AEDs – On the Horizon, New Ways to Treat SCA

Envision a future AED as a cell phone-sized device, small and light enough to be carried in a pocket. Even better, what if it was simply an app one could download onto the cell phone?

With the never-ending advancements in technology, there is no doubt that we will find better ways to stay safe and remain healthy. Science is an evolving practice that changes as technology improves. This is especially beneficial in the health and safety fields, where heart technology is concerned. The automated external defibrillator (AED), for example, once did not exist. It was not until technology improved, and researchers realized that electrical shocks could be administered to the heart to save a life, that these lifesaving machines came into being! Heart technology has advanced to impressive and astonishing heights, and the industry can only expect it to continue to expand.

Global market
The global AEDs market, valued at USD 680 million in 2018, is expected to reach USD 1040 million by the end of 2025, growing at a CAGR of 5.6 percent during 2019 to 2025, estimates QY Research. The rising prevalence of sudden cardiac arrests (SCAs) coupled with the growing aging population will be few of the factors impelling the AED market growth during the next few years. With the increasing number of cardiac arrest cases across the advanced and emerging economies, the demand for defibrillators has increased considerably in recent years.

With growing age, the chances of cardiac arrest also increase. In 2018, over 670 million people across the globe were above 65 years of age and the number is likely to increase to over 810 million by 2025. Furthermore, the increasing instances of coronary artery disease (CAD), obesity, and diabetes are also, in turn, driving the demand for AEDs in the forthcoming years.

With growing digitization, vendors in the AED market are focusing on upgrading AED machines with advanced features, such as rechargeable batteries, voice prompts, CPR tutorials, LCD screens, and other new types of shocks. Some vendors have developed mobile-phone defibrillators, which are expected to provide instructions on how to perform CPR. Moreover, vendors in the market are increasing the focus on using drones to carry these defibrillators, in turn, improving the chances of survival by arriving faster than emergency medical services. Such rising technological advances will be gaining traction in the market during the next few years.

The impact of the driving factors is expected to surpass that of the restraints. Moreover, emergence of new technologies and increase of AEDs are anticipated to provide new growth opportunities in the near future.

Despite the presence of rising competition, but due to the global recovery, the trend is clear; investors are still optimistic about this area – the future will see more new investments enter the field.

North America continues to account for the highest revenue with increasing several cardio-vascular diseases, aging population, and advancements in medical technology, which is likely to augment the market of AEDs. Europe accounts for the second-largest market for AEDs in terms of revenue. Rising prevalence of coronary artery disease, and increase in physical activities is propelling the market for AEDs in Europe. Asia-Pacific is anticipated to be on a fast growth track with increasing prevalence of sudden cardiac arrests, and growing investment by market players in the region. The Middle-East and Africa and Latin America are expected to grow over the next 7 years. Increasing obesity and geriatric population in the region is propelling growth of the market.

Major players for AEDs include Asahi Kasei Corporation, Cardiac Science, GE Healthcare, Philips NV, Medtronic PLC, Nihon Kohden, Schiller, Mindray Bio-Medical, Stryker, and Zoll Medical.

Vendor update
In April 2019, Stryker has launched in the United States its Lifepak CR2 defibrillator with LIFELINKcentral AED program manager. The company has announced that the LIFEPAK CR2 AED has received premarket approval (PMA) from the USFDA. The LIFEPAK CR2 AED features the cprINSIGHT technology that allows chest compressions to continue during ECG analysis, helping to increase hands-on time and reduce the longest pauses in CPR, which can improve survival outcomes.

In January 2019, Philips and the American Heart Association joined forces to increase global SCA survival rates in densely populated cities around the world. The Connected Pulse program leverages a unique end-to-end solution combining education programs to increase awareness of CPR, the use of publicly available AEDs and new technologies to strengthen the chain of survival from the moment an incident occurs to the patient reaching the hospital.

In January 2019, Zoll Medical Corporation acquired Payor Logic Inc. that specializes in best-in-class accounts receivable (A/R) software solutions for the healthcare industry. With this acquisition, Zoll intends to surpass the level of A/R efficiency to hundreds of organizations across the healthcare spectrum, offering better financial performance, freeing up capital to reinvest in their operations, and ultimately providing better patient care.

Way forward
Technology moves incredibly fast in the 21st Century. Look at the difference in cell phones from just 10 years ago and today! Medical technology has also moved quickly. Surgeons can now perform heart bypass surgery via robotic fingers through five small slits in a person’s chest rather than making a long incision and then cracking open the chest to reach the heart. Bluetooth-enabled bionic limbs have moved out of 1970s television and into the real world. Even the complete human genome has been mapped!

Strangely, though, AEDs have not really changed all that much in this century. The biggest advance was the switch from monophasic to biphasic waveforms. After that, the only real changes that have occurred are in the areas of cases, batteries, and user interface.

From AED drones to cell-phone AEDs, there are lots of great ideas in the works for how to make current AED technology more accessible and faster to implement. But even these ideas are still in the development stage and are years out, provided they ever receive USFDA approval.

So are there new technologies on the horizon when it comes to defibrillation technology? The short answer is maybe. Researchers at Johns Hopkins University and Germany’s University of Bonn recently revealed findings showing how lethal heart arrhythmias can be terminated by using gentle light beams rather than harsh electrical shocks. Termed optical defibrillation, its initial primary use would be in implantable defibrillators.

Currently, implantable cardioverter defibrillators (ICDs) work like AEDs, delivering an electrical shock to the patient’s heart via wire leads any time an abnormal rhythm is detected. Unlike an AED, these shocks might be delivered while the patient is conscious, and they can be painful. The researchers are working toward optical defibrillation of the heart, where light will be given to a patient who is experiencing cardiac arrest, and the patient will be able to restore the normal functioning of the heart in a gentle and painless manner. How soon can one expect to see ICDs, which use light instead of electricity? Junior Professor Philipp Sasse of the Institute of Physiology-I at the University of Bonn, emphasized the new method is still in the stage of basic research. Until implantable optical defibrillators can be developed for the treatment of patients, it will still take at least 5 to 10 years.

And that is for the implantable application. Can this technology be applied to external defibrillators? That question cannot be answered at this time, but one can be sure AED manufacturers are watching this new development very closely.

Another possibility is ultrasound technology. Still in the very early stages of research, researchers at Drexel University released findings that ultrasound could be used to change the beat frequency of the heart muscle. This is advantageous on two levels. One, AEDs on the market today cannot affect a heart in asystole (flatline) as there has to be some electrical activity in the heart to begin with in order to be reset. If an ultrasound AED can cause heart muscle contractions, it could possibly reduce the need for CPR, as well as getting the heart beating again.

Ultrasound’s second advantage would be the non-invasive nature of the treatment. It could be delivered externally, much the same way existing AEDs deliver an electrical current, and unlike the optical defibrillators, which are more effective as an implanted device.

Outlook
Envision a future AED as a cell phone-sized device, small and light enough to be carried in a pocket. The device could be placed on a victim’s sternum to analyze the patient and administer treatment, if needed. Today’s AEDs are considered simple to use, but these could be made even simpler – merely emitting a sound wave or light strong enough to penetrate clothing, as well as the sternum bone, and reset the heart. Even better, what if it was simply an app one could download onto their cell phone? Everyone could literally have everyone else’s lives in their hands.