Automatic External Defibrillation Monitoring in Cardiac Arrest
Automatic External Defibrillation Monitoring in Cardiac Arrest
We propose to randomize automatic external cardioverter/defibrillators (AECD) in patients who
 are at high risk for life-threatening abnormal heart rhythms (arrhythmias) and are admitted
 to the telemetry ward, all other treatments being constant including cardiopulmonary
 resuscitation.

 We hypothesize that the automatic, rapid, accurate and specific diagnostic and therapeutic
 technology used in AECDs will further increase the rate of survival in patients with cardiac
 arrest through rapid and automatic defibrillation, independent of operator initiation, as
 compared to standard cardiopulmonary resuscitation initiated by healthcare providers.
Cardiac arrest (CA) is defined as the sudden cessation of effective cardiac pumping function
 as a result of either ventricular asystole (inactivity of the heart) or pulseless ventricular
 tachycardia/ventricular fibrillation (VT/VF). Pulseless ventricular tachycardia/ventricular
 fibrillation is an abnormal electrical activity of the ventricles of the heart. Rapid
 diagnosis and treatment are essential because first, more than a few minutes of total CA
 results in permanent damage to the brain due to lack of oxygen, and second, the success of
 resuscitative measures is related to the rapidity with which they are instituted following
 arrest. For a person in VT/VF the probability of successful defibrillation and subsequent
 survival to hospital discharge is directly and negatively related to the interval between
 onset of VT/VF and delivery of first shock.

 Comparison: By using AECDs we will evaluate if an automatic, rapid, accurate and specific
 diagnostic technology will further increase the rate of survival in patients with VT/VF by
 rapid and automatic defibrillation, independent of operator initiation, as compared to
 standard cardiopulmonary resuscitation (CPR) with conventional defibrillators initiated by
 healthcare providers. This trial will be a randomized, controlled trial and will test if
 AECDs can improve outcome measures when compared to traditional responses.

 Conventional defibrillators are manually operated defibrillators that have to be attached to
 the patient and operated by a healthcare provider or layperson. In contrast, the purpose of
 AECDs is to automatically detect life-threatening arrhythmias and deliver external shocks
 according to a programmable prescription for hospitalized patients, who may be at transient
 risk for the development of life-threatening arrhythmias. AECDs immediately and automatically
 monitor, detect and treat cardiac arrhythmias with no human intervention. The AECD proposed
 to be utilized in this trial, PowerHeart CRM, a product of Cardiac Science, Inc, has been
 evaluated in the hospital setting to assess safety and efficacy, and has been approved by the
 FDA to be prophylactically attached to hospital patients and provide automatic defibrillation
 therapy without human intervention.

 All patients admitted to the telemetry unit will be asked to volunteer for this study. Up to
 3,000 patients will be asked to volunteer in this study during their stay in the telemetry
 unit. This study will evaluate if there is a way to improve survival in CA by comparing two
 groups

 Group 1: This group includes patients admitted to telemetry unit who will undergo standard
 measures of CPR in case cardiac arrest is suspected.

 Group 2: This group includes patients admitted to telemetry unit who will have an AECD
 attached to the chest wall and who will also undergo standard measures of CPR in case of
 cardiac arrest.
Inclusion Criteria:

 -  All patients admitted to telemetry ward and emergency department

 -  Age > 18 years.

 Exclusion Criteria:

 -  Pregnant women

 -  Patients with R wave less than 0.5 millivolts.

 -  Patients with functioning Internal Cardiac Device.

 -  Patients with cardiac pacemakers if oversensing by AECD is demonstrated (double
 counting of pacer spikes).

 -  Patients with visible chest lesions that would prevent AECD pad placement.

 -  Patients who are designated Do Not Resuscitate.

 -  Right bundle branch block.

 -  Patients with Parkinson's disease.

 -  Patients with seizure disorders