PubMed · 15032161
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2004. Automatic defibrillators save lives.. https://pubmed.ncbi.nlm.nih.gov/15032161/
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We describe the case of a 59-year-old gentleman with severe dilated cardiomyopathy requiring implantation of a dual-chamber biventricular implantable cardioverter-defibrillator (ICD). High defibrillation thresholds (DFT) were encountered at implant with an inadequate defibrillation safety margin. Testing of all possible shock vectors/polarities with and without the SVC coil and optimization of the distal RV coil position all proved inadequate. A satisfactory defibrillation safety margin was achieved following placement of a second lead in the coronary sinus to enable biventricular defibrillation. This case highlights an additional strategy for combating high DFTs and is an option even in dual-chamber biventricular ICD systems.
Time to defibrillation is the most important controllable factor for survival. Hospitals also must respond to cardiac arrest in nonpatients (i.e., visitors and staff members) within their public areas. In-hospital cardiac arrest teams may be unaccustomed to resuscitating visitors under what is essentially a prehospital environment. All cardiorespiratory arrests over a 2-year period at the investigators' institution were reviewed. Six of the 749 in-hospital cardiorespiratory arrests (0.8%) occurred in visitors within public areas of the hospital. The average time to defibrillation for the public area cohort was significantly longer than for the in-hospital arrest control group (12.3 vs 2.5 minutes, p <0.0001). Further research is needed to reduce the time to defibrillation and consequently improve survival outcomes for cardiac arrest in hospital public areas.
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