**Author details**

**3.8. Legal issues concerning AED**

18 Cardiac Defibrillation

In the past use of AEDs was limited partly because of the concern for subsidiary responsibility of those who are not health personnel. The fact that defibrillation is a medical act represents a legal obstacle in many countries. In 2000 the U.S. Congress approved the Act of survival in car‐ diac arrest, which extended the protection of the Good Samaritan to the users of an AED. Lay rescuers are protected from lawsuits if they act voluntarily to try to help a person who is hav‐ ing a medical emergency. The rescuer should act with good faith and make an effort help an‐ other person The rescuer's efforts must be reasonable and with common sense. This has been

While these devices are very effective when treating ventricular arrhythmias, they still the need the presence of a bystander capable of applying and operating it. Also, it must be taken into account, that only a half of the cardiac arrests are witnessed so for a large number of

The main drawback that was observed when using an AED is that it requires interruptions in CPR in order to analyze the rhythm and to deliver the electric shock.Ongoing efforts are aimed at minimizing this time, and technical advances may eventually enable accurate rhythm interpretation even while CPR is ongoing [92, 93]. Recent resuscitation guidelines emphasize strongly the need to reduce 'hands-off' time in order to obtain a favorable result.

It was advocated that AED should be included in the category of compulsory safety equip‐ ment such as smoke alarms or fire extinguishers. However this approach has not demon‐

One of the future directions of research is AED analysis of shape and pattern of VF wave‐ form recorded by ECG. It promises help in guiding the rescuers for the best course of treat‐

Sudden cardiac arrest, frequently due to VF or pulseless VT, is traditionally associated with poor survival rates. Saving the lives of these patients depends on early cardiac defibrillation which, with manual defibrillators, is limited only to qualified rescuers who can interpret ECGs. AEDs solve this problem since they are able to analyze rhythm and inform the rescu‐ ers whether a shock is indicated. This approach allows lay rescuers to provide effective early defibrillation which has been shown to significantly improve survival and survival with in‐ tact neurologic function after out-of-hospital cardiac arrest. One limitation is that AED use requires interruptions in CPR which was proved to be deleterious especially in patients with non-shockable rhythms. Special efforts are being made in order to improve rhythm analysis

an important step in the diffusion and generalization of these devices.

strated survival benefit and at the moment is cost prohibitive.

ment with CPR, defibrillation and medication. See section 3.3

**3.9. Challenges and future development for AED**

patients this therapy cannot be available.

**4. Conclusions**

and 'hands-off' time during CPR.

Hugo Delgado, Jorge Toquero\* , Cristina Mitroi, Victor Castro and Ignacio Fernández Lozano

\*Address all correspondence to: jorgetoquero@secardiologia.es

Hospital Puerta de Hierro Majadahonda, Madrid, Spain
