Cardiac Defibrillation by Nurses

When you experience cardiac arrest, your heart stops beating. It can stop beating as a result of an obvious illness or an injury, or also stop unexpectedly for a variety of reasons. When this happens it is called “sudden cardiac arrest.” According to the American Heart Association, brain damage begins after four to six minutes, and death can occur within minutes unless you are defibrillated. With the introduction of automatic external defibrillators (AEDs) hospitals and nurses are reexamining the role of noncritical care nurses in defibrillation and the use of AEDs.

Defibrillator History

• In 1947, Dr. Claude Beck was the first to use a defibrillator successfully. It was on a 14-year-old boy during surgery. Later, Beck’s defibrillator was used on patients in settings other than the surgical suite. By 1950 Beck’s cardiopulmonary resuscitation techniques were being used to educate other cardiac specialists. Over 3,000 doctors and nurses received training over the next 20 years, but defibrillator use was generally restricted to the critical care staff and code teams.

Defibrillators in Hospitals

• Survival following cardiac arrest in a hospital setting is directly related to the rapid response of medical staff trained to perform defibrillation. For each minute you go without the procedure following arrest, your survival rate decreases by 7 to 10 percent. In the past, most of the hospital staff trained to use defibrillators were in critical care areas such as the emergency rooms and cardiac intensive care units (CICU). This often caused delays getting staff and equipment—often called the “crash team”--to patients outside these critical care wards. The 2006 Joint Commission of Accreditation of Healthcare Organization’s manual for hospitals recognized the problem when it added that, "Resuscitation services [must be] available throughout the hospital."

Automatic External Defibrillators

• The automatic external defibrillator (AED) was originally planned as a tool for the emergency medical teams (EMT). As the technology improved and the benefits became more obvious; AEDs became more available to the general public. Today, it is not unusual to see AEDs at airports, golf courses, football stadiums, shopping malls, nursing homes and even jails. Hospitals have formed code committees to study defibrillation times in noncritical areas in an effort to develop the most effective protocols for delivery regardless of the equipment.

Nurses

• Nurses are the focal point of patient contact and care in a hospital setting. As the availability of AEDs grew, studies to determine the best AED protocols called for taking advantage of the nurses staffed in noncritical care areas to deliver the procedure. In 2005, Boston Medical Center reported on their two-tier system that allowed use of AEDs by the bedside nurse, and then manual defibrillators by the code team when it arrived. A major effort during the trial period was gathering the feedback of the nurses involved. According to the August, 2005, issue of "Critical Care Nurse," the nurses who used the AEDs “…reported a high level of satisfaction and thought that AEDs should be considered for noncritical areas of the hospital."

The Future

• AED training for the noncritical care nurses is paying significant benefits in many ways. The number of hospital patients who expire from sudden cardiac death (SCD) has decreased and more nurses are responding to life-threatening situations wherever they confront them. Armed with their understanding of their value, nurses have become a vocal group calling for locating more AEDs in public places. In the future, we can expect that nurse defibrillation will become a routine skill.