Does congestive heart failure improve with a pacemaker?

Answer 1

Yes, you should externally defibrillate a patient with a pacemaker who has gone into cardiac arrest. Chest compressions, rescue breathing and standard cardiac arrest procedures should be followed, while paying attention to the following points.

EMS personnel should be aware that the pacemaker has its own implanted defibrillator and will fire charges at regular intervals. This should not harm the person doing chest compressions. A slight tingling feeling may be felt on the patient as the shock from the pacemaker is delivered. To avoid this, wear thick nitrile or latex gloves while doing chest compressions.

The shock from the external defibrillator may cause damage to the pacemaker, and even interfere with it. To lessen the risk of this, the defibrillator should be placed on the lowest possible charge that is clinically accepted. If you notice that the implanted defibrillator and the external defibrillator both deliver a shock at the same time, standard procedure dictates that you wait 30 to 60 seconds prior to re-shocking with the external defibrillator. In the meantime, chest compressions and manual ventilation may be commenced.

Intubation, artificial airways and other standard practices should be performed, despite the patient having a pacemaker.

It is also vital that urgent medical help be called as with all cardiac arrest patients. Remember, cardiac arrest patients are not normally transported in the ambulance unless they are revived on scene.

Answer 2

An automated implantable cardioverter-defibrillator (AICD) would be more appropriate.