When and How to Use an AED During CPR

Sudden cardiac arrest (SCA) is one of the leading causes of death worldwide, claiming hundreds of thousands of lives each year. However, survival rates can significantly improve with the prompt use of an automated external defibrillator (AED) in conjunction with cardiopulmonary resuscitation (CPR) and early defibrillation. Studies show that immediate defibrillation combined with effective CPR can double or even triple the chance of survival.

In this guide, we’ll explore the importance of AEDs, when to use them, and how to effectively integrate them with CPR to provide the best possible response during a cardiac emergency.

Understanding the Role of Automated External Defibrillator in Cardiac Emergencies

An AED is a portable medical device designed to diagnose life-threatening cardiac arrhythmias, such as ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), and deliver a shock to restore the heart’s normal rhythm. These devices are lightweight, user-friendly, and equipped with voice prompts that guide rescuers through every step, making them accessible even to those with minimal training. Understanding the importance of both CPR and AED can significantly increase survival chances in cardiac emergencies.

Understanding Sudden Cardiac Arrest

Sudden cardiac arrest (SCA) is a life-threatening medical emergency that occurs when the heart suddenly stops beating effectively. It is a leading cause of death worldwide, accounting for over 350,000 deaths in the United States alone each year. SCA can strike anyone, regardless of age or health status, and can be caused by a variety of factors, including heart disease, electrical disturbances in the heart, and other medical conditions.

SCA is often confused with a heart attack, but they are not the same thing. A heart attack occurs when the blood flow to the heart is blocked, causing damage to the heart muscle. SCA, on the other hand, occurs when the heart’s electrical system malfunctions, causing the heart to stop beating.

The symptoms of SCA can be subtle, but they often include sudden collapse, loss of consciousness, and lack of breathing or pulse. If you suspect someone has suffered a SCA, it is essential to call 911 or your local emergency number immediately and begin cardiopulmonary resuscitation (CPR) if you are trained to do so.

When to Use an AED

The use of an AED is critical in the following situations:

Having an AED nearby during a cardiac emergency is crucial, as its immediate retrieval while performing CPR can significantly enhance a victim's chances of survival.

1. Unconsciousness and Absence of Normal Breathing

• If you come across a person who is unresponsive and not breathing normally (or is only gasping), it is a strong indication of cardiac arrest.

• Gasping, also known as agonal breathing, can occur during cardiac arrest and should not be mistaken for normal respiration.

2. Signs of Sudden Cardiac Arrest (SCA)

• SCA occurs when the heart’s electrical system malfunctions, leading to irregular heartbeats that cannot sustain circulation. Common signs include:

  • Sudden collapse.

  • Loss of consciousness.

  • Absence of a pulse.

It’s important to note that AEDs are not designed to treat other medical emergencies such as heart attacks or strokes. Their sole purpose is to detect and correct irregular heart rhythms that occur during SCA.

How to Use an AED in Conjunction with CPR

Effective use of an AED involves a clear and organized response. Immediately resume chest compressions after a shock is delivered to maintain blood circulation. Below is a step-by-step guide to ensure you maximize the chances of saving a life:

Step 1: Assess the Scene and Ensure Safety

• Before approaching the victim, check for potential dangers such as traffic, electrical hazards, or unstable environments.

• Ensure both your safety and the victim's before proceeding.

Step 2: Check for Responsiveness

• Gently tap the victim and ask loudly, “Are you okay?”

• If there’s no response, proceed to the next step.

Step 3: Call for Emergency Assistance

Dial 911 or your local emergency number immediately. Provide the dispatcher with:

• Your exact location.

• Details of the victim’s condition (unresponsive, not breathing normally).

• If others are present, assign someone to retrieve an AED while you begin CPR. This ensures trained medical professionals are en route to assist while you start life-saving measures.

Step 4: Start High-Quality CPR

• Initiate chest compressions without delay. Proper technique includes:

  • Placing the heel of one hand on the center of the chest, with the other hand on top.

  • Compressing the chest at a depth of 2 inches in adults at a rate of 100–120 compressions per minute.

  • Allowing full chest recoil after each compression.

• Alternate 30 chest compressions with 2 rescue breaths, if trained. If not, focus solely on compressions.

Step 5: Retrieve and Prepare the AED

• Once an AED arrives, turn it on and follow the voice prompts.

• Some AEDs require pressing a button to start, while others activate automatically when the lid is opened.

Step 6: Expose the Chest and Attach Pads

• Remove clothing or obstructions from the victim’s chest. Use scissors if necessary.

• Shave excessive chest hair if it prevents good pad contact. Most AED kits include a razor for this purpose.

• Attach the electrode pads according to the diagrams:

  • One pad goes on the upper right chest.

  • The other pad goes on the lower left side, below the armpit.

Step 7: Analyze the Heart Rhythm

Ensure no one is touching the victim while the AED analyzes the heart’s rhythm and instructs you to stop CPR. The device will prompt you to stay clear.

Step 8: Deliver a Shock if Advised

• If a shockable rhythm (VF or pulseless VT) is detected, the AED will instruct you to press the shock button.

• Ensure everyone is clear of the victim before delivering the shock.

Step 9: Immediately Resume Chest Compressions

• After delivering the shock, resume chest compressions without delay.

• Continue CPR for 2 minutes (about 5 cycles of 30 compressions and 2 breaths) or until the AED reanalyzes the rhythm.

Step 10: Alternate CPR and AED Use

• Follow the AED’s prompts to alternate between CPR and rhythm analysis.

• Repeat cycles until one of the following occurs:

  • The victim shows signs of life (e.g., breathing, movement).

  • Emergency medical personnel arrive and take over.

  • You are physically unable to continue.

Importance of Uninterrupted Chest Compressions

Uninterrupted chest compressions are a critical component of CPR and are essential for maintaining blood flow to the brain and other vital organs during a cardiac arrest. When performed correctly, chest compressions can help to keep the heart pumping blood, even if it is not beating on its own.

It is recommended that chest compressions be performed at a rate of 100 to 120 per minute, with a depth of at least 2 inches (5 cm) and a complete recoil of the chest between compressions. It is also essential to minimize interruptions in chest compressions, as this can reduce the effectiveness of CPR.

In addition to chest compressions, rescue breathing is also an important part of CPR. However, if you are not trained in CPR or are not comfortable performing rescue breathing, you can still provide effective CPR by performing chest compressions only.

Special Considerations When Using an AED

1. For Pediatric Patients

• Use pediatric pads or settings if available for children under 8 years old or weighing less than 55 pounds.

• If pediatric pads are not available, standard adult pads can be used, ensuring they do not overlap.

2. In Wet Environments

• If the victim is wet, dry the chest thoroughly before attaching AED pads.

• Avoid standing water during defibrillation. Some AEDs are designed for outdoor use and can function in moist conditions.

3. Implanted Devices

• Be cautious of pacemakers or defibrillators. Avoid placing AED pads directly over these devices, usually visible as small lumps beneath the skin.

4. Medication Patches

• Remove any medication patches (e.g., nitroglycerin) from the chest area before applying AED pads to prevent burns or interference.

The Importance of Training and Familiarity

While AEDs are designed for ease of use, familiarity with the device can boost your confidence during an emergency. Regular CPR and AED training can prepare you to act decisively. Here are some ways to stay prepared:

• Participate in CPR/AED Certification Courses: These courses provide practice with real AED devices and prepare you for a variety of emergency scenarios.

• Review AED Instructions Regularly: Familiarize yourself with the AEDs available in your workplace, gym, or community.

• Practice Scenario Drills: Simulate cardiac emergencies to reinforce your response skills.

Why Early AED Use Matters

Time is critical in cardiac emergencies. For every minute that defibrillation is delayed, the chance of survival decreases by 7–10%. Rapid defibrillation combined with effective CPR ensures the heart receives oxygenated blood, keeping blood flowing to vital organs, preventing brain damage, and increasing the likelihood of survival.

Preparing for Cardiac Arrest

While cardiac arrest can strike anyone at any time, there are steps you can take to prepare for this medical emergency. Here are a few tips:

• Learn CPR: Take a CPR training course to learn how to perform chest compressions and rescue breathing.

• Know where the AEDs are located: Automated external defibrillators (AEDs) are devices that can help to restore a normal heartbeat during a cardiac arrest. Knowing where the AEDs are located in your community can help you to respond quickly in the event of a cardiac arrest.

• Keep a phone nearby: In the event of a cardiac arrest, it is essential to call 911 or your local emergency number immediately. Keeping a phone nearby can help you to respond quickly.

• Stay calm: If someone suffers a cardiac arrest, it is essential to stay calm and follow the proper procedures for CPR and AED use.

By taking these steps, you can help to prepare for cardiac arrest and increase the chances of survival for someone who suffers a SCA.

The Chain of Survival

AEDs play a vital role in the chain of survival, which includes:

1. Early recognition and calling for help.

2. Immediate CPR to maintain circulation.

3. Rapid defibrillation with an AED.

4. Advanced care from emergency medical personnel.

5. Post-cardiac arrest care.

By understanding this chain and acting promptly, you can make a lifesaving difference.

Conclusion: Empower Yourself to Save a Life

The ability to use an AED in conjunction with CPR is a skill that everyone should possess. By following the steps outlined above, you can confidently respond to cardiac emergencies and become a vital link in the chain of survival. Remember, your timely action can be the difference between life and death for someone in cardiac arrest.

Make a commitment to educate yourself, practice your skills, and encourage others to do the same. Together, we can build a community of prepared and empowered responders.