John A. Stewart RN, MA
Seattle, Washington
THE NEED FOR DEFIBRILLATION BY NURSES
ARE AEDS NECESSARY FOR IN-HOSPITAL EARLY DEFIBRILLATION?
METHODS
THE NEED FOR
DEFIBRILLATION BY NURSES
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A more effective approach to
in-hospital defibrillation.
Journal of Cardiovascular Nursing, July 1996.
This article is my most complete statement of my views on the general problem of delayed in-hospital defibrillation and possible approaches to improve survival.
Defibrillation by nurses.
Letter. Resuscitation, January 1994.
This letter was written in response to an article which reported positive results from a study of performance of a group of nurses after brief training in AED use. I took that as an opening to promote early in-hospital defibrillation by nurses in general (with or without AEDs).
"A comparison of resuscitation
skills...."
Letter. Heart & Lung, 1994.
An article on basic CPR training was the stimulus (excuse?) for this critique of nurses' traditional resuscitation priorities.
Why not let staff nurses defibrillate?
Editorial. American Journal of Nursing, December 1993.
I have not received permission to republish this, but AJN is widely available.
Beyond code teams:
early defibrillation by nurses for in-hospital cardiac arrests.
Editorial. Journal of Emergency Nursing, December 1992.
This editorial (together with the article "Defibrillation training for general unit nurses" in the same journal issue) was my first publication.
ARE AUTOMATED EXTERNAL
DEFIBRILLATORS (AEDS) NECESSARY FOR IN-HOSPITAL EARLY
DEFIBRILLATION?
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________________
Yes
Early
defibrillation--the role of automated external defibrillators.
By Chris Klufas, MD. Critical Interval, Volu Number 3.
[Link to abstract] Kaye W, Mancini ME, et al.
Strengthening
the in-hospital chain of survival with rapid defibrillation by first responders
using automated external defibrillators: training and retention issues.
Annals of Emergency Medicine. 1995;25(2):163-168.
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________________
No
Delayed in-hospital
defibrillation.
Letter. Annals of Emergency Medicine, January 1996.
This letter was intended to criticize the treatment of the problem of delayed in-hospital defibrillation in the current edition of the American Heart Association's Textbook of ACLS. The recent AHA medical/scientific statement In-Hospital Resuscitation is an improvement in that it explicitly endorses use of "conventional" defibrillators as well as AEDs.
A perspective on the automatic
external defibrillator controversy.
Unpublished, December 1995.
This piece was written in response to an article in the November 1995 Annals of Emergency Medicine which criticized the FDA for misunderstanding AED technology. I thought the authors' critique had problems as well.
Are AEDs faster than manual
defibrillators?
Published on World Wide Web, December 1997.
Shock value.
Letter. JEMS, August 1994. Comment on "To focus on the forest...,"
JEMS, May 1994, by Mary M. Newman.
This letter was written in response to the article "To focus on the forest: recognizing the value of early defibrillation despite isolated failures," by Mary M. Newman, a past editor of Currents in Emergency Cardiac Care, in the May 1994 issue of Journal of Emergency Medical Services (JEMS).
Questions remain about shocking asystole.
Letter. American Journal of Emergency Medicine, May 1996.
The 1992 ACLS Guidelines "strongly discourage" shocking asystole. This letter challenges that position on the basis that the rationale is flimsy and the recommendation may impede delivery of early defibrillation. Permission to republish was not granted. The reference is:Stewart JA. Questions remain about shocking asystole. Am J Emerg Med. 1996;14(3):337-338.
Some new light has been cast on this issue by a recent case report. The reference (with a link to the abstract) is:
Amaya SC , Langsam A. Ultrasound detection of ventricular fibrillation disguised as asystole. Ann Emerg Med. 1999 Mar; 33(3): 344-6.
Dr. Amaya and I submitted a worksheet to the Guidelines 2000 Evaluation Conference, held in Dallas in September 1999. Our conclusion was that the negative recommendation discouraging shocking apparent asystole should be removed, with an explicit statement in the Guidelines noting the change. The result: the negative recommendation was dropped--quietly. For a restatement of the main points made in the worksheet, click here.
Another interesting approach
Here's a commercial site which promotes a bedside automatic external defibrillator, designed for continuous monitoring of at-risk hospitalized patients with completely automatic shock delivery. Their device received FDA approval for in-hospital use in October 1998. Disclosure statement: I have received travel expenses and an honorarium for a one-day visit to Cardiac Science, Inc. , and they are paying for Web hosting for this site.
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Defibrillation training
for general unit nurses.
Journal of Emergency Nursing, December 1992.
This article (together with the editorial "Beyond code teams..." in the same journal issue) was my first publication. It remains my most detailed account of the "nuts and bolts" of a defibrillation training program.
Determining time to
defibrillation--Abstract.
Published on World Wide Web, July 1996.
This is an unpublished abstract (except on the Web, of course). This is my current area of research--click here for an article that appeared in Resuscitation. See "Recommended Guidelines for Reviewing, Reporting, and Conducting Research on In-Hospital Resuscitation: The In-Hospital `Utstein Style'" for more on the general problem of data-gathering in in-hospital "codes."
Guidelines 2000 Recommendations
Sharon Croom Amaya MD and I submitted an evidence evaluation worksheet to the
Guidelines 2000 Evidence Evaluation Conference. Our conclusion was that
the negative recommendation discouraging shocking apparent asystole should be
removed, with an explicit statement in the Guidelines noting the change. For
a restatement of the main points made in the worksheet and relevant changes in
the AHA's Guidelines 2000, click here.
I also collaborated with Floyd A. Short MD on an evidence evaluation worksheet to the Guidelines 2000 Evidence Evaluation Conference. Our conclusion was that AED technology should not be promoted by the American Heart Association and ILCOR for use by trained healthcare providers in settings where manual defibrillators are a feasible option, unless and until the clinical superiority of AED technology is demonstrated in those settings. For a restatement of the main points made in the worksheet and relevant changes in the AHA's Guidelines 2000, click here.