Using an AED on Someone with a Pacemaker

What is a Pacemaker?

Definition:

A pacemaker is a small, battery-operated medical device implanted under the skin, typically in the chest area, that helps manage abnormal heart rhythms. It sends electrical impulses to the heart muscle to ensure that the heart beats at a consistent rate and rhythm, maintaining effective circulation of blood throughout the body.

How Pacemakers Work:

How Electrical Impulses Work:

Pacemakers are designed to monitor the heart’s electrical signals continuously. When the heart’s natural rhythm slows down or becomes irregular, the pacemaker generates small electrical pulses that stimulate the heart to beat at the correct pace. These impulses ensure that the heart maintains an adequate rate and rhythm to support the body’s needs.

Components:

• A typical pacemaker consists of two main components:

  • Pulse Generator: This is the main body of the pacemaker, housing the battery and the electronic circuitry responsible for generating electrical impulses.

  • Leads (Wires): These are thin, insulated wires that connect the pulse generator to the heart. The leads carry the electrical impulses from the generator to the heart muscles, ensuring that the heart beats in response to the pacemaker's signals.

Conditions Treated by Pacemakers and Implantable Cardioverter Defibrillators:

Bradycardia:

• Bradycardia is a condition where the heart beats too slowly, often below 60 beats per minute. Symptoms of bradycardia include fatigue, dizziness, fainting, and shortness of breath. A pacemaker helps by maintaining a regular, adequate heart rate, preventing the heart from slowing down to a dangerously low level.

Abnormal Heart Rhythms:

Arrhythmias, or heart arrhythmias, refer to irregular heartbeats, which can be too fast, too slow, or erratic. These irregular rhythms can lead to inefficient blood flow, reducing the oxygen supply to vital organs. Pacemakers correct certain types of arrhythmias by restoring and maintaining a regular rhythm, ensuring that the heart pumps blood effectively.

Using an AED on a Person with a Pacemaker

When someone with a pacemaker experiences sudden cardiac arrest (SCA), using an Automated External Defibrillator (AED) can be life-saving. Despite the presence of a pacemaker, an AED can accurately assess the heart's rhythm and deliver appropriate treatment. Below are the detailed steps and considerations for using an AED on someone with a pacemaker:

1. Assess the Situation

Action:

• Rapidly assess the victim's condition. Begin by checking for responsiveness by tapping the person and shouting. If there's no response and the person is not breathing normally (gasping or not breathing at all), start Cardiopulmonary Resuscitation (CPR) immediately and call for emergency medical assistance. Early recognition and intervention are critical for survival in cases of sudden cardiac arrest.

CPR Start:

• Start with chest compressions: Position your hands in the center of the chest and push hard and fast, at a rate of 100 to 120 compressions per minute. The compression depth should be about 2 inches (5 cm) for an adult. Allow the chest to recoil fully between compressions to maximize blood flow to the heart and brain.

2. Retrieve and Apply the AED

Action:

• Quickly locate the nearest AED. Turn it on as soon as possible and follow the voice prompts or visual instructions provided by the device. The AED will guide you through each step, from applying the electrode pads to delivering a shock if needed.

Expose the Chest:

• Cut or tear away clothing to expose the victim's chest. Ensure that the chest is dry and free from sweat or water, as moisture can interfere with the electrical shock and reduce its effectiveness.

Apply Electrode Pads:

Attach the adhesive electrode pads to the victim’s chest according to the AED’s instructions. Typically, one pad is placed on the upper right side of the chest (just below the collarbone), and the other on the lower left side of the chest (a few inches below the armpit), ensuring the left arm remains still to avoid any sudden movements. This placement ensures that the electrical shock travels through the heart in a manner that is most likely to restore a normal rhythm.

3. AED Analysis
Action:

• Once the pads are correctly placed, the AED will automatically begin analyzing the heart's rhythm. During this time, do not touch the victim to avoid interference with the analysis and to ensure the AED can accurately assess the heart's condition.

Rhythm Detection:

The AED is programmed to detect shockable rhythms such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). It can distinguish these life-threatening rhythms from non-shockable rhythms, even in the presence of a pacemaker or an implantable cardioverter defibrillator.

Pacemaker Influence:

• Pacemakers generally do not interfere with the AED's ability to analyze the heart's rhythm. Modern AEDs are equipped with sophisticated algorithms that can accurately interpret heart rhythms, regardless of the presence of a pacemaker.

4. AED Shock Delivery
Action:

• If the AED detects a shockable rhythm, it will prompt you to deliver a shock. Ensure that everyone is clear of the victim—shout "Clear!" and visually confirm that no one is touching the victim before pressing the shock button.

Shock Delivery:

The electrical shock will pass through the chest and heart, including the area around both a pacemaker and an ICD. This shock is intended to reset the heart’s electrical system, allowing the heart to potentially resume a normal rhythm. The presence of a pacemaker does not typically prevent the AED from delivering an effective shock.

Multiple Shocks:

• If the AED recommends additional shocks, follow its instructions. Some AEDs are programmed to reanalyze the heart rhythm after each shock and will instruct you when to deliver subsequent shocks if needed.

5. Continue CPR and Chest Compressions
Action:

• After delivering a shock, immediately resume CPR, starting with chest compressions. High-quality chest compressions are crucial as they help maintain blood flow to the brain and vital organs, especially when the heart is not pumping effectively on its own.

CPR Technique:

• Press down hard and fast, with a compression depth of about 2 inches (5 cm) for adults. Maintain a rate of 100-120 compressions per minute, and allow the chest to fully recoil between compressions to maximize blood flow.

AED Reanalysis:

• The AED will typically prompt you to pause CPR after 2 minutes to reanalyze the heart rhythm. Follow the AED's instructions during these intervals, continuing CPR as directed.

6. Monitor the Victim
Action:

• Continue to monitor the victim's condition. After delivering shocks and performing CPR, observe for signs of recovery, such as spontaneous breathing, movement, or coughing. These are positive indicators that the heart may be resuming normal function.

Special Attention for Pacemaker:

If you know the victim has a pacemaker or ICD, be mindful of any unusual responses to the AED shocks. Pacemakers are designed to withstand external defibrillation, but it’s important to communicate the presence of the pacemaker to emergency medical personnel when they arrive.

Prepare for Handoff:

• When emergency responders arrive, inform them about the pacemaker and the number of shocks delivered. This information is crucial for ongoing care and helps emergency personnel tailor their treatment approach accordingly.

Special Considerations When Using an AED on Someone with a Pacemaker

1. Always Follow AED Instructions

Action:

• Trust the AED's prompts and instructions. These devices are highly reliable and designed to operate effectively even in the presence of implanted devices like pacemakers. The AED will analyze the heart's rhythm and guide you through the process, minimizing human error and increasing the chances of successful resuscitation.

2. Do Not Remove or Disable the Pacemaker

Action:

• Under no circumstances should you attempt to remove, disable, or tamper with the pacemaker. The pacemaker is a critical device that helps manage the victim's heart rhythm. Interfering with it can cause significant harm and may worsen the situation.

3. Correct Electrode Pad Placement

Action:

• Ensure the electrode pads are placed correctly, following the AED's visual or auditory prompts. If the pacemaker is visible as a small bulge under the skin, place the AED pads at least 1 inch (2.5 cm) away from the device to avoid direct interference.

Avoid Direct Placement Over Pacemaker:

Placing an electrode directly over the area where the pacemaker is implanted can interfere with both the AED’s function and the pacemaker’s operation. Adjust the placement slightly if necessary, but always follow the general pad placement guidelines provided by the AED.

4. Communicate with Emergency Personnel

Action:

• If you are aware that the victim has a pacemaker, communicate this information clearly to the emergency medical personnel upon their arrival. This allows them to tailor their treatment approach accordingly and be aware of any potential complications related to the pacemaker.

Information Sharing:

• Provide details about the pacemaker, the number of shocks delivered, and the victim's response to these interventions. This information is crucial for the ongoing management of the victim's condition and helps ensure continuity of care.

Conclusion: Safely and Effectively Using AEDs on Individuals with Pacemakers

When faced with sudden cardiac arrest in an individual with a pacemaker, using an AED is both safe and essential. The AED's advanced technology ensures that it can accurately assess the heart's rhythm, regardless of the pacemaker's presence, and deliver life-saving shocks when necessary.

Key Points to Remember:

• Prompt Action: Begin CPR and use the AED as soon as possible to increase the chances of survival.

• Correct Pad Placement: Ensure the AED pads are placed correctly, avoiding direct placement over the pacemaker.

• Follow Instructions: Always follow the AED's prompts and continue CPR as directed until emergency medical help arrives.

• Monitor the Victim: Pay close attention to the victim's response to the shock and provide detailed information to emergency responders.

By understanding these detailed steps and considerations, you can confidently and effectively use an AED on someone with a pacemaker, providing the best possible care during a critical emergency. The proper use of an AED, combined with CPR, can significantly increase the likelihood of survival and recovery, making your quick and informed actions truly life-saving.