Hey all,
A comment was posted on this thread that I thought was worth a better venue than just remaining in the comments section. I have posted the comment/question below. Please feel free to add your introspect. Please leave a comment on this post rather than the last one.
Posted by Jason…
My daughter went into ventricular fibrillation last June on the last day of school. The EMTs were over in 3 minutes (the fire station / paramedic unit is next door to the school). The paramedics were not able to get her heart rhythm going while at school or during the 10 minute ride to the hospital. What complicated things was her pacemaker. Actually it took the ER a half hour to get her back and only after my wife suggested they find the electrophysiologist and turn the device off. She was without a pulse for over 45 minutes and died 4 days later.
My question is related to the procedure necessary to restore the heartbeat for patients with implanted pacemakers. I understand that EMTs are not equipped with devices that would turn a pacemaker off. Do you think that is essential? Also, should the defibrillators be placed directly above the pacemaker? Is that recommended? Why not
What do you all think?
I remember hearing that EMS used to use industrial magnets to de-activate pacemakers and defibrillators that were malfunctioning. I don’t know if this would still work. Doctors obviously didn’t like when paramedics would turn off pacers and externally pace a patient (TCP)
I remember hearing that EMS used to use industrial magnets to de-activate pacemakers and defibrillators that were malfunctioning. I don’t know if this would still work. Doctors obviously didn’t like when paramedics would turn off pacers and externally pace a patient (TCP)
I asked a medic I know and got this response. It was written responding directly to Jason, so EMS folk can glaze over the explanations.
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Disclaimer: This was written on a Blackberry between calls, so cut me some slack.
Many models of pacemakers and implanted defibs can be stopped or reset if exposed to a very strong magnetic force. Many units carry them, but not all. They can be used to stop a malfunctioning device or stop it from interfering with other resuscitation effort. As far as any specialized electronic device to shut down the pacer is concerned, it is likely a different piece of equipment for different makes and models and it would not be possible, let alone practical to carry all of them.
In the absence of some sort of malfunction, I doubt that the pacer itself was actually impeding her hearts ability to beat, as it is designed to kick in and create an electrical impulse to make the heart beat as opposed to stopping it from doing so. The pacer kicks in only when the heart rate drops below a preset rate. It could be that her device was a combined pacemaker/implanted automated defibrillator (IAD) and it was being triggered by detection of the V-Fib and was attempting defibrillation.
Unfortunately some patients will go into asystole (total absence of detectable electrical activity, aka flat line) after being defibrillated. You have the best chance of regaining a spontaneous pulse when defibrillation is carried out in conjunction with well coordinated chest compressions, specifically following each shock with a two minute cycle of uninterrupted chest compressions.
A reassessment of the heart rhythm should then be made and either defibrillation repeated if the patient is still in V-fib or V-tach, or other interventions if another rhythm is found. Stopping the IAD device would keep it from interfering with this sequence.
Without knowing exactly how your daughter responded to defibrillation other treatments implemented by the EMTs I cannot be advise you any further in that respect. Any additional underlying heart conditions, which led to her needing the pacer, could have interfered with her hearts ability to produce its own intrinsic electrical impulse and subsequent ability to maintain a pulse after the V-fib activity was corrected.
EMTs are taught to place defib pads as close to the normal sites in patients with a pacemaker, but just to be sure they are not on top of or touching the device. Preferably at least one to two inches away. If a magnet or other device is available it can also be used prior to implementing any additional external electrical therapy.
I hope this gives you a better understanding.
I asked a medic I know and got this response. It was written responding directly to Jason, so EMS folk can glaze over the explanations.
*****************************************
Disclaimer: This was written on a Blackberry between calls, so cut me some slack.
Many models of pacemakers and implanted defibs can be stopped or reset if exposed to a very strong magnetic force. Many units carry them, but not all. They can be used to stop a malfunctioning device or stop it from interfering with other resuscitation effort. As far as any specialized electronic device to shut down the pacer is concerned, it is likely a different piece of equipment for different makes and models and it would not be possible, let alone practical to carry all of them.
In the absence of some sort of malfunction, I doubt that the pacer itself was actually impeding her hearts ability to beat, as it is designed to kick in and create an electrical impulse to make the heart beat as opposed to stopping it from doing so. The pacer kicks in only when the heart rate drops below a preset rate. It could be that her device was a combined pacemaker/implanted automated defibrillator (IAD) and it was being triggered by detection of the V-Fib and was attempting defibrillation.
Unfortunately some patients will go into asystole (total absence of detectable electrical activity, aka flat line) after being defibrillated. You have the best chance of regaining a spontaneous pulse when defibrillation is carried out in conjunction with well coordinated chest compressions, specifically following each shock with a two minute cycle of uninterrupted chest compressions.
A reassessment of the heart rhythm should then be made and either defibrillation repeated if the patient is still in V-fib or V-tach, or other interventions if another rhythm is found. Stopping the IAD device would keep it from interfering with this sequence.
Without knowing exactly how your daughter responded to defibrillation other treatments implemented by the EMTs I cannot be advise you any further in that respect. Any additional underlying heart conditions, which led to her needing the pacer, could have interfered with her hearts ability to produce its own intrinsic electrical impulse and subsequent ability to maintain a pulse after the V-fib activity was corrected.
EMTs are taught to place defib pads as close to the normal sites in patients with a pacemaker, but just to be sure they are not on top of or touching the device. Preferably at least one to two inches away. If a magnet or other device is available it can also be used prior to implementing any additional external electrical therapy.
I hope this gives you a better understanding.
Fire Critic thanks for the reposting giving my message a chance of a wider viewing and response. EMT Tim thanks for the response and it definitely helps but I would like to add a bit of background material that might help in sharpening the response in any way.
While still in utero my daughter was diagnosed with congenital heart problems and the obstetrician was recommending aborting the fetus. After talking to a couple of influential specialists (prenatal cardiologist and a thoracic surgeon) we decided to proceed to full term. The moment she was born she was fitted with a pace maker (no defibrillator) and had been maintaining one until she died (at 10 years & 6 months). She was diagnosed with a complete heart block, leaking heart valves, AV Canal defect and a slightly enlarged aorta. All of these (expect for the aorta) were addressed successfully in her open heart surgery about 6 months after birth.
She continued quarterly visits to the cardiologist and the electro-cardiologist without any sign of complication. The only time she visited the hospital following the open heart was for pacemaker maintenance. From her lifestyle you would have never known her condition. She was into soccer, volleyball, basketball and anything that kids her age were into.
The day she went into ventricular fibrillation she was watching a kickball match and passed out falling on the lap of classmate behind her. From the conversations I had with the EMT in charge of the call he said it was the hardest call he had made all year. According to the paramedic he used chest compressions and discharged the paddles on my daughter continually. A number of times he would see what he thought was a pulse but he said it was a reading from the pace. That is when he voiced his frustration at not having the ability to turn off the device. That is also when he mentioned that the protocol calls for the paddles to be clear of the implantable device.
Just a side note which may have no bearing but a chest X-ray showed particles. According to school sources it had been hours since she last ate or drank.
Obviously my wife and I extremely saddened by this tragic loss and grateful for everyone that helped in this dreadful moment but we can’t help but think was this event avoidable in any way? Could she have regained a pulse sooner?
Fire Critic thanks for the reposting giving my message a chance of a wider viewing and response. EMT Tim thanks for the response and it definitely helps but I would like to add a bit of background material that might help in sharpening the response in any way.
While still in utero my daughter was diagnosed with congenital heart problems and the obstetrician was recommending aborting the fetus. After talking to a couple of influential specialists (prenatal cardiologist and a thoracic surgeon) we decided to proceed to full term. The moment she was born she was fitted with a pace maker (no defibrillator) and had been maintaining one until she died (at 10 years & 6 months). She was diagnosed with a complete heart block, leaking heart valves, AV Canal defect and a slightly enlarged aorta. All of these (expect for the aorta) were addressed successfully in her open heart surgery about 6 months after birth.
She continued quarterly visits to the cardiologist and the electro-cardiologist without any sign of complication. The only time she visited the hospital following the open heart was for pacemaker maintenance. From her lifestyle you would have never known her condition. She was into soccer, volleyball, basketball and anything that kids her age were into.
The day she went into ventricular fibrillation she was watching a kickball match and passed out falling on the lap of classmate behind her. From the conversations I had with the EMT in charge of the call he said it was the hardest call he had made all year. According to the paramedic he used chest compressions and discharged the paddles on my daughter continually. A number of times he would see what he thought was a pulse but he said it was a reading from the pace. That is when he voiced his frustration at not having the ability to turn off the device. That is also when he mentioned that the protocol calls for the paddles to be clear of the implantable device.
Just a side note which may have no bearing but a chest X-ray showed particles. According to school sources it had been hours since she last ate or drank.
Obviously my wife and I extremely saddened by this tragic loss and grateful for everyone that helped in this dreadful moment but we can’t help but think was this event avoidable in any way? Could she have regained a pulse sooner?