Lifesaving Device to Jump-Start Failing Hearts Proves Successful

A month ago David Shutts would have died, doctors say.

On the morning of June 9, Shutts, a 69-year-old retired truck driver from Duarte, and his wife, Lela, were driving to the market. As he was about to turn into the parking lot, Shutts slumped over the steering wheel of his pickup, unconscious.

Steve Lopez, an off-duty county firefighter, ran over, realized Shutts’ heart was not beating, and started performing cardiopulmonary resuscitation. About half a mile away, at Los Angeles County Fire Station 44, Capt. Richard Wilk had just tested the station’s new defibrillator, which can automatically jump-start a failing heart.

Two minutes later, firefighters had arrived on the scene. One minute later, Wilk had attached two electrodes to Shutts’ chest and turned the defibrillator on, preparing to shock him back to life.

Within two more minutes, David Shutts’ heart was beating again.

“I wouldn’t be here now if it weren’t for that machine,” said Shutts, back home last week after 13 days in the hospital.

Shutts was the first person in Los Angeles County to be saved by public rescue workers using an automatic defibrillator that can be operated by non-paramedics.

By putting electric shock therapy into the hands of rescuers who until now were prevented by law from using anything but basic first aid and CPR--which are nowhere near as reliable--the defibrillators can restart the hearts of more people faster then ever before, doctor say.

In fact, the state Emergency Medical Services Authority estimates that in widespread use, the automatic defibrillators could save 2,600 Californians each year. Doctors caution that the machines, by themselves, cannot replace emergency services, which still depend on quick reponse transportation and good medical care.

Since June 1, the Los Angeles County Fire Department has been testing the devices in 15 of its 128 stations to decide whether they should be purchased and used on a larger scale. It’s the biggest and most advanced program in the state so far and “it’s already a great success,” said Capt. Eugene McCarthy, the department’s paramedic coordinator.

Last week, the Los Angeles City Council voted to equip every one of about 150 city fire engines with an automatic defibrillator at a cost of about $750,000. The first models will be in use within the next few months, according to chief city paramedic Alan Cowen, and by 1990 will be within a three-minute range of anywhere in the city.

Manual defibrillators have been used throughout the county and state for years, but only by paramedics with about 900 hours of medical training. They must interpret a patient’s heartbeat, activate the machine and deliver the shock themselves, almost always with the advice of a doctor.

The defibrillator that saved Shutts is designed to be used without a doctor’s direction by rescuers with only four hours of instruction. The self-contained, automatic models virtually operate themselves: They quickly read a heartbeat to decide whether a shock is needed, charge themselves to emit a shock and advise users with a synthesized voice while recording events for doctors to evaluate later. One brand even delivers a shock on its own, without rescuers having to take any action.

“All the CPR and first aid in the world can’t reverse the problem, but this thing reverses it,” said Dr. Franklin Pratt, the county Fire Department’s medical director and head of pre-hospital care at Harbor-UCLA Medical Center’s Department of Emergency Medicine. The department is overseeing the county’s yearlong pilot program.

Such computerized defibrillators have been widely available since 1985 and have been used by firefighters in some cities, including Seattle and Salt Lake City, for several years. Only recently were studies published proving their effectiveness, however, prodding other states to change their regulations and allow use by all rescuers. About three-quarters of all states now have such laws.

Harbor-UCLA Medical Center’s Department of Emergency Medicine submitted a proposal to the state in 1985 detailing a plan to allow county firefighters to use the lifesaving devices, but it was not until last year that the concept was authorized in state law. Bruce E. Haynes, director of the state Emergency Medical Services authority, said the state delayed action while deciding whether to also make other changes governing emergency workers, but finally chose to go ahead without them.

A state law that allowed only those with paramedic-level skills to operate defibrillators was altered last March to permit almost any rescuer with the proper training, including police officers, to use them.

In recent weeks, county firefighters have used the automatic machines to restart the heart of all four of the victims whose hearts were still alive, but jittering and shaking, rather than pumping blood through the body. Defibrillators jolt the malfunctioning heart with about a 6,000-volt shock, effectively resetting the heart to its normal beat.

The latest rescue came last Friday when county firefighters in Lakewood restarted a 68-year-old man’s heart with one shock. “It’s the first time we did it and we were all elated,” said Firefighter Richard Willeford. “The guys think the thing is amazing.”

Cure-All Proof Lacking

Many studies have proven that while electric shock therapy is not a cure-all, it is by far the most effective remedy for sudden death caused by a heart attack, increasing the chance of survival by at least 25% over a negligible chance with CPR alone. The sooner a shock is delivered, the greater a patient’s chances of living. After about 10 minutes, those chances drop almost to zero.

“Right now, without a defibrillator, almost everyone suffering a cardiac arrest outside a hospital will die,” said Ken Stults, director of emergency medicine at the University of Iowa. In several studies conducted in rural Iowa counties, Stults found that defibrillators used within six minutes of a heart attack raised survival rates from 5% to 28%.

Each automatic defibrillator costs about $5,000. For the county’s test program, however, three major manufacturers each donated six of their models in the hopes that county fire officials will decide to buy many more.

Fire stations with the highest number of cardiac emergencies and those which could get to a scene within eight minutes, but at least four minutes before paramedics, were selected to try the defibrillators. Besides Duarte, stations in such scattered locations as Claremont, Commerce, Industry, Norwalk, Carson, Bell and Pico Rivera are part of the trial run.

Besides the people who are alive because of the equipment, the ones using it are most ecstatic about it. “It’s really perked up morale, even for the old curmudgeons. And you can see why,” said county Assistant Fire Chief Harold McCann.

“Before, we would have just gone up, done CPR and waited for a (paramedic) squad to arrive,” said Wilk, now the talk of his Duarte station after using the defibrillator successfully on Shutts. “This time, we saw him open his eyes and come back to life. We were all staring at each other. I said, ‘My God, it did it. It really worked.’ ”

THE RESCUE TRANSCRIPT

Partial transcript of first successful automatic defibrillator rescue:

Capt. Richard Wilk: We have full arrest. CPR was in progress when we arrived. It is five minutes to 9. Pressing (button on defibrillator) to analyze. Stop CPR. Patient is breathing. Patient is V-Fib (no heartbeat). Pressing to shock. Clear!

(First shock delivered.)

Press to analyze. Stop CPR.

Machine: Stand back. Stand back.

Wilk: Patient is still breathing. Patient is breathing at a constant pace of about 20 respirations. Pressing to shock. Clear!

Others: Clear!

(Second shock delivered.)

Wilk: No CPR. Leave him alone. Leave him alone. Pressing to analyze.

Machine: Stand back. Stand back.

Wilk: It looks like we have some sort of a, uh, super-ventricular rhythm (heartbeat). No shock indicated. Check for pulses.

Firefighter Dirk Chausse: Checking his radial pulse. We have radial pulse. He has a good, strong radial.

Wilk: We have a radial pulse at 8:57.

Firefighter Richard Rapier: Spontaneous respiration.

Wilk: Spontaneous respiration. This son-of-a-gun works. (Laugh)

Off-duty firefighter Steve Lopez, who performed CPR: Yeah. (Laugh)

Wilk: Hey, Doc, it worked! (Laugh) Good job, Steve.

Lopez: I was going to work out and I saw this guy going down.

Wilk: Can you see the BP (blood pressure) on it?

Lopez: You guys, good job.

Wilk: Press to analyze

Machine: Stand back. Stand back.

Wilk: No shock indicated. OK. Pupils are equal. He’s got a respiration rate of 20. Why don’t we go ahead and put on a face mask at 10 (liters per minute of oxygen). He’s breathing on his own. Turn him on his side.

Rapier: He’s opened his eyes. We’ve got a spontaneous eye opening.

Wilk: Patient is now opening his eyes. It is, uh, 8:59.

Rapier: (to patient) Can you hear us? Can you hear me, buddy? Hey, buddy, do you hear me?

Patient: (coughs)

Rapier: (as patient struggles on stretcher) No, no stay right where you’re at. We’ll take care of you. No, no, stay down. We’ll take care of you.

Source: L.A. County Fire Department