Defibrillation

[EricTAMUCC-BSN, BSN, RN]

Have movies like Flatliners and television shows like ER overinflated the success of defibrillation?

[NurseFirst]

Have movies like Flatliners and television shows like ER overinflated the success of defibrillation?

I used to be amazed how often people were shown to have been rescued from cardiac arrest on the TV show of yore, Rescue 9-1-1. But that was rescue with CPR being provided for the first several minutes.

There was a study done in a casino, (casinos?) where the security guards were trained in the use of AEDs. An amazing 6 out of 10 people who collapsed with sudden cardiac arrest survived!

So...let's see...in Flatliners there was no question about immediate defibrillation (although what they were doing was not putting people into v-fib but into asystole--a much less likely rhythm to be resuscitated from.). On ER, it all depends--are they showing witnessed arrests, that happen in the hospital, or people who were found to be in cardiac arrest at the time the paramedics arrived 'on scene' ? Another difference, of course, is that there may be more cardiac arrests shown on ER that are due to trauma, instead of due to sudden cardiac arrest.

I am being trained as a CPR Instructor. I can tell you that the news about the AED survival rate is quite exciting and needs to be heard by more people.

NurseFirst

[NotReady4PrimeTime, RN]

There are shockable rhythms and rhythms that will not respond to shocks. Asystole is not a shockable rhythm. If you can generate some electrical activity with CPR then shock might work. I find that movies and TV will shock for just about any reason, and unrealistically inflate the number of successful resuses. It's the very dramatic effect of the shock that they're interested in, since giving round after round of epi, bicarb, atropine and amiodarone isn't nearly as exciting. I was watching "Medical Investigation" the other night, the episode about Marburg. An infected patient went into V-fib and was successfully defibrillated. Seconds later, one of the NIH doctors checked a carotid pulse and pronounced the patient to be STABLE now. Right. My definition and timeline of "stable" must be completely different.

The AED issue only muddies the waters a bit because the AED itself determines whether the rhythm will respond to shock or not. The user simply follows instructions given by the disembodied voice.

[EricTAMUCC-BSN, BSN, RN]

An amazing 6 out of 10 people who collapsed with sudden cardiac arrest survived!

I wonder if any of those people would have survived without defibrillation. I also wonder if they were all in true ventricular fibrillation. I do believe defibrillation is a quick and effective intervention until the underlying problem can be corrected. You are probably aware that defibrillation can kill as quickly as it can heal. However, I agree with your view that defibrillation is a life saving intervention when minutes count and its use should not be discouraged but we should aire on the side of caution during execution. It is good to see the self instructing / self analyzing AEDs being utilized for the public, this I am not so concerned about. I am more worried about manual defibrilation in stressful situations and appropriate training.

It's the very dramatic effect of the shock that they're interested in, since giving round after round of epi, bicarb, atropine and amiodarone isn't nearly as exciting.

You are so right.