By Don Colburn
Times-Picayune
Copyright 2008 The Times-Picayune Publishing Company
MAUI, Hawaii — Larry Ledwith has no clear memory of the most spectacular moment of his July vacation on the west coast of Maui.
He and his wife were out for an early morning walk. Midway, they stopped to use a restroom in the tiny terminal of one-runway Kapalua Airport and then resumed their hike.
Debbie Ledwith, walking just ahead, heard an odd disturbance behind her and turned to see her husband on the ground, his face turning bluish, eyes rolled back and blood leaking from the back of his head where it had struck the pavement.
She yelled, and bystanders, including a doctor, came running. They checked for a pulse — zilch — and started cardiopulmonary resuscitation. An airport employee summoned a firefighter, who raced to retrieve the airport’s only portable heart-shocking defibrillator.
The next thing Ledwith remembers, blearily, is coming to in an ambulance with a paramedic telling him he’d had a cardiac arrest. One jolt from the defibrillator had shocked his haywire heart back into normal rhythm.
“If they didn’t have that defibrillator out there in the sticks,” says Ledwith, 70, of Portland, Ore., “I wouldn’t be talking to you.
“Quite frankly, I had died.”
Minutes — even seconds — matter when a person’s heart stops. A recent study in the New England Journal of Medicine underscored the importance of quick response to cardiac arrest, even in hospitals. Researchers analyzed nearly 7,000 cases in more than 300 hospitals and found that patients who received defibrillation within two minutes were nearly twice as likely to survive as patients for whom the response took longer.
Ventricular fibrillation, when the heart quivers instead of beating, is the most common type of cardiac arrest; it kills about 225,000 people a year in the United States. Once a person’s heart goes into fibrillation, it is estimated that the chance of survival drops 10 percent every minute without direct treatment.
Portable defibrillators, which can shock a heart back into a normal beat, are proliferating in places where crowds routinely gather, such as casinos, airports and stadiums. Since 2004, every commercial airline flight has carried a defibrillator.
Their size and convenience make them ideal for such places. Unlike the early models of the 1970s, which “took up half the back of an ambulance,” says Dr. Mohamud Daya, an emergency medicine specialist at Oregon Health & Science University, “now some of them are book-sized.”
Fortunately for Ledwith, Hawaii installed 100 defibrillators at its airports a year ago, including 60 at Honolulu International and the rest at more than a dozen smaller airfields, including Kapalua.
Some models, called automatic external devices, or AEDs, are designed especially for use by untrained bystanders in an emergency; they come with a built-in recording of step-by-step instructions triggered by the “On” switch.
“You put the pads on somebody, push the button and do what it tells you,” says Pat Pangburn, a respiratory therapist and resuscitation specialist at the Oregon university, where about a third of the 182 defibrillators are AEDs.
All defibrillators come with a sensor that allows the machine to deliver a cardiac shock only to hearts whose rhythm is dangerously out of whack.
Pangburn was walking to the gate in the Atlanta airport a few years ago when a man went into cardiac arrest “and did a face plant right in front of me.” Pangburn pulled a defibrillator off the wall and shocked the man back to life. By the time the man was stabilized and headed for the hospital, Pangburn had missed his flight and had to reschedule for the next day — when he was surprised to notice the cardiac arrest victim, apparently recovered, as a fellow passenger.
A national study covering 24 research centers, including the Oregon university, found that having defibrillators available in crowded public places can save lives. Teams trained to perform CPR and use defibrillators saved twice as many cardiac arrest victims as teams performing CPR alone.
Overall survival rates from cardiac arrest remain low, hovering around 5 percent or 6 percent, Daya says. That’s in part because many such incidents take place out of sight or beyond the reach of a quick response.
Survival is much higher in places where there are bystanders, security monitors and defibrillators with employees trained to use them.
“The majority who survive do so because someone sees them go down and a defibrillator arrives within two or three minutes,” Daya says.
For people with a cardiac arrest due to ventricular fibrillation, having bystanders and an AED nearby can boost the survival rate as high as 50 percent, studies at Chicago’s O’Hare Airport and Las Vegas casinos have shown.
But even nearby defibrillators cannot save all people with cardiac arrest. The machines work on hearts undergoing only a certain kind of rhythm disturbance: ventricular fibrillation (chaotic beat) or tachycardia (extremely rapid beat). Those account for about a third of the cardiac arrest cases ambulance teams see.
The other limiting factor is time. The best chance of rescue comes if defibrillation happens within two or three minutes. After four minutes, the chance of full recovery drops sharply; after 10 minutes it’s almost zero.
Once Larry Ledwith was jolted back to life outside Kapalua Airport, it was 25 bumpy miles to the nearest hospital on Maui, where doctors stabilized him, pinpointed a blocked coronary artery and implanted a defibrillator. The next day, they airlifted him to Queens Hospital in Honolulu, where surgeons propped open his blocked artery with a tiny mesh stent.
Four days after his collapse, he left the hospital and returned with his wife to Maui for another week. After all, he explains, “We had reservations.”