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Cardiac Arrest Cases and Automated External Defibrillator Use in Railroad Stations in Tokyo  [PDF]
Satoko Fukuike, Yasuhiro Otomo
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.520170
Abstract: Objective: Nationwide dissemination of public-access defibrillation (PAD) contributed to an increase of survival rate in Japan. We analysed cardiac arrests (CAs) that occurred in railroad stations in Tokyo to evaluate PAD in the metropolis. Methods: We collected Utstein data from the Tokyo Fire Department (TFD) and analysed CA cases that occurred in stations. In total, 245 non-traumatic CAs from January 1, 2007 to March 31, 2008 were analysed; CAs in children under 8 years were excluded. Results: The rates of pre-hospital return of spontaneous circulation (ROSC) were 41 out of 145 witnessed CA patients (28.3%) and 12 ROSC out of 100 unwitnessed CA patients (12%). Of 245 CA cases, bystander cardiopulmonary resuscitation (CPR) performed in 156 (63.7%), automated external defibrillator (AED) used in 117 (47.8%) and shock delivered in 65 (26.5%). Rates of ROSC were 31.6% (37/117) with AED use significantly higher than those of 12.5% (16/128) without AED use (P < 0.001). Most CAs occurred on platforms; the use of AEDs on platforms increased from 18/31 (58.1%) in 2007 to 32/43 (74.4%) in 2008 and ROSC rates increased from 8 (25.8%) to 14 (32.6%), respectively. On train CAs: ROSC cases were very few, 1 case each year (8.3%; 7.7%) while the use of AED increased from 8/12 (66.7%) in 2007 to 10/13 (76.9%) in 2008. Conclusion: Bystander CPR and the use of AED at railroad stations improved ROSC for out-of-hospital cardiac arrest (OHCA) patients. AED location and strategies for dealing with CAs on trains should be re-evaluated.
Mismatch between Sites of Incidence of Out-of-Hospital Cardiac Arrest and Locations of Installed Automated External Defibrillator in the Tokyo Metropolitan Area  [PDF]
Kyoko Tsukigase, Hideharu Tanaka, Hiroshi Takyu
World Journal of Cardiovascular Diseases (WJCD) , 2017, DOI: 10.4236/wjcd.2017.76017
Background: Since 2004, the number of installed Automated External Defibrillator (AED) has been increased in Japan annually, the cumulative number of sold AED more than 600,000 units by 2016. Despite there have been about 130,000 out of hospital cardiac arrest annually, there have only 1302 cases delivered defibrillation by bystanders at the scene. Therefore, we investigate that number of AED installation and usage rate for Out of Hospital Cardiac Arrest (OHCA) patients. Methods: Retrospective metropolitan wide cohort study. Subject: Total 13,364 OHCA patients in the Tokyo Metropolitan area from Jan. 1 through Dec. 31 in 2012 were eligible for theses analyses. Also, OHCA occurrence place and AED usage rate were studied. Results: 82.8% of OHCA occurred at residences, 10% at outdoors, 6.4% at indoors, only 0.7% at schools. In the other hand, highest bystander’s CPR rates were found in sports facilities and schools (71.4%). The installation rate of AEDs in residences was 9.6%, instead of highest incidence for OHCA patients, school and sports institute made up 21.4% of AED installations, but only 1.0% of the incidences of cardiac arrest. We found that there is a mismatch between incidence sites of cardiac arrest and locations of installed AED. Discussion: It is essential to increase the number of AED installations. Furthermore, it is desirable to install AEDs in locations where cardiac arrest is liable to occur following guidelines for the proper placement of AEDs, and important to further spread BLS education among the general citizens.
Igor V. Venin Founder of Biphasic Waveform Defibrillators  [PDF]
Vyacheslav A. Vostrikov, Boris B. Gorbunov, Sergey V. Selishchev
Journal of Biomedical Science and Engineering (JBiSE) , 2015, DOI: 10.4236/jbise.2015.85032
Abstract: Igor V. Venin since 1966 and up till now has been an outstanding engineer of the Soviet Union and Ukraine, who has dedicated all his life to defibrillators development. Under his guidance 16 models of DC defibrillators with different waveforms, including the world’s first defibrillator with biphasic waveform (1971) have been developed and put into commercial production.
Defibrillation in children
Haskell Sarah,Atkins Dianne
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Defibrillation is the only effective treatment for ventricular fibrillation (VF). Optimal methods for defibrillation in children are derived and extrapolated from adult data. VF occurs as the initial rhythm in 8-20% of pediatric cardiac arrests. This has fostered a new interest in determining the optimal technique for pediatric defibrillation. This review will provide a brief background of the history of defibrillation and a review of the current literature on pediatric defibrillation. The literature search was performed through PubMed, using the MeSH headings of cardiopulmonary resuscitation, defibrillation and electric countershock. The authors′ personal bibliographic files were also searched. Only published articles were chosen. The recommended energy dose has been 2 J/kg for 30 years, but recent reports may indicate that higher dosages may be more effective and safe. In 2005, the European Resuscitation Council recommended 4 J/kg as the initial dose, without escalation for subsequent shocks. Automated external defibrillators are increasingly used for pediatric cardiac arrest, and available reports indicate high success rates. Additional research on pediatric defibrillation is critical in order to be able to provide an equivalent standard of care for children in cardiac arrest and improve outcomes.
Early History of Cardiac Pacing and Defibrillation
Seymour Furman
Indian Pacing and Electrophysiology Journal , 2002,
Abstract: The Electricity and the Heart website1 is intended to facilitate the collection, cataloging and presentation of historical information about technical and scientific advances in cardiac devices. Over the course of the past century as the fields of cardiac pacing and electrophysiology have evolved, the technological devices used by physicians and researchers has been a fascinating and rapidly changing portion of the history of the fields. NASPE's Oral History Project houses hundreds of devices collected over the years that illustrate the evolution from crude and simple machines to the sophisticated and advanced technological wonders that are used in the field today. The photos and descriptions of many of these devices show just how far we have come in the advancement of treatment and patient care.
Construction of Energy-Optimal Smooth Monophasic Defibrillation Pulse Waveforms Using Cardiomyocyte Membrane Model  [PDF]
Vyacheslav A. Vostrikov, Boris B. Gorbunov, Sergey V. Selishchev
Journal of Biomedical Science and Engineering (JBiSE) , 2015, DOI: 10.4236/jbise.2015.89058
Abstract: The goal is to help create smooth energy-optimal monophasic pulse waveforms for defibrillation using the Luo-Rudy cardiomyocyte membrane computer model. The waveforms were described with the help of the piecewise linear function. Each line segment provides a transition from one present level of the transmembrane potential to the next with a minimal energy value. The duration of the last segment was defined as a minimum duration at which an action potential occurs. Monophasic waveforms of segments 3, 10 and 29 were built using different increments of the transmembrane potential. The pulse energy efficiency was evaluated according to their threshold energy ratios in mA2·ms/cm4. There was virtually no difference between the threshold energy ratios of the three waveforms constructed and those of the previously studied energy-optimal half- sine waveform: 241 - 242 and 243 mA2·ms/cm4. The pulse waveform constructed is characterized by a low rise and fall as the duration of the rise is ~1.5 times longer than that of the fall. Conclusion: Energy-optimal smooth monophasic pulse waveforms have the same threshold energy ratio as the optimal half-sine one which was studied before. The latter is equivalent to the first phase of biphasic quasisinusoidal Gurvich-Venin pulse which has been used in Russia since 1972. Thus, the use of the Luo-Rudy cardiomyocyte membrane model appears to offer no possibilities for a substantial increase in the energy efficiency (threshold energy ratio reduction) of the classical monophasic defibrillation pulse waveforms.
Fast Electrocardiogram Amplifier Recovery after Defibrillation Shock
Ivan Dotsinsky,Tatyana Neycheva
Bioautomation , 2005,
Abstract: A procedure for fast ECG amplifier recovery after defibrillation shocks was developed and simulated in the MATLAB environment. Exponentially decaying post-shock voltages have been recorded. Signals from the AHA database are taken and mixed with the recorded exponential disturbances. The algorithm applies moving averaging (comb filter) on the compound input signal, thereby obtaining the samples of the disturbance. They are currently subtracted from the input signal. The results obtained show that its recovery is practically instantaneous.
Fighting cardiac arrest: Automated external defibrillator
Kumar V,Adhikari K,Singh Y
Indian Journal of Critical Care Medicine , 2003,
Abstract: Ventricular tachyarrhythmias - Ventricular fibrillation (VF) and Ventricular tachycardia (VT) account for most of out-of-hospital sudden cardiac arrests. Defibrillation is the specific therapy for VF/pulseless VT. Time to defibrillation is the most important determinant of survival from these cardiac arrests. Automated external defibrillator (AED) has largely replaced the conventional defibrillator in Basic life support (BLS) programmes for out-of-hospital cardiac arrests. AED use by trained laypersons in the community as part of Public Access Defibrillation (PAD) programmes has significantly reduced time to defibrillation and increased survival. AED is now being stipulated for home use in people at high risk of sudden cardiac death. AED placement is also recommended in all areas of hospital. Physicians and Intesivists should strive to familiarize the medical fraternity in our country with AED use so that PAD programmes can be launched in the near future.
Umbral de impedancia transtorácica para la detección del paciente en desfibrilación
Colorado,Osmani; Portela,Alejandro Ernesto; Folgueras,José;
Universidad, Ciencia y Tecnología , 2007,
Abstract: the value of transthoracic impedance for defibrillation is commonly employed by impedance compensation algorithms in order to ?gtailor?h the discharge for each patient. the upper limit reported for the impedance may be exceeded if no conductive gel is used as an interface between paddles and skin. the present work is aimed to determining a maximum acceptable value when measured on a patient so that it can guarantee the discharge even if no gel is used and also to make a comparison between adult and pediatric paddles applying gel or not. the impedance of 27 volunteers was measured applying gel or not, finding that the value measured with pediatric paddles was 1,95 ± 0,61 times greater than the value measured with pediatric paddles, when no gel was applied. the influence of applying gel was significantly greater in men and particularly in hirsute individuals. a similar result was achieved when reducing the area of pediatric paddles 3,7 times by employing a pediatric adapter. following these results, a top 400 ω value was selected for patient detection. results suggest that applying no gel to pediatric paddles is equivalent to the reduction in nearly four times of the adult paddle area.
Defibrillation Testing of the Implantable Cardioverter Defibrillator: When, How, and by Whom?
Luis A. Pires
Indian Pacing and Electrophysiology Journal , 2007,
Abstract: The implantable cardioverter-defibrillator (ICD) has become an integral part of treatment for a variety of patients with symptomatic, or at risk for, ventricular tachyarrhythmias. The ICD's effectiveness is attributed to its ability to promptly detect and terminate ventricular tachycardia (VT) and fibrillation (VF). The clinical trials that established the positive role of ICD therapy were based on patients who underwent some form of defibrillation testing at the time of implantation. Therefore, since its advent, intraoperative defibrillation testing of the ICD to assure reliable detection and termination of VT/VF has been a standard practice. But because of advances in defibrillator and lead technology, which now facilitates successful device implantation (i.e., low defibrillation energy requirement to allow for an adequate programmed safety margin) in the majority of patients, the necessity of defibrillation testing has been called into attention. Despite substantial progress, it is not altogether clear whether a wholesale abandonment of intraoperative ICD testing is appropriate at this point. We review pertinent data regarding pros and cons of ICD testing and offer a suggestion as to when, how, and who should test ICDs.
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