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automated external defibrillator; wearable defibrillator (AED, LifeVest)

portable, electronic medical devices that automatically sense cardiac arrhythmias (i.e. ventricular fibrillation) & either automatically deliver electrical stimulation or advise the user to do so in order to re-establish a viable heart rhythm. Indications: - cardiac arrest - ventricular fibrillation * indications for Lifevest - same as for implantable ICD, but when - temporary contraindication exists for implantable ICD - indication may resolve - bridging device in heart transplantation [5] Contraindications: - Lifevest should not be used where non-arrhythmic risks outweigh arrhythmic risks. especially where life expectacy is < 6 months [5] Clinical significance: - use in patients with in-hospital cardiac arrest does not lower mortality [2] - use in post-MI patients with LVEF < 35% does not lower mortality [6] Procedure: - automated external defibrillators deliver 150-360 J Notes: - history of malfunction issues [3] - LifeVest wearable cardioverter defibrillator approved for use in children [4]

Related

defibrillation (electrical cardioversion, automated external difibrillation, AED)

General

defibrillator

References

  1. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
  2. Chan PS et al. Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA 2010 Nov 17; 304:2129 PMID: 21078809 - Haines DE. Automated external defibrillators and the law of unintended consequences. JAMA 2010 Nov 17; 304:2178. PMID: 21078808
  3. FDA News Release. January 28, 2015 FDA takes steps to improve reliability of automated external defibrillators. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431907.htm
  4. FDA News Release. December 17, 2015 FDA approves wearable defibrillator for children at risk for sudden cardiac arrest. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm466852.htm
  5. Piccini JP Sr, Allen LA, Kudenchuk PJ et al Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death, A Science Advisory From the American Heart Association. Circulation, March 28, 2016 PMID: 27022063 http://circ.ahajournals.org/content/early/2016/03/28/CIR.0000000000000394.full.pdf+html
  6. Olgin JE et al. Wearable cardioverter-defibrillator after myocardial infarction. N Engl J Med 2018 Sep 27; 379:1205. PMID: 30280654 https://www.nejm.org/doi/10.1056/NEJMoa1800781 - Field ME, Page RL. Another shock for sudden death prevention after myocardial infarction. N Engl J Med 2018 Sep 27; 379:1274 PMID: 30257160 https://www.nejm.org/doi/10.1056/NEJMe1809832