2023-04-22 10:00:24
Atlantico: Because she carried a defibrillator with her, an American citizen had the opportunity to save a life in 2021; while everything suggested that the victim was going to stay there. This kind of experience illustrates a simple fact: the democratization of such devices could potentially save lives. Are defibrillators sufficiently accessible in France?
Alexandre Bensaid : Each year, there are approximately 60,000 deaths from cardiac arrest, of which 95% of the victims will die. The interest of the defibrillator, made available early, in the event of cardio-respiratory arrest is indisputable. It is obvious. In 50% of cases, cardio-respiratory arrest is caused by myocardial infarction, which is associated with heart rhythm disorders. Most often, it is possible to correct them by means of an electric shock. Of course, there are various rhythm abnormalities that can cause cardiac arrest, but most of them remain accessible to defibrillation, which then makes it possible to restore a normal rhythm.
Another major point to mention: the intervention time is the main prognostic element in the management of a cardio-respiratory arrest. In other words, first aid gestures such as the accessibility of the defibrillator constitute major elements in the prognosis of the patient treated. Beyond three minutes of unrecovered cardio-respiratory arrest, the cerebral sequelae begin to settle. After 8 minutes, the sequelae are irreversible. Early intervention is more likely to return a patient to their initial state after providing care. Therefore, it is obvious that we need more defibrillators and proximity defibrillators.
Fortunately, these are starting to be more and more widespread in France, particularly in establishments that welcome the public, such as town halls or sports complexes, for example. The ideal, however, would be to have a defibrillator on every street corner and in every café.
Are the French sufficiently trained?
In France, there is reason to be enthusiastic about this: the popularization of first aid gestures and the development of first aid networks, in particular with the help of increasingly popular applications, allow interventions that are much more numerous. This is an effort to be welcomed and it is clear that progress has been made in recent years.
However, this remains highly insufficient. These reflexes must be democratized more, more quickly. Admittedly, the trend that can be observed is positive, but we are still far from touching the ideal to which we are aiming.
Should the democratization of these devices go so far that all homes in France should be equipped with them?
This question is complex and it is because it affects the very nature of certain defibrillators. Such a device, remember, must be used correctly.
Today, there are two types of defibrillators. The first, manual, should be reserved for individuals who have been duly trained in first aid and for health personnel.
The second, found in particular in stadiums and other public places, is semi-automatic. It incorporates, in its operation, an integrated analysis of the heart rate. This allows him to identify whether or not it is useful to produce an electric shock.
As a result, defibrillators have become quite easily usable; even without necessarily having had recourse to specialized training. The problem is as much the number of defibrillators available as their use: you have to know how to locate them and encourage the general public to use them. However, would it be justified and useful to see every household in France equipped with a semi-automatic device? Some would argue that this would be a bit excessive. Personally, as a cardiologist, I can only wish so.
The Samu’s home response time, let’s not forget, is on average 13 minutes to deal with a cardiac arrest. One can therefore quite imagine that with a home defibrillator, a certain number of patients would have benefited greatly from it.
Such devices can be very expensive and in some cases would not always be very useful. Thus, according to the New York Times, a significant number of victims of cardiac arrest, although equipped, could not be saved. How to explain this situation ? Do these elements call into question the usefulness of home defibrillators?
To answer this question, we must take into account several realities, it seems to me.
An individual living alone at home, for example, cannot take advantage of the presence of a semi-automatic defibrillator in his home if he cannot perform the operation himself. However, in a state of cardio-respiratory arrest, he will obviously be unable to do so.
Moreover, not all cardio-respiratory arrests can be recovered by defibrillation. In this case, the defibrillator will therefore not be useful.
In addition, one should not underestimate the state of panic and bewilderment in which those around you can be plunged when faced with the cardio-respiratory arrest of a loved one. In doing so, it sometimes happens that we forget, at least for a time, the actions to be applied: cardiac massage, call for Samu, use of the defibrillator. In this regard, there is only one answer: training.
Of course, the question of the fallibility of the device may be raised. But since defibrillators are more and more often automated, they now make it possible to dispense most often with any human analysis.
Finally, the cost of installing the defibrillator, which is estimated at between 1,000 and 2,000 euros, excluding maintenance, can also constitute an obstacle to its installation in some homes.
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