As a disclaimer,
it should be remembered that each case is fact specific. Would the outcomes
have been different, is unanswerable. What is answerable is what was
done by the responding personnel and the kind of equipment which was
available in response to the emergency. Had emergency response equipment,
e.g., an AED and emergency oxygen been readily available, opinions can
be given as to the outcome (see liability).
The following is an opinion on some of the cases.
Where Oxygen Was Not Used
A child in an Alabama school suffered a cardiac arrest (2003). The
school district had acquired 40 AED's but opted not to purchase emergency
oxygen equipment that would have accompanied the AED. Newspaper articles
reported CPR was given as the student was shocked three times over
a period of 8-10 minutes but did not resuscitate. EMS arrived, medication
was given and the child was successfully defibrillated. The concern
now is one of irreversible brain damage because of the delay.
Not reported, but obviously, one of the major differences between
the defibrillation method of the EMS and that employed by the school
was in the use of oxygen. It is known that the more hypoxic the victim,
the harder it is to defibrillate. Also, what was not stated in the
article is whether the student was initially breathing at the time
of emergency and whether the student then went into cardiac arrest.
Incidentally, the school district reported a successful defibrillation
on another student the same week. As stated earlier each case is different.
Perhaps the blood oxygen content was sufficiently high to achieve
successful defibrillation without supplemental oxygen. Presumably,
oxygen post defibrillation was given by EMS; there was no apparent
neurological damage for failure to provide oxygen post defibrillation,
only time will tell.
A student attending school in central PA collapsed in class after
recess (2002). Newspaper articles reported the school nurse gave
but the student did not become conscious. A defibrillator was brought
from the high school but defibrillation was not successful. Not much
is known from the newspaper reports, but CPR with supplemental oxygen
would have been better.
2 children from Delaware and one from New Jersey died from an attack
of asthma. Newspaper reports indicated CPR was given. Administration
of oxygen may have prevented these deaths.
O'Hare was, it is believed, the first
airport to install public access AED's. O'Hare opted not to incorporate
emergency oxygen with their AED's allegedly because they had an EMS
unit on site and would arrive within 3 minutes. Their report for
the first two years, in operation, has been published.
1 O'Hare reported that 26 patrons
were treated, 4 did not have cardiac arrest, 2 had seizures, 1 shortness
of breath. In those cases, the defibrillator was used as a monitor.
18 victims were in ventricular fibrillation. 11 were given CPR and
successfully defibrillated; 7 individuals did not defibrillate, i.e.,
39%. All survivors were given CPR and one for 10 minutes between
of ventricular fibrillation before eventually being resuscitated.
Relevant to response time, it was reported that HeartSave trained
personnel standing next to a defibrillator took at least two minutes
to ready the patient and the equipment.
on O'Hare report. First, what cannot be overlooked is that 39%
the victims did not successfully defibrillate and of those that did,
some required several shocks. Whether early administration of oxygen
with CPR instead of mouth to mask CPR would have made a difference
is conjecture, but it is known that CPR provides a low concentration
of oxygen to the victim. Victims that are hypoxic are not easy
defibrillate. Second, the patrons who were monitored with the defibrillator
would have been better off with oxygen. Third, oxygen in the first
two minutes necessary to ready the equipment, retrieve the CPR
and the victim may have averted a cardiac arrest in the case where
the victim is not yet in cardiac arrest. The lay responder does
the exact situation until the AED advises whether or not to "
Shock". A better plan is to have the combination unit with oxygen
A prominent university basketball coach suffered a heart attack in
the airport. The airport has public access AED's stored
in a single cabinet. Oxygen is not available with the AED's. Oxygen
is available only on arrival of EMS. In the case of a heart attack,
the defibrillator is of no value. Did the lack of oxygen in the time
interval between the heart attack and arrival of oxygen aggravate
FITNESS CENTER 50+ male suffered
apparent heart attack and passed out. CPR administered. EMS arrived
in about 10 minutes and successfully defibrillated. Brain dead. Oxygen
was not administered prior to EMS arrival.
The Following Cases Where The Facilities Maintained
The Combination Unit And The Victim Benefited From The Oxygen.
Female staff member at a JC Penny lost consciousness, O2
administered. Defibrillator did not fire. Became conscious with O2
and the victim transferred to hospital. Victim Survived.
Elderly male collapsed during service of apparent cardiac arrest.
Oxygen administered CPR and Defibrillator fired. Victim received
an internal defibrillator at hospital and lived.
Suffered an apparent heart attack while practicing in a simulator.
The pilot passed out. When O2 was administered the pilot revived.
The pilot suffered from a hemorrhage, not a heart attack. Had the
pilot been in ventricular fibrillation, the outcome may have been
different, thus showing the necessity of the combination unit.
88 year-old female passed out, recovered, and passed out again. O2
administered, no pulse; defibrillator prepped. The women recovered
defibrillator did not fire. Episodic ventricular
The above cases
are but a few illustrating that in an emergency the lay responder needs
to be able to address not only the cases of ventricular fibrillation
by the use of an AED, the lay responder needs to address other types
of emergencies, such as, respiratory difficulty or to prevent the victim
from critically deteriorating during post defibrillation and that includes
the administration of oxygen.
Public Use of Automated External Defibrillators, Sherry L. Caffrey
et al, N. Engl. J. Med., Vol. 347, No. 16 October 17, 2002 p1242-1246.
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