CPR With Pacemaker and Defibrillator

 Is it possible to perform CPR on someone who has a pacemaker or implantable cardioverter-defibrillator, ICD? Yes! CPR should be done on a person with a pacemaker if need be. We recommend learning about the differences between a pacemaker and a defibrillator. If they are unconscious, it is possible that something is seriously wrong with their heart, or their pacemaker for that matter. AED devices may also be used to deliver defibrillation shocks to ICD patients who require extra support in reducing the risk of death. 

Arrhythmia, including ventricular tachycardia and ventricular fibrillation, can be regulated with a pacemaker, however, it has no power over the heart’s systole. CPR leads to the heart operating again and gaining control over a normal heartbeat if it fails, which normally means something is wrong with the systolic functions.

When Should You Not Perform CPR?

We normally concentrate on when and how CPR should be administered when someone has a life-threatening or abnormal heart rhythm, but when should you stop CPR, or when is it not necessary on patients? CPR should be initiated as soon as possible and should not be done for more than three hours. There are four general requirements for determining when CPR should be stopped:

1. The person is dead
2. Physical exhaustion
3. If there is an indication of life
4. The emergency medical health team arrives

The Person is Dead

If a person with a pacemaker experiences sudden cardiac arrest, begin CPR or external defibrillation as soon as possible to give the victim the best chance of survival. Sudden cardiac arrest is not always apparent, which means you may find the victim unresponsive after an unexplained period of time. It is also conceivable that the deceased suffered from life-threatening injuries like traumatic brain damage. Therefore, when confronted with unresponsive patients, one must evaluate the situation to determine whether you need to deliver any treatments. Here are several warning signs to look out for: 

The Person with a Pacemaker is Cold to the Touch

If you touch someone and they are incredibly cold, it is probable that they are beyond the point of being revived. However, the climate must be considered. Feeling the skin may offer false indications if a person is outside in cold weather or if they are a drowning patient.

Rigor Mortis

This Latin phrase means the third stage of death. It is one of the recognizable symptoms of death, caused by chemical changes in the muscles postmortem, which causes the limbs of the body to stiffen. 

Rigor mortis is an extremely late symptom of death. It’s too late to initiate treatment if you find a patient absolutely rigid with limbs that don’t move freely. In whatever shape a person with a pacemaker is in, they stiffen. 

Livor Mortis

When a body starts to turn blue, this is a sign of livor mortis. It is caused by blood collecting on the skin and gradually penetrating it. It looks like bruises but covers a wide area of the body.

Lividity happens at a person’s center of gravity at all times and is a clear sign of death. 

Severe Injuries that a Person Cannot Live With

These kinds of injuries are serious, and even the strongest efforts would be ineffective. Decapitation, torso amputations, and other amputations are examples of this. Some medical providers have procedures that prevent paramedics from performing treatment on major traumatic arrests.

A traumatic arrest occurs when a person experiences a traumatic injury, such as an amputation, that causes them to bleed excessively to the point where their heart stops beating. Since there is no blood to flow with compressions and no red blood cells to bring oxygen from rescue breaths, any clinical procedure would not be helpful. 

Physical Exhaustion

Physical exhaustion makes it impossible to continue CPR. Unlike in the movies, CPR seldom brings anyone back to life with just a few compressions; it can take anything from 30 minutes to one and a half hours before a patient responds after suffering from sudden cardiac arrest. Longer resuscitation attempts, in reality, have been shown to enhance brain function in survivors.

CPR is exhausting. After 15 minutes of CPR, a person burns 165 calories. However, according to the national American Heart Association, CPR performed for a full 38 minutes links to significant improvements in control of a normal heartbeat. In fact, because of the increased chance of resuscitation, the younger an individual is, the longer you should attempt CPR. However, if you are doing the procedure by yourself, you can only go for so long before being exhausted.

Indication of Life

Guidelines do not recommend checking for a pulse every two minutes while CPR is done outside of specialized medical treatment. If you initiate the process, it should be continued without interruption for as long as possible before visible signs of life appear.

When it comes to knowing when to avoid CPR, there are a few main signs to watch for. The following are the main indicators to look for in a victim:

• Movement with an intent – When someone lifts their arm, raises their head, grimaces, and so on.
• Making Noises – During CPR, involuntary sounds such as inconsistent “agonal breaths” can occur from patients. You should listen for more noticeable sounds like crying or speaking as a sign of when to stop.
• The patient moves their eyes – If there is eye movement, the opening of eyelids is not enough to stop CPR. Blinking eyes, gazing around, and concentrating on things are all signs that the victim is thinking.

These signs of life are unusual outside of the hospital, but they do occur. If you stop performing CPR after seeing these signs of life, the individual may become unresponsive again.

Emergency Medical Health Team Arrives

Finally, if advanced assistance arrives and takes over CPR, you can stop all activity. A trained first responder, such as a paramedic or a firefighter, is usually sufficient. If you are willing and able, they might ask you to keep doing compressions while they set up their equipment. You might even be asked to come to a halt so that they may take over immediately.

Advanced aid typically arrives at patients in a few minutes in urban areas. In rural areas, however, response times can take up to 30 minutes or more. There are several variables to consider before deciding when CPR should be stopped. In the vast majority of cases, you are never pressured to make that choice. With a few exceptions, you can generally expect the medical service to arrive and take over before you even consider stopping.

If you have never taken a CPR lesson, we recommend you do so now so that you are ready to respond in an emergency. 

Can You Use an AED on Someone With a Pacemaker? 

Yes, this follows all necessary safety measures. The upper left side of the chest is where you should implant a pacemaker and implantable cardioverter-defibrillator, ICD. Chest compressions are performed in the center of the chest during the process and do not interfere with a pacemaker or implantable cardioverter-defibrillator, ICD, that has been in operation for some time. 

When using an automatic external defibrillator (AED), the pads placement is typically on the upper right side of the chest and on the side of the rib cage under the left arm, out of the way of pacemakers or ICDs.

While there is evidence that an implantable cardioverter-defibrillator is going to save your life in the event of sudden cardiac arrest, it cannot fully prevent it. When a sudden cardiac arrest is not caused by a fast and life-threatening heart rhythm or heart rate, the ICD does not produce an electrical shock; therefore, you should initiate CPR right away. Alternatively, an ICD device can produce one or more electrical shocks but may fail to restore a normal heart rhythm, which poses a greater risk.

If the individual is unconscious and not breathing, CPR should be administered immediately. The internal shock would not affect the person performing CPR if an ICD delivers an electrical shock while CPR is being performed.

A defibrillator should be used as soon as possible if one is available. It uses external pads to analyze the heart rhythm and heartbeat; if it senses that the heart has been returned to a normal rhythm by an ICD device, it is not going to produce a defibrillation shock. Defibrillators do not damage the ICDs.

If you have had CPR or defibrillation, you can check your pacemaker or ICD devices to ensure the settings are still correct to provide the necessary support in case of an abnormal heart rhythm, ventricular tachycardia, or ventricular fibrillation.

How to Use an AED on Someone With a Pacemaker?

The AED pads should be a few inches away from a person’s pacemaker if they have one. Pacemakers can be seen just below the collarbone, just under the muscle and skin. ICDs have the appearance of a slight bulge under the surface of the skin. There is normally a scar from the implantation procedure if the pacemaker is not visible.

However, since modern devices are becoming smaller and smaller, you should not count on seeing if the patient has an implanted pacemaker. In the event of sudden cardiac arrest, some people wear a rubber band bracelet that states they have a pacemaker, which is an excellent way of sharing their health information. 

To use an AED device on patients who have an implanted pacemaker, you must do the following:

1. Call for assistance or ask others to call for help.
2. Find the AED device, open it, and plug in the pads.
3. Remove the person’s shirt who is suffering from cardiac arrest or an abnormal heart rhythm.
4. Make sure their skin is smooth, shave away any excess hair, and remove any medicinal patches or pads they may have.
5. Track down the implanted pacemaker.
6. Place the AED pads a few inches away from the implanted pacemaker.
7. All should stay away from the patient.
8. To use the device, click the button.
9. Wait until the AED device has administered the electric shock and has given you the go-ahead to make contact with the patient.
10. Continue CPR if possible, or wait before the AED device gives the patient another electrical defibrillation shock.
11. Continue to provide assistance before the ambulance arrives.

How Long Should You Do CPR Before Using a Defibrillator?

When a person with a pacemaker stops breathing and their heartbeat stops, CPR should be performed as it maintains oxygenated blood circulating to the brain and heart before a defibrillator or an emergency response team arrives to restart the heart with sudden electrical shocks. CPR, if initiated as soon as possible after a cardiac arrest, has the ability to double or triple the victim’s chances of survival, thus reducing the risk of death. 

Use the following method to deliver CPR on an unresponsive adult, child, or infant:

Call 911 right away and get access to an external defibrillation device. If you do not know how to do CPR, do not be discouraged: Over the phone, 911 operators are instructed to walk people through the steps.

Once you have dialed 911, begin CPR right away. Keep the CAB process in mind:

• C- Compressions: Place the heel of your hand on the victim’s chest in the middle. Place your other hand, fingers interlaced, on top of the first. Adult’s and children’s chests should be compressed by at least two inches, while babies should have their chests compressed by one and a half inches. It is best if you can do it 100 times a minute or even a little quicker. 
• A – Airway: If you have been trained in CPR, you can now use a head-tilt and chin-lift technique to open the airway. Pinch the victim’s nose shut.
• B – Breathing: Take a natural breath, then cover the victim’s mouth with yours to form an airtight seal, then take two one-second breaths while watching for the chest to rise. Compressions and breaths should be continued before the care service arrives (30 compressions, two breaths).

If one is available, use an automatic external defibrillator, AED to perform a shock to create a normal heart rate or heartbeat and reduce the risk of death. It should be attached to the victim and used as soon as possible. Follow the external defibrillation device’s directions carefully for it to function correctly. Most devices are programmed to guide you through the operation, or you can call 911 for help. Reduce the number of times you interrupt the compressions before and after each defibrillation electrical shock. After each shock, restart CPR, starting with compressions.

What to Avoid if You Have a Defibrillator?

ICDs and pacemakers last anywhere from five to seven years, depending on use and system type. With ICDs, patients can usually live a regular life.

Microwaves, for example, are less likely to mess with your AED device due to technical advances. Even so, if you have an implanted pacemaker or an ICD device, you must take some precautionary measures.

Please remember to take the following factors. With your doctor, go through the following points in detail:

1. Going through a security detector is usually secure; it does not negatively impact the pacemaker or ICD devices in any way. However, remind airport screening services that you have a pacemaker prior to going through. 
2. Stop devices that use magnetic resonance imaging (MRI) or additional significant magnetic surfaces. These factors can have an effect on the pacemaker’s programming or work. Additionally, the quick-adjusting magnetic field inside the MRI scanner may cause the pacemaker to heat up. There are typically other choices for individuals with pacemakers than an MRI scan; however if your doctor decides that you need one, speak to your cardiologist initially. If the expert and you consent to proceed, you must be closely supervised by a cardiologist during the MRI scan, with the pacemaker programming system readily available. As long as monitoring and specific safety measures are taken, modern pacemakers and ICD technology can be a secure choice for MRI.
3. Diathermy should be stopped at all costs. This is where heat is used to heal muscles in physical therapy.
4. When operating on big engines, such as boats or vehicles, switch them off. The magnetic attraction created by these bigger motors can temporarily “confuse” your ICD system.
5. Cell phones with less than three watts available in the United States are usually secure to use. Hold your handset at least six inches away from your laptop as a general rule. Avoid putting your phone in your breast pocket if you have a pacemaker or ICD device implanted in your body.
6. If a person is getting a surgical operation performed by a dentist or medical provider, let them know you have a pacemaker or an ICD. Certain operations necessitate temporarily turning off or setting your ICD devices to a special mode. Your cardiologist is going to make this decision. Temporarily adjusting your implanted pacemaker’s mode can be performed noninvasively, but only trained medical professionals can do so.
7. Without proper planning, shock wave lithotripsy, which is used to remove kidney stones, can cause your system to malfunction. Before scheduling this procedure, make sure your healthcare provider is aware of your ICD or pacemaker.
8. The use of transcutaneous electrical nerve stimulation to cure specific types of pain can cause your ICD’s pacemaker to malfunction. If someone is thinking about trying this treatment, let the doctor know.
9. The circuits in your device may be affected by therapeutic radiation, for example, those one uses in cancer treatments. Higher doses of radiation increase the risk. Precautions should be taken as deemed fit. Before starting radiation treatments, tell your doctor whether you have an ICD or a pacemaker.
10. Always have a pacemaker or ICD identification card on you. If the individual has a device, we recommend that they wear a medical warning necklace or bracelet for extra care.

If you contain any reservations about the function of equipment or medicine near your implanted pacemaker or ICD devices, please contact your doctor or the system manufacturer.

What Is the Most Common Reason for Unsuccessful CPR?

This national care procedure may not always be successful when you deliver it to patients. If you want to deliver successful first aid: 

• Remember to seek clinical assistance before beginning the process as most people give up performing the procedure for a few minutes.
• Do not forget CPR and begin treating minor injuries: Every minute that passes without compressions to restore blood flow in the body reduces the victim’s chances of survival, thus posing a higher risk.
• Do not favor rescue breath over chest compression: If you are untrained in performing mouth to mouth, you must stop it and concentrate solely on the chest compression.
• Compressions should be slow but not too fast: 100 to 120 compressions per minute is the standard protocol.
• Avoid bending your elbows: Instead, hold them straight and your fingers clenched together so you can apply enough pressure when performing compressions on the person with a pacemaker.
• Do not be concerned about harming the victim if you add enough pressure to the compressions. A crack in the chest does not mean you are injuring them or putting them in more danger than they already are.
• Remember to tilt your head: If the airway is blocked when providing rescue breaths, there would be insufficient air accessing the victim’s lungs, resulting in less oxygenated blood to the heart and body.
• Check for an open airway and place the victim’s head in a tilt position using the head tilt/chin raise process.
• Avoid leaning on the cardiac victim: You need to allow the victim’s chest to fully recoil. This is just as vital as performing compressions for health purposes.
• Avoid leaning on the person you are attempting to resuscitate: It may seem obvious, but since the process requires a lot of physical work over a long period, you may be tempted to lean on the victim when you get tired.

Conclusion

Defibrillators could be used to deliver sudden electrical shocks to patients with ICDs, pacemakers, heart health, or cardiac issues; an AED device is still effective in helping these people when they suffer from arrhythmia, or ventricular fibrillation, ventricular tachycardia, or an abnormal heart rate or heartbeat. Whether dealing with adults or children, first aid services should be a primary concern when there is an issue with their beating heart. If you are a person with a pacemaker device, you could receive the necessary treatment services in times of need.