Bronny James collapse showed again that defibrillators save lives. Should you get one?

They are not cheap, but can be priceless.

Should we all invest in a home Automatic External Defibrillator? Is the potential lightning strike from an AED worth ~$1,000?

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Bronny James, son of NBA legend Lebron James, suffers a sudden cardiac arrest playing basketball at USC last week. Medical staff are on hand, start CPR immediately, and then use an on-site defibrillator (AED) to restore a normal heart rhythm within minutes. He’s alive and well.

Last year another USC basketball player named Vincent Iwuchukwu drops suddenly. Cardiac arrest. CPR and defibrillation in less than a minute. He also survives and is playing Division I basketball again within 6 months.

Damar Hamlin, NFL player, gets hit hard in the chest while playing NFL Monday Night Football in January this year. CPR is performed and an AED restores his heart rhythm. He’s alive, too.

And while these are just high-profile cases that make the news, over 365,000 Americans suffer a sudden cardiac arrest each year. The American Heart Association estimates that only 10% of them survive when outside of the hospital setting.

This year one of my very healthy patients suffered a completely unexpected cardiac arrest. She was in the parking lot of the medical school affiliated with my healthcare system, prepared to go in and help with teaching. Upon witnessing her collapse, a medical student hopped in and assisted first responders with CPR. It was not the worst place in the world for a sudden event. She too received defibrillation. Upon receiving notification of what had happened, I called her husband at home. We shared shock, disbelief, and fervent hope. She did make a full recovery. And when I finally saw her back in our primary care office I was elated. Karen’s story can be heard firsthand on this podcast from Independence Blue Cross. (Yes, it’s the same great podcast series that I appeared on for a different interview).

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After the collapse and rescue of Bronny James last week, an AHA spokesperson was asked what can schools and athletic teams do to prevent or prepare for these events in young athletes. By way of response, he referred to his organization's cardiac emergency response plan that prioritizes AED availability, broad education about hands-only CPR, and routine drills.

So, what do these dramatic events mean for the rest of us? Should we all be upping our game at home, too?

At a minimum I think we should know the out-of-hospital chain of survival:

CPR can be learned and relearned. There are online, offline, and in-person classes and educational resources. Two excellent starting points would be:

• The Red Cross

• The AHA

But should we consider having an AED at home, too?

I think The Mayo Clinic does a good job answering this question:

Proponents of home AEDs say putting them where they're needed most will save many lives. But critics argue there's no reliable evidence that home defibrillators save more lives.

Deciding if an AED is right for the home.

For some people at high risk of cardiac arrest, having an AED can provide peace of mind and might help save their lives. Here are some things to keep in mind when considering whether to buy an automated external defibrillator:

Risk of sudden cardiac death. For someone at high risk of sudden cardiac death due to a specific heart rhythm problem, a health care provider will likely recommend an implantable cardioverter-defibrillator (ICD) rather than an AED. An ICD is implanted in the chest and connected to the heart through a wire that can deliver a shock when needed.

Living arrangements. You need someone with you to use the AED if you have cardiac arrest. And the person needs to be able to get on the floor to use the device and get back up. If you live alone or if the person you live with can't get up and down, a home AED might not make sense.

Costs. Home AEDs can be expensive and aren't usually covered by insurance.

Overall health and quality of life. Someone with many medical conditions, especially those that might be fatal, or who has a very weak heart that hasn't responded to treatment might choose not to be resuscitated from sudden cardiac death.

Photo by Eduardo Goody on Unsplash

Sometimes people want to know what doctors do, and sometimes they don’t. I got all the recommended Covid shots and boosters, for example, and we have a home AED. One year we had about $1,000 left in our health savings account. In a cynical display of American economic gambling, as you know, if you don’t spend the money you lose the money. Unreal. So, we decided to buy an AED for over a thousand dollars.

How much do we spend on a week’s vacation? A couple thousand dollars? How much is our monthly credit card bill, our mortgage, a new car? This newsletter is free (but with an option to say thanks for $4/month), so any lifesaving information gleaned here is comparatively cheap. But if you are interested in getting a home AED, I think a good place to start would be through The Red Cross, and you can follow this link to get to specific AED related material.

I called The Red Cross as I prepared this post. I spoke with Sherri Harris. You can too, and she is very helpful. She stated that it was OK to give out her contact information for anyone wanting to talk instead of clicking: (800) 567-1474 ext. 134581. The Red Cross acts as a curator of quality AED’s and a central educational hub. They coordinate with distributors and manufacturers to facilitate AED purchases. Any units bought through their website also help to support the overall Red Cross mission, which is noble and beneficial to millions of people. Otherwise, there are other distributors out there, and some manufacturers sell directly to the public.

Most AED units do not require a doctor’s prescription. If you are trying to use healthcare savings account money or have significant healthcare expenditures that reach the threshold for being tax deductible, a prescription might be needed for those documentation purposes.

Investing in a home AED is a lot of money. But is cardiac arrest a low probability event? In the short term, probably. In the long term, probably not. 365,000 Americans a year is not a small number in my opinion. An AED will not rescue everyone, either. But I’ll give the last word on this to the Red Cross, from a helpful email Ms. Harris forwarded to me after our conversation:

The average response time for local EMS ranges from eight to twelve minutes. This is a critical time for being able to help a victim in cardiac arrest. Having an AED on site and ready to use within two to three minutes can increase the chance of survival from 10% to 70% from CPR alone. This gives the victim a better chance of survival before EMS arrives.

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In conclusion, sudden cardiac arrests are common events. When these occur in young, healthy, athletic individuals it can be shocking. But about 1,000 of us experience sudden arrest on a daily basis here in the U.S. Knowing the chain of survival is key. Oversimplified: we call 911 and do chest compression to buy time for defibrillation. Home AED’s are an expensive investment, but so are summer vacations that pass too quickly. Home AED’s are generally not recommended for the masses by any major guidelines. Yet it’s hard not to see the pattern in between the headlines, and what saved Bronny, Vincent, Damar, and Karen by way of example.