TechNation Editor John Wallace recently asked some HTM leaders for the latest information regarding automated external defibrillators (AEDs) and defibrillators for a roundtable article. The goal of this roundtable article is to provide insights regarding important features to look for when purchasing these devices and advice regarding maintenance.
Participants who agreed to share their knowledge are:
- Soma Tech Intl Senior Biomedical Engineer Schleshin Molly David
- ReNew Biomedical Director of Training and Employee Development Dustin Dinkins
- Rigel Medical Product Manager for North and Central America Lewis Lennard
- Datrend Systems Inc. Director of Business Development Owen Liu
- Fluke Biomedical Senior Technical Sales Engineer Justin Ross
- ECRI Principal Project Engineer Mairead Smith
Q: What are the basic functions or features every defibrillator/AED should have?
David: A defibrillator is a medical device that delivers an electric shock to the heart to restore its normal rhythm during a sudden cardiac arrest. Basic functions and features that are commonly found in defibrillators include biphasic waveform, automatic and manual modes, ECG monitoring, voice and visual prompts, battery and electrode status indicators, portability and ease of use, pediatric capability, self-testing and diagnostic features, CPR assistance, data recording, and retrieval. For AEDs, the important features include ease-of-use, voice and visual prompts, self-testing and status indicators, automatic operation, CPR guidance, portability and durability, data storage, and training mode. It’s important to note that the specific features may vary between different models and manufacturers. When choosing a defibrillator/AED, considerations should include the intended use (professional or public access), training requirements, and compatibility with local regulations and guidelines.
Dinkins: The most basic function that a defibrillator and AED should have is the ability to analyze and deliver electric shock therapy to a patient in cardiac arrest. This primary function lets medical personnel, or even bystanders, use these devices in an emergency situation to analyze the patient and determine what therapy level needs to be administered.
Lennard: A defibrillator or AED should at minimum exhibit audio and visual prompts for seamless operation. An important attribute is the capacity for automated analysis, identifying cardiac arrythmias and determining the need of an electric shock. An AED must also provide guidance on proper pad placement, as any untrained individual may use them. Performance is arguably the most important function. For example, if a defibrillator energy output is out of specification, it can lead to unsuccessful attempts at restoring a normal heart rhythm, ultimately resulting in the failure to save lives.
Liu: After being revived by a defibrillator, many patients’ heart beats are still irregular. Having a defibrillator with pacemaker running in demand mode would be helpful during monitoring to ensure pacemaker is only active when necessary. For AEDs, models with more “shockable” waveform detection would cover more AED activation scenarios during use. Since AED discharge is determined by the unit itself, users cannot override a discharge if the unit cannot detect a shockable signal.
Ross: Every defibrillator/AED must have a few fundamental features. These include clear and easy-to-follow instructions (voice-guided for AEDs), and adaptability to every patient size varying from pediatric through adult. With defibrillators an Advisory or AED mode, that includes the latest CPR protocols, and a manual override function for medical professionals. Additionally, it should also include a robust self-testing and alerts for malfunctions features.
Smith: Defibrillator – Manual monitor/defibrillators used by qualified hospital or EMS personnel should, at minimum, be able to display the ECG waveform clearly and be capable of defibrillation, synchronized cardioversion and pacing. Users must also be able to select the desired energy level quickly and without confusion. The unit must be able to operate on battery power and transmit data to a central database using common methods, such as USB or Wi-Fi. AED – One of the key defining factors of an AED is its ease of use. These devices are generally intended for employees of common businesses, such as security guards, or members of the general public to use. The user interface must be simple, the device must provide adequate guidance, and prompts should walk users through the essential steps to deliver a shock quickly, when warranted. In the U.S., AEDs must also have received premarket approval (PMA) for both adult and pediatric patients. The AED must provide a high degree of accuracy in identifying shockable and non-shockable rhythms, and it must be reliably ready to deliver a shock when needed.
Q: What types of checks and regular maintenance do defibrillators/AEDs require?
David: Defibrillators require regular checks and maintenance to ensure their proper functioning and readiness for use during emergencies. Here is a list of common checks and maintenance tasks for defibrillators: Visual inspection for electrode pads, cables, and connections, and exterior damages; battery status indicators; software updates; self-test feature; event data review; expired or damaged accessories; cleaning; environmental considerations; documentation and training; and education. Always refer to the specific user manual and guidelines provided by the defibrillator/AED manufacturer for detailed instructions on maintenance procedures and recommended intervals. Compliance with local regulations or standards related to defibrillator maintenance is also essential, especially in health care or public access settings. Regularly scheduled professional inspections may also be required, depending on the device’s usage environment.
Dinkins: As with any medical device, it’s recommended to perform maintenance checks on these devices following the manufacturer’s specifications. Checks on these devices can include ECG rhythm tests, energy output tests, internal self-tests and patient parameter testing. Using a patient simulator/analyzer on these devices will help ensure your device is within the recommended specs.
Lennard: Routine maintenance for defibrillators/AEDs is crucial for their reliability in critical situations. Conduct visual inspections, checking cables, connectors, and electrode pads for wear, and monitor the battery status regularly. Periodic self-tests ensure operational functionality, but to ensure performance, a defibrillator analyzer, such as the UniPulse 400, is recommended. This testing tool performs the simulation of various cardiac arrythmias, measures energy levels and charge times, ensuring an AED’s accurate response and better patient outcomes.
Liu: Since every model of defibrillator/AED is different, following the manufacturer’s annual service procedure and checklist should be the starting point, as these manuals will cover critical function checks for your model of defibrillator/AED. For example, some manufacturers require regular tests using a variable test load to simulate patients of different internal body resistance, which is outlined under AAMI DF-80/IEC 60601-2-4. Without checking the service manual, it is one of the areas that can be overlooked or forgotten during routine testing.
Ross: Regular maintenance for defibrillators and AEDs is critical, and ranges from daily checks performed by clinical staff, through annual maintenance performed by a service professional. Checks should include verifying the functionality of all the device’s features, buttons, and connections, inspecting all cables and paddles, and ensuring the device provides the correct amount of energy output. Regular battery checks and replacements are also necessary, as well as verifying the readiness and expiration date of electrodes. It is also important that if the Defib/AED has Advisory/AED Mode and it has the correct CPR protocol that your facility has adopted. Some defibs may have a lot of features and capabilities, the PMs can get very extensive and involved, and over time many of the service manuals will have a revision. Working with a manufacturer who is focused on providing the latest service revision along with Fluke Biomedical OneQA workflow automation software can help streamline this process, creating a more efficient and effective program.
Smith: Defibrillators perform regular self-tests to verify readiness for use. In addition to these self-tests, users should visually inspect the unit daily or during each shift to confirm that the unit is clean, plugged in, free from damage, and that accessories (such as electrode pads) are readily available. Historically, many facilities have performed manual discharge tests, as well. Since the defibrillators perform discharge tests during their regular self-tests, manual discharge tests are not generally required, though they can help improve user familiarity. Healthcare technology management (HTM) professionals should perform inspections and preventive maintenance on each defibrillator as recommended by the manufacturer – typically annually. AEDs perform regular self-tests to verify readiness for use – usually daily or weekly. These tests check battery capacity, ECG circuitry, and charge/discharge circuitry, and display the results with a status indicator (usually an LED on the outside of the unit). HTM professionals or other device managers should ensure that these status indicators are checked weekly. In addition, batteries, electrode pads, and other accessories should be replaced before they reach their expiration date. Fortunately, in most cases, these accessories will last for several years; however, if the device is stored outside of ideal temperature ranges, the life of these accessories can be shortened.
Q: What are the most important things to look for in a defibrillator/AED?
David: When choosing a defibrillator, whether for professional use in health care settings or for public access, there are several important factors to consider. Here are some key things to look for in a defibrillator: Ease-of-use; biphasic waveform technology; simplicity of operation; clear voice prompts; automatic and manual modes; ECG monitoring capability; pediatric capability; portability and durability; battery life and status indicator; self-test and diagnostics; CPR assistance; data recording and retrieval; compatibility with guidelines and regulations; training options; total cost of ownership; integration with emergency services; durability and environmental considerations; regulatory compliance and support; and training. Before making a decision, it’s advisable to consult with medical professionals, review user manuals, and consider any specific needs or requirements for the intended use environment. Additionally, check for local regulations and guidelines related to the use and maintenance of defibrillators.
Dinkins: A defibrillator/AED should be considered based on the needs of the location or user. Both devices will be able to analyze a patient and deliver shock therapy. Beyond this feature, users will want to decide if they want manual controls and patient monitoring. AEDs are a great choice for public access or BLS due to their ease of use and range of additional features, such as pediatric functions or CPR guidance. AEDs are specifically meant for cardiac arrest emergencies. Defibrillators are for professionals who need to provide advanced care by monitoring patients and checking vitals after stabilization.
Lennard: When selecting a defibrillator, prioritize usability, automated analysis for timely intervention and durability for versatile deployment. Look for clear prompts, adjustable energy levels, and adhesive pads with precise placement instructions. Ensure a visible battery indicator for readiness and consider optional features like CPR guidance based on specific needs. Factor in regular training and maintenance to guarantee ongoing effectiveness in critical situations and safeguarding patients.
Liu: For defibrillators, I would look for models that can expand with additional modules. There are many advantages with a modular design, for one I can add more features to existing units with a smaller budget without having to replace entire fleets, I can also move “modules” from one hospital zone to another depending on patient/hospital needs, and I can send out just the modules for calibration or repair without downtime from my main units. For AEDs, I would look for units that are compact, high battery capacity and, most importantly, easy to use. AEDs are quite often located in public spaces, so it is possible the operator has never used an AED before, someone will need to learn quickly in those scenarios to save lives.
Ross: When looking for a defibrillator/AED, the most important aspect to consider is where the device will be utilized and ensure that it has the correct capabilities. There are so many possible parameters to consider, from simple AED function, through a full equipped transport defib. Then consider reliability, user-friendliness, adaptability to various patient needs, and quality of after-sales support. Don’t forget every defib or AED requires some sort of maintenance and upkeep to ensure it works when needed, how much will that cost, who will be performing the required services, and if in-house is your current biomedical test equipment capable of the required services.
Smith: One key consideration is, whenever possible, to use defibrillators by the same manufacturer throughout a facility – and ideally, one single model. This supports patient transfer, data transmission, and user familiarity with any unit they may need to use. Beyond that, purchasers should choose the advanced monitoring capabilities that offer the most benefit to their application. This can include features like NIBP, EtCO2, SpO2, and 12-lead ECG monitoring. Facilities focused on improving their response to cardiac arrest may want to look for real-time CPR feedback, which has been shown to improve adherence to AHA guidelines for CPR quality.
There are multiple benefits to choosing an AED from the same manufacturer as monitor/defibrillators that the AED may be used alongside, such as those used by your facility or local EMS agencies. For health care facilities, this aids in patient transfer between care teams, streamlines data transfer, supports user familiarity, and simplifies the purchase of accessories. Beyond that, an AED should be easy to use and should have features to reduce the time to shock. Several newer models also have remote monitoring capabilities using Wi-Fi or mobile networks so that device managers are notified if the AED fails a self-test.
Q: How can a HTM professional extend the life of defibrillators/AEDs?
David: HTM professionals play a crucial role in maintaining and extending the life of medical equipment, including defibrillators/AEDs. Here are some strategies that HTM professionals can employ to extend the life of defibrillators:
- Regular preventive maintenance
- Adherence to manufacturer recommendations
- Timely software and firmware updates
- Battery management
- Electrode pad management
- Environmental controls
- Proactive troubleshooting
- Data recording and analysis
- Training and education
- Documentation
- Inventory management
- Collaboration with manufacturers
By implementing these strategies, HTM professionals can contribute to the longevity and reliability of defibrillators, ultimately ensuring that these life-saving devices are ready for use when needed. Regular and proactive maintenance practices are key to extending the life and functionality of medical equipment.
Dinkins: In addition to performing annual maintenance on your unit, it’s important that the installed battery and pads are not expired or damaged. During annual maintenance, check the battery’s performance using a multimeter to ensure it’s not below the recommended voltage. Also during maintenance, clean the device and the battery contact points, ensuring the battery is making proper contact inside the unit.
Lennard: To optimize the life span of defibrillators, HTM professionals can employ a strategic approach with emphasis on testing and measurement, using a comprehensive defibrillator analyzer. Regular testing using these tools facilitate accurate measurement of the device’s energy output and charge time, ensuring it aligns with international standards. Defibrillator analyzers also enable HTM professionals to simulate various cardiac scenarios, testing the AED’s responsiveness and accuracy in delivering shocks. Testing and measurement aids in early detection of potential issues, allowing for timely intervention and maintenance.
Liu: Keeping your machine and all its connectors clean plus ensuring the battery is replaced during regular intervals are probably the easiest ways to extend the life of your defibrillator/AED.
Ross: HTM professionals can extend the life of defibrillators/AEDs by following a rigorous, consistent maintenance schedule and using quality test equipment, and the most current version of the OEM service manual. Addressing minor issues before they escalate can save costs and extend the device’s life span. Leveraging a workflow automation software to record PMs and technician notes that are readily available to an entire biomed team creates a more efficient and compliant process.
Smith: Defibrillators are durable devices that can last for many years. To maintain them in good condition, they should be protected from dropping or other impacts, and they should be stored at moderate temperatures and humidity levels. They should also be cleaned and disinfected in accordance with manufacturer guidelines as needed, while taking care to avoid liquid ingress. HTM professionals should be sure to perform recommended inspections and preventive maintenance on the unit, and keep up with manufacturer updates as they become available. AEDs are intended to need little maintenance over their lifetime, so there is little that HTM professionals need to do. To give them the best chance of lasting a long time, AEDs should be stored in a sheltered, though easy to access, location. They should be kept at moderate temperatures and humidity levels. They should also not be subjected to dropping or other impacts that could cause damage. To help reduce the risk of damage, they can be placed in a padded case and/or mounted in a dedicated storage cabinet.
Q: What else should TechNation readers know about defibrillators/AEDs?
David: TechNation magazine readers interested in defibrillators and automated external defibrillators (AEDs) may find the following additional information relevant:
- Regulatory compliance
- Industry trends
- Integration with health care systems
- Telemedicine applications
- Training and education programs
- Global initiatives
- Data security and privacy
- Community engagement
- Research and development
- Sudden cardiac arrest (SCA) statistics
- Collaboration with emergency services
- Post-event analysis
Please hire trained professionals for your equipment maintenance. Soma Tech Intl can be reached at 800-438-7662 for any professional needs. By staying informed about these aspects, TechNation magazine readers can contribute to the ongoing dialogue surrounding defibrillators and AEDs in health care, fostering advancements, and ensuring the effective deployment of these critical life-saving devices.
Dinkins: An AED/defibrillator is a device we all hope we never have to use; but when the time comes, it has to work. An AED has one job, and that is to save a patient’s life in cardiac arrest. These devices are often forgotten in a cabinet or hung on a wall and may go untouched until needed. A note about storage: always store your AED with the battery and pads installed. In an emergency, the unit must be ready for action. As an HTM or medical professional, we must check these daily and perform annual maintenance, so they stay ready to save a life.
Lennard: The future of defibrillators holds exciting possibilities with the integration of Artificial Intelligence (AI) algorithms, which may enhance cardiac rhythm analysis, reducing false positives and negatives. AEDs will likely connect with health care software, allowing real-time communication with medical professionals and facilitating remote guidance during resuscitation efforts. Smart connectivity features may enable automatic data transmission for maintenance alerts and event summaries. We’ve also seen Augmented Reality (AR) as a major player now in HTM, and assistance could simplify AED operation through visual overlays or step-by-step guidance.
Liu: When it comes to patient safety, regular PMs of defibrillators/AEDs are extremely important to minimize tragedy. In 2022, a father died in a U.S. hospital when a defibrillator used on him malfunctioned and exploded during use. In 2023, a passenger died on an U.S. airline when the battery in an AED unit failed. Perhaps these are some of the reasons why the FDA categorizes defib analyzers as a medical device and require FDA approval to be sold in the United States.
Ross: TechNation readers should know that defibrillators/AEDs are life-saving devices, and their maintenance should never be compromised. It needs to work the first time, every time. Consider the working environment of these devices. AEDs/defibs may be transported in the trunk of police cruisers, or compartments of a firetruck, exposed to harsh environmental conditions, and possibly even dropped. Ensuring these devices are in top-notch condition is essential to patient safety. Fluke Biomedical can greatly help in ensuring effective testing, tracking, and documenting of the device’s performance, thus providing reliability and peace of mind.
Smith: ECRI is sometimes asked about the different biphasic waveforms that defibrillators use, and whether one waveform or energy protocol is better than another. The short answer is that all biphasic waveforms used in the U.S. are highly effective for defibrillation and cardioversion, but there is insufficient evidence to support the superiority of one waveform over another. Therefore, ECRI recommends that facilities prioritize other purchasing considerations, such as those listed above, over waveform characteristics. Similarly, the 2020 AHA guidelines state that, lacking conclusive evidence that one biphasic waveform is superior to another, it is reasonable to use the manufacturer’s recommended energy dose for the first shock. Higher energy levels may be considered for subsequent shocks. AEDs are intended to reduce the time from onset of cardiac arrest to delivery of a lifesaving shock. They enable bystanders to take action. However, of the roughly 50,000 cardiac arrests that occur in public locations every year in the U.S., AEDs are used by bystanders only about 10% of the time. As a country, we have a long way to go in ensuring that AEDs are ready and easily found, and that bystanders are prepared to act.