CPR vs. AED; When to Drop the Paddles
Many of our readers would never admit in public that they’re not 100 percent sure when to drop the AED paddles, opting for traditional CPR.
There are few cases where a heart has stopped beating and the AED is a bad idea, but that does not mean all CPR efforts must involve an AED.
To get to the bottom of this, I’ll first review CPR and AED terminology, separating CPR from BSL. We’ll come back to what those two acronyms are in a second.
Then we’ll cover in as much detail as possible when and why one should use an AED, but also when and why one should not use the AED.
For the record, this is not meant to be medical advice or serve as training in any way. It is a blog intended for entertainment purposes only. Refer to an authorized certification organization for the most current data on CPR and AED administration. I suggest you start with the Australian Resuscitation Council. Medshop Australia assumes no responsibility for your competency with your applied CPR techniques nor for your use of any AED units.
Now that we have that out of the way, let’s answer your questions about when to use CPR over an AED...
First, what does CPR stand for?
For some, they find the meaning of CPR in the words that make up the acronym, cardiopulmonary resuscitation.
For someone whose life was saved by CPR, the term means so much more. The acronym stands for life itself.
The act of applying the standard of CPR, ensuring that the body receives oxygen until advanced care can take over, could involve chest compressions, mouth-to-mouth resuscitation, and in today’s world, use of the AED. We’ll come back to that in a moment.
The basic training of CPR, outside of the AED, uses almost no equipment. "Almost," as some certified AED administrators use CPR barrier devices for mouth-to-mouth to prevent transmission of viruses and bacteria.
A simple, inexpensive option many medical professional keep handy are face shields, which can stuff into keyring-sized pockets.
How does CPR compare to Basic Life Support (BSL)?
In short, CPR and BSL are similar as they share the same goal: keep the airway open, the heart beating, and the circulation of oxygen to the body going without the use of advanced life support.
In some countries, the two are interchangeable. In the UK and Australia, however, there is a slight difference.
A BSL certification is a little more advanced, not so much as an advanced life support (ALS) certification, but more than a standard CPR certification. That said, in practice, there is little daylight between these two certifications.
Some BSL certifications teach advanced methods like the administration of oxygen, team approaches, and in-hospital procedures, but the two certifications are close neighbours.
In the case of someone seeking a certification for employment, it’s best to make sure with the employer if they consider the certifications as equivalent qualifiers.
To someone suffering a catastrophic cardiovascular event, it will make little difference whether their attendant is CPR or BSL certified. Both are only slightly better than doing nothing without the use of an AED.
What is the AED?
The acronym AED stands for Automated External Defibrillator, but advocates would argue it stands for so much more.
Defibrillator AEDs, like the ones produced by Laerdal, Zoll, and HeartSine allow untrained people to administer ventricular fibrillation (VF) to a human body that has suffered a cardiovascular event such as a heart attack.
The AED has changed the fate of cardiac arrest victims forever. Before their introduction, without medical attention, standard CPR was the only chance someone had of surviving a cardiac event.
Sadly, CPR barely improves chances of survival for someone suffering a cardiac arrest without any damage to the body or brain, but it’s better than nothing.
Without CPR, the chances of survival drop to zero. The modern AED, however, changes those chances dramatically.
In cities where CPR is widely practised and AEDs are readily available, success rates range from 25 to better than 60 percent.
The high end of the data comes from cases where the AED came into play. In the absence of CPR training and AEDs, success rates drop closer to 10 percent.
It’s the AED units that improve these data the most.
Unlike the hospital defibrillation machines, which predated AEDs and required specific training, these new consumer-friendly defibrillators are accessible to even the untrained.
As stated by Defib First Australia,
“Modern AEDs cannot be used inappropriately and it is not possible to do any further harm to a cardiac arrest victim who is, in effect, dead and will remain so unless defibrillated.”
As far as the value of the AED on cardiac patients, the same site said it best:
“An AED is the most vital piece of emergency first aid equipment and the only effective first aid treatment for cardiac arrest.”
Why is a defibrillation important in CPR?
Think of defibrillation as the super-power of CPR. Like any superhero, it’s not 100 percent effective, but it’s way more effective than more pedestrian efforts like mouth-to-mouth and compressions.
As mentioned in the previous subsection, without VF, one’s chances of surviving a cardiorespiratory event are low, around one in ten.
Traditional CPR may keep a body from severe brain damage if the administrator can keep the oxygen flowing well enough.
But, an AED can force the afflicted person’s own heart to beat again, doing the work of pumping oxygen-rick blood through the body provided the airway is open.
There is no substitute in the wild for one’s own heart doing its job.
When should you deliver shock from AED?
In short, whenever someone’s heart has stopped beating, that’s the best time to use the AED. At that point, there is little you can do to make things worse.
Few people, way fewer than 1 percent, will come back to life once that happens. The good news is that any effort to get their heart beating is a step in the right direction.
That said when a heart stops beating time is of the essence. After six minutes of oxygen depletion, the brain begins to die. Few survive the 20 minute window without serious damage, if they make it that far.
Damage can and will likely occur long before that point. That means you have minutes to get the oxygen moving through the body again.
In the heat of such a moment, even though time seems to slow down, minutes slip away quickly.
The good news about today’s AEDs is that they will not deliver a shock to a body with a beating heart. As such, there is no bad time to grab the AED if someone has fallen down.
You can always NOT use it or try anyway, but if you wait any time to bring an AED to the scene, it may be too late. For this reason, most response training advises you to delegate retrieval of the nearest AED in the first moments of the incident.
It’s almost easier to define when you should NOT deliver a shock from an AED.
When not to use an AED?
So the big question, when is the appropriate time to stop using AED, opting for CPR instead? The simple answer is any case where a person’s heart is clearly still beating.
Some examples that come to mind are when someone has fallen but is still alert. They may have sprained an ankle or broken a bone, but they are otherwise cognizant.
The easy test is to ask the person, “are you okay?” If they can answer, there’s a good chance you DON'T need the AED.
That said, the number of cases where the circumstances of a victim escalated from consciousness to unconsciousness, would be impossible to calculate.
A simple sprained ankle during a sporting event might not be enough to warrant sending someone to retrieve the AED, but discovering someone on the ground for unknown reasons who seems responsive at first shouldn’t be reason enough to rest on your laurels.
Until you know more about the situation, it can never hurt to retrieve the AED, especially if you’re not alone.
Another case where you would not want to use the AED is where doing so would present a danger to you, say in an unstable environment like a collapsing building or in a flooded room. You could suffer electrocution even in a small puddle.
In such cases, it would be acceptable to move the fallen person to a dry spot, but you would want to remove their wet clothing and towel them off before administering shocks.
Do you use an AED on someone with a pacemaker?
The simple answer is yes, but there are a few caveats to AEDs used with pacemakers. Know that pacemakers of any sort should withstand external defibrillation without a problem.
The problem with the pacemaker placement is that it usually coincides with the placement of one defibrillator pad. As such, you’ll have to get as close as possible to the correct location.
Some AED units may assist with placement. Others may reject the placement. You may need to place the pad directly on the pacemaker, but try to avoid this.
In any case, remember that any effort you make is better than none. This person only stands to improve their situation as they are essentially terminal without a heartbeat.
Once the pads are in place, run the AED as normal and keep your hands off. After a successful resuscitation, their pacemaker may require attention from a professional, but that’s not a reason to avoid AED administration.
Can you use an AED on an infant?
In short, yes. Hopefully, you'll live your entire life and never have to face this stressful situation; a child without a heartbeat.
But, if you find yourself in this spot, know that there are special pads and accompanying instructions with most AED units for delivering a shock to a child. The cutoff age is eight.
Any human under eight years old will need specially-sized defibrillation pads.
You should NEVER use the adult pads on a child under the age of eight, even if you have no other options. The risk is not only to the child but to those in the near vicinity.
Again, check with your accredited CPR/AED organization for more details on that.
When push comes to shove, humans will always have basic CPR as an option when there are no other options available. The likely future for humanity is one where AEDs are everywhere.
We already have drone-based devices which deliver AED life-support faster than any vehicle or human. These systems can reach beyond the walls of a given business or municipality.
It won’t be long before these devices are smart enough to completely take over, but there will always be remote situations where trusty CPR comes in handy.