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Portable defibrillation for all

Cardiac arrest is easy to manage with the help of this defibrillator, discovers Dr Bryan Palmer.

The National Defibrillator Programme suggests that more defibrillators will be made available in public places. Even our local shopping mall has acquired one.

The more defensive among you might feel that a practice that did not possess one in time of need could be potentially open to criticism. That's despite cardiac arrest being a rare event; in my practice of 15,000 patients we have not had an arrest during my seven years of service.

Only two interventions have been shown to have positive outcomes in cardiac arrest. One is basic life support and the other is early defibrillation in ventricular fibrillation.

AEDs in the UK
AEDs have only been available in the UK for about nine years and the Lifeline AED unit is designed to be used by those who have had BCLS/ AED training rather than general bystanders.

I had the chance to test the Lifeline AED - a loose term because no one arrested during the time I had it to test.

It is marketed as easy to use, portable, and battery powered. Bright yellow and shaped like a ladies' handbag, it is the easiest to grab when needed in an emergency of all the models I have seen. It does weigh in at a hefty 4.2lb (1.9kg), but its size (22 x 30 x 7cm) makes it easy to store in a convenient but immediately accessible place such as a shelf or cabinet.

I should point out at this stage that it is also possible to use the Lifeline AED for paediatric emergencies as it can come with a smaller pad front and back for use with the under-eights and infants.

The basic model is semi-automatic and has an intuitive two-button operation (one to turn on and the other to shock if advised), which employs a sophisticated algorithm to detect ventricular fibrillation or high-rate ventricular tachycardia.

There is no rhythm to read, which might cause some users to find it disconcerting, but the authoritative way in which the voice directs you soon puts you at ease.

It is the simplicity of this model which really grabs the attention.

The electrodes can be ready attached to the device and stored in a little pocket at the back but then can be whipped out at a moment's notice and deployed on the chest. After that it is just a case of following the instructions from the device as it reads the rhythm. Essentially it will follow an arrest protocol, so it will advise on CPR and pulse checks when required.

Its set-up is just as simple. It requires one 9v battery, which is to power the Active Status Indicator (ASI) and which sits inside the main lithium/manganese dioxide, non-rechargeable, disposable, recyclable battery.

The former battery lasts about one year but will be very cheap to replace, while the latter will last five years.

The main battery just slots into the side of the main body and that's it. The ASI will blink green every five seconds and as long as it continues to do that you have nothing to worry about. Although one could suggest that an audible alarm could be useful in the event of a problem.

The battery has its own sell-by date which you will have to take note of, but if it is starting to run short it will fail its self-test and the ASI will blink red.

The pads also have to be kept under review as they too have a sell-by date which has to be manually checked.

Optional data card
One available extra is that the Lifeline can be used with an optional removable data card that automatically records incident information (ECG and optional voice) for subsequent review. Data are downloaded via a card reader to a computer loaded with the data management software.

The AED needs little maintenance because it runs its own self-diagnostics every time it is turned on, and it has its own weekly, monthly and quarterly tests that it will do without disturbing you.

One interesting aspect of this AED is that it delivers the same shock of 150J each time because it measures impedance and compensates, so removing the necessity of escalating shocks as seen on wards with standard equipment.

Although some of the Lifeline AED's simplicity means it needs more checks to ensure it is going to work when required, this is more than offset by its ease of portability and use. Most of us would find ourselves with sweaty palms if presented with a cardiac arrest scenario, and at that moment in time I think a very simple piece of equipment is going to prove to be your best friend.

- An independent review by Dr Bryan Palmer, a GP in Fareham, Hampshire

- Equipment provided by Williams Medical Supplies

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