Cardiac Arrest

[dralex]

HAs anybody else seen the recent ads in the back of yachting magazines for onboard defibrillators? More to the point, does anybody think it is justified to spend over £2000-3000 on a piece of kit like this?

Unfortunately real life is not like Baywatch, where after some gentle intervention, people get up and are back in the bar. I feel this product is playing on peoples fears. Unless you have a helicopter to lift you off pretty sharpish, your stuffed anyway if you have a cardiac arrest, even if you have a defib, IMHO.



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[AlexL]

I'm not a doctor, but I have some 1st aid training, there are now first aid courses which train you to use defribs. I think they are a good Idea , especially if you are well offshore. If someone has a cardiac arrest irriversible brain damage will start to occur in about 8-10 minutes and death in about 12-15. The point of mouth to mouth and CPR is to keep the blood supply oxygenated and circulating, until rescue arrives. In situations where rescue is unlikely then the next stage (i.e defribulation) needs to be available locally (hence defribulators are carried by alot of major airlines). I have been lead to believe in my training that if the arrest is caused by a shock or trauma (i.e there is no real medical reason, like old age, or blocked arteries) then it should be relatively easy to restart the heart, the stats show that early avaialbilty of defribulation means a very high survival chance.
In seattle all emergency services (fire, police etc.) carry defribs and the heart attack stats are the lowest in all of America.
The bottom line IMHO are that yes they work, and are useful but at a few grand you really need to balance the risk - for most people with finite budgets the risk analysis would indicate that the 2grand is better spent on other stuff - Radar, liferafts etc.

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[snowleopard]

if you believe some first aid instructors, a few simple operations (mouth-to-mouth, cpr) and you are guaranteed to be able to raise the dead. one instructor shook me out of my complacency by revealing that these work in no more than around 15% of cases. i suspect this machine is in the same category.

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[AlexL]

The point is slightly different - in my understanding the chance of restarting the heart by using CPR is minimal, the point is to keep the blood circulating by squeezing the heart (and oxygented by mouth-to-mouth) so that the brain can be kept alive, until the medical services arrive - then the first thing they do is some form of defribulation - which is the bit that is supposed to restart the heart. The point being that if you are out of the range of EMS then you need to be able to do this bit yourself aswell.
My first aid instructor made the point that in 9/10 cases (this is for CPR, not defribulation) they will still die (unless defribultation occurs quickly), but when you arrive a victim is has no pulse and no breathing is ,in effect, dead and nothing you can do can make that worse.

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[dralex]

ALexL- you're totally right about CPR- it will not bring anybody back. The problem with all of this is that if you have a cardiac arrest, it's a fairly major thing to happen and it's not just a case of defibrilating- you're quite right in terms of younger people arresting ie in the sailing setting it is usually due to trauma or hypothermia or drowning, therefore potentially reversible. You do however still need intensive medical intervention following an event and most boats are not equipped to give this. As an example, if someone arrests due to trauma and hypovolaemia, a defib is not going to be much use- you need other interventions such as large quantities if IV fluids. Hypothermia is different in that in a way it can give you more time, but until someone is warm, their heart will keep going off into different rhythms. Things like head injury also need serious intervention.

If you look at the adverts, they show older people in the scenario. They stand less of a chance because the arrest may well be secondary to other illnesses.

The reason community defibs are good is that intensive medical care is available fairly quickly.
Best chance is knowing CPR and hoping you can get to an A E resus really fast. Alternatively hope there's fully equipped ITU doctor on the helicopter.

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[Cutter]

Who can give me any information about the incidence of cardiac arrest afloat? Anecdotal stories apart - is this a real problem?
Cardiac arrests occurs (generally) either as a result of coronary artery thrombosis (the classic heart attack) or as a terminal event when all else has gone to pot - such as in drowning etc) To diagnose the former you need to have and read an ECG (although modern defib units often provide some rudimentry analysis and give advice). In the latter case removing the causative problem will be more effective.
I think these devices are overrated, expensive and pander to our fears. Much better to have invested in some red wine to keep the coronary arteries free in the first place!!

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[ubuysa]

If I thought that either I or one of my crew was ever likely to need the assistance of a defibrillator I wouldn't put to sea. What next, a mobile surgery????

Just my opinion.....Tony C.

<hr width=100% size=1>There are 10 kinds of people, those who understand binary and those who don't.

 

[dralex]

I agree totally about drinking plenty red wine. I don't know incidence figures for cardiac arrest while afloat, but suspect the RNLI or MCA may be able to tell us. I think that it's really low compared to other serious injuries such as head injury and fractures. I also suspect that boating people are a self selecting in being generally a bit fitter and healthier ( there will always be exceptions /forums/images/icons/laugh.gif. )

in answer to you question, no it's not a real problem IMO.

Having been in hundreds of arrest situations, even when you have all the kit and personnel, the chances are still pretty low, so spend your money on red wine and luxuries.

This is all IMHO just in case the company take offence.

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[dralex]

Pete Goss's book CLose on the Wind was interesting- he did surgery on his own elbow- now that takes balls. You probably couldn't defib yourself /forums/images/icons/laugh.gif

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[jimi]

Red wine ..

.. the stuff's overrated as medicine ... its only ever made me wish I was dead .. much better off with apirin & irn bru...

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[Allegro]

Defibrillators have made a significant difference to survival from out of hospital cardiac arrest where carried by emergency services, and probably where (particularly in the states) they've been installed in shopping malls and other public places. However, in these situations thousands of different people pass by every day, so the chances of one or two of them having a survivable cardiac arrest is not insignificant. On the other hand, a defibrillator on your boat will be exposed to perhaps half a dozen people for just a fairly small number of days a year. The chances of a situation arising where a defibrillator will be of use must be so much lower that I'd doubt it was a very cost effective purchase. I'd go with the emerging consensus that the money's better spent on red wine!

Cheers
Patrick

<hr width=100% size=1>Sailing a Victoire 25 on the Scottish West Coast

 

[bedouin]

Interesting Question

The care received in the first few minutes after a heart attack is critical to your chances of survival or making a full recovery. Offshore there is no chance of external aid getting to you within the critical window - so having a defib machine on the boat would greatly increase your chance of living (assuming that there was a trained 1st Aider on board).

The price of £2000 seems excessive for what is essentially a very simple piece of kit but it puts it in the same area as a good liferaft. It would be interesting to know whether there is more chance of our lives being saved by the liferaft than by the Defib. I imagine there is but the chances of using either piece of kit are very small.

That said I carry a liferaft, and won't be rushing out to buy a defib /forums/images/icons/smile.gif

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[Roberto]

I\'ll buy two

as I am half deaf, the second defrib will be used to resuscitate the crew I sent to the other world after trying to defrib him with the first one



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[dralex]

Re: I\'ll buy two

Fortunately, modern automatic defibs should stop you doing this.

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[dralex]

It may increase your chance of having your heart restarted for a time, but probably won't increase your chances of living unless you get quick specialist intervention as well.

Allegro makes a good point in terms of the chances of the defibrillator being exposed to a cardiac event on a boat- very slim.

I like the analogy with the liferaft, but the liferaft is a very specific bit of maritime kit- there is far more chance of being exposed to a maritime emergency. BTW- I carry a liferaft and EPIRB.

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[Peppermint]

Re: Problems in use

Defibs are best left to experts. I don't think you get to that level by doing a one day course and reading the manual.

Heart rhythems are tricky things to detect and by jolting a heart with the defib you can do more harm than good.

These auto defib units are supposed to be foolproof in use. That means they won't work if they aren't needed. Professionals I've just asked, tell me that's not the case. It might be the usual pro v amateur debate but they don't think the public should be let loose with these things.

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[jimi]

Surely if the need arose you could improvise a defibrithingie using a couple of jump leads to the alternator output?

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[dralex]

That's more like it- a proper PBO response /forums/images/icons/laugh.gif. You aslo need to include some marine ply in the plan.

<hr width=100% size=1>Life's too short- do it now./forums/images/icons/wink.gif

 

[zefender]

pour old engine oil over chest, take lead from invertor and connect to anchor chain. Raise chain on halyard and lower to casualty. Switch on power, raising and dropping anchor as required.

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[steve_cronin]

Well, I'm amazed (or am I?)

Let me tell you that if my ticker stops and I'm going to be dead in ten minutes of less then anyone (including my two medical student sons) can shock me as many times as they like. I will have nothing to loose.

Certainly don't get one unless you've had the proper training (BHF do a course which I must attend to update as these defibs weren't around when I did mine) but if like us you intend to spend a lot of time on your boat a long way from western civilisation then one of these proved life recoverers might be money well spent for a lot of us overweight, high BP, high collesterol middle aged matelots but CERTAINLY well spent if some primitive shore power set up or your own inverter/generator decides to put a stop to YOUR circulator pump!

Steve Cronin



<hr width=100% size=1>The above is, like any other post here, only a personal opinion