visuelle Aufforderungen, die den Anwender durch alle Schritte einer nach den aktuellen Leitlinien durchgeführten Reanimation begleiten. Das Design des AEDs ist soweit simplifiziert worden, dass viele Geräte lediglich noch einen zu bedienenden Knopf haben. Umfangreiche Speicherfunktionen erlauben es, den gesamten Vorgang in allen Einzelheiten aufzuzeichnen, zu exportieren und die Daten nachträglich zu analysieren. Durch den Einsatz von AEDs können die Latenz zwischen Kollaps und Defibrillation vielfach auf unter 4 min gesenkt und die Erfolgsaussichten der Reanimation (und damit die Prognose des Patienten) signifikant verbessert werden. Bis zu 93% untrainierter Probanden konnten eine Frühdefibrillation erfolgreich durchführen, Schulkinder ohne Vorkenntnisse waren hierbei im Mittel nur wenige sec langsamer als professionelle Rettungssanitäter. Die Durchführung einer AED-geführten kardiopulmonalen Reanimation hängt maßgeblich von der Verständlichkeit der akustischen Aufforderungen ab, die auf die Verständlichkeit in der jeweiligen Landessprache angewiesen sind. Die derzeit verfügbaren AEDs übertreffen die Anforderungen der AHA z. T. bei weitem, weisen jedoch alle Vor- und Nachteile auf, die hier im Einzelnen erörtert werden.
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Israel, C.W., Grönefeld, G. Technische Voraussetzungen der Frühdefibrillation: Was können automatisierte externe Defibrillatoren?. Herzschr. Elektrophys. 16, 84–93 (2005). https://doi.org/10.1007/s00399-005-0468-7
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DOI: https://doi.org/10.1007/s00399-005-0468-7
Key words
- Automated external Defibrillator
- sudden cardiac death
- cardiac arrest
- cardiopulmonary resuscitation
- ventricular fibrillation