Desfibrilador Manual
Giulia Satmary
Los desfibriladores son dispositivos que aplican una descarga elctrica al corazn para restablecer el ritmo cardaco normal en pacientes que han sufrido o estn en riesgo de sufrir un paro cardaco repentino. Pero, qu tipos de desfibrilador existen? Cules son los ms usados?
Los desfibriladores internos manuales se emplean en procedimientos quirrgicos a corazn abierto en salas de operaciones y salas de emergencias. La descarga se realiza a travs de unas palas que son colocadas directamente sobre el corazn.
Los desfibriladores automticos implantable pueden prevenir la muerte sbita en personas que tienen un alto riesgo de una arritmia potencialmente mortal. Estos pequeos dispositivos se implantan debajo de la piel de la misma manera que un marcapasos en personas que padecen problemas cardacos, latidos descontrolados, bradicardias o sufren de taquicardias.
Un DAI controla constantemente el ritmo cardaco del paciente y emite impulsos elctricos a travs de uno o ms cables conectados al corazn para regular los ritmos cardacos anormales potencialmente mortales. Los tratamientos que puede administrar un DAI son: estimulacin, cardioversin y desfibrilacin.
Todos los desfibriladores externos, sean manuales o automticos, generan ondas de tipo bifsico. Comparadas con las monofsicas, disminuyen significativamente el nivel de energa necesario para una desfibrilacin exitosa, as como el riesgo de quemaduras y dao miocrdico.
Un DEA es capaz de diagnosticar automticamente el ritmo cardaco y, tras una seal sonora de aviso, el desfibrilador aplica la descarga elctrica por medio de unos electrodos adhesivos de forma automtica y sin la intervencin del usuario.
El inconveniente de este tipo de desfibrilador es que, si el rescatista que est auxiliando al paciente no sabe esto, puede correr peligro de sufrir una descarga. Por este motivo, los desfibriladores automticos DEA son cada vez menos empleados.
El desfibrilador externo semiautomtico, despus de analizar el ritmo cardaco del paciente, recomienda si se debe o no aplicar la descarga elctrica. Asimismo, permite realizar varias descargas que deben alternarse con el masaje cardaco. A diferencia de los DEA, el usuario deber presionar un botn para aplicar la descarga cuando el aparato se lo indique.
Un desfibrilador cardioversor porttil es un chaleco-desfibrilador externo que monitorea al paciente en riesgo de paro cardaco repentino de forma continua las 24 horas del da. Un desfibrilador cardioversos puede administrar automticamente una descarga bifsica si detecta una fibrilacin ventricular FV o una taquicardia ventricular TV.
En coachRCP ponemos a tu disposicin los mejores desfibriladores externos DESA para cardioproteger tu espacia y estar preparado para salvar vidas. Adems podemos encargarnos del mantenimiento preventivo y correctivo de estos equipos para garantizar que estn en perfecto estado y listos para su uso en caso de emergencia.
Tambin proporcionamos la formacin necesaria para capacitar al personal no sanitario a travs de nuestro curso de Soporte Vital Bsico y Desfibrilador Semiautomtico (SVB y DESA), adaptado a la normativa de cada comunidad autnoma y englobado en el Plan Nacional de Resucitacin Cardiopulmonar.
Suministro, instalacin, registro y mantenimiento de desfibriladores, Formacin homologada en RCP y primeros auxilios, Soporte Vital Bsico SVB, Soporte VItal Avanzado SVA y uso del desfibrilador externo automatizado DEA/DESA
Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach).[1][2] A defibrillator delivers a dose of electric current (often called a counter-shock) to the heart. Although not fully understood, this process depolarizes a large amount of the heart muscle, ending the arrhythmia. Subsequently, the body's natural pacemaker in the sinoatrial node of the heart is able to re-establish normal sinus rhythm.[3] A heart which is in asystole (flatline) cannot be restarted by a defibrillator; it would be treated only by cardiopulmonary resuscitation (CPR) and medication, and then by cardioversion or defibrillation if it converts into a shockable rhythm.
In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle.[4] Although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac arrhythmias, such as supraventricular tachycardia.[1][2]
Defibrillators can be external, transvenous, or implanted (implantable cardioverter-defibrillator), depending on the type of device used or needed.[5] Some external units, known as automated external defibrillators (AEDs), automate the diagnosis of treatable rhythms, meaning that lay responders or bystanders are able to use them successfully with little or no training.[2]
Defibrillation is often an important step in cardiopulmonary resuscitation (CPR).[6][7] CPR is an algorithm-based intervention aimed to restore cardiac and pulmonary function.[6] Defibrillation is indicated only in certain types of cardiac dysrhythmias, specifically ventricular fibrillation (VF) and pulseless ventricular tachycardia.[1][2] If the heart has completely stopped, as in asystole or pulseless electrical activity (PEA), defibrillation is not indicated. Defibrillation is also not indicated if the patient is conscious or has a pulse. Improperly given electrical shocks can cause dangerous dysrhythmias, such as ventricular fibrillation.[1]
The defibrillation device that is usually available out of the medical centers is the automated external defibrillator (AED),[8] a portable machine that can be used even by users with no previous training. That is possible because the machine produces pre-recorded voice instructions that guide to the user, and automatically checks the patient's condition and applies the correct electric shocks. There also exist written instructions of defibrillators that explain the procedure step-by-step.[9]
Survival rates for out-of-hospital cardiac arrests in North America are poor, often less than 10%.[10] Outcome for in-hospital cardiac arrests are higher at 20%.[10] Within the group of people presenting with cardiac arrest, the specific cardiac rhythm can significantly impact survival rates. Compared to people presenting with a non-shockable rhythm (such as asystole or PEA), people with a shockable rhythm (such as VF or pulseless ventricular tachycardia) have improved survival rates, ranging between 21 and 50%.[6][11][12]
Manual external defibrillators require the expertise of a healthcare professional.[13][14] They are used in conjunction with an electrocardiogram, which can be separate or built-in. A healthcare provider first diagnoses the cardiac rhythm and then manually determine the voltage and timing for the electrical shock. These units are primarily found in hospitals and on some ambulances. For instance, every NHS ambulance in the United Kingdom is equipped with a manual defibrillator for use by the attending paramedics and technicians. [citation needed] In the United States, many advanced EMTs and all paramedics are trained to recognize lethal arrhythmias and deliver appropriate electrical therapy with a manual defibrillator when appropriate. [citation needed]
An internal defibrillator is often used to defibrillate the heart during or after cardiac surgery such as a heart bypass. The electrodes consist of round metal plates that come in direct contact with the myocardium. Manual internal defibrillators deliver the shock through paddles placed directly on the heart.[1] They are mostly used in the operating room and, in rare circumstances, in the emergency room during an open heart procedure.
Automated external defibrillators (AEDs) are designed for use by untrained or briefly trained laypersons.[15][16][17] AEDs contain technology for analysis of heart rhythms. As a result, it does not require a trained health provider to determine whether or not a rhythm is shockable. By making these units publicly available, AEDs have improved outcomes for sudden out-of-hospital cardiac arrests.[15][16]
Trained health professionals have more limited use for AEDs than manual external defibrillators.[18] Recent studies show that AEDs does not improve outcome in patients with in-hospital cardiac arrests.[18][19] AEDs have set voltages and does not allow the operator to vary voltage according to need. AEDs may also delay delivery of effective CPR. For diagnosis of rhythm, AEDs often require the stopping of chest compressions and rescue breathing. For these reasons, certain bodies, such as the European Resuscitation Council, recommend using manual external defibrillators over AEDs if manual external defibrillators are readily available.[19]
As early defibrillation can significantly improve VF outcomes, AEDs have become publicly available in many easily accessible areas.[18][19] AEDs have been incorporated into the algorithm for basic life support (BLS). Many first responders, such as firefighters, policemen, and security guards, are equipped with them.
AEDs can be fully automatic or semi-automatic.[20] A semi-automatic AED automatically diagnoses heart rhythms and determines if a shock is necessary. If a shock is advised, the user must then push a button to administer the shock. A fully automated AED automatically diagnoses the heart rhythm and advises the user to stand back while the shock is automatically given. Some types of AEDs come with advanced features, such as a manual override or an ECG display.
Implantable cardioverter-defibrillators, also known as automatic internal cardiac defibrillator (AICD), are implants similar to pacemakers (and many can also perform the pacemaking function). They constantly monitor the patient's heart rhythm, and automatically administer shocks for various life-threatening arrhythmias, according to the device's programming. Many modern devices can distinguish between ventricular fibrillation, ventricular tachycardia, and more benign arrhythmias like supraventricular tachycardia and atrial fibrillation. Some devices may attempt overdrive pacing prior to synchronised cardioversion. When the life-threatening arrhythmia is ventricular fibrillation, the device is programmed to proceed immediately to an unsynchronized shock.
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