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Defibrillators Advancing in Preventing Cardiac Arrests

The modern defibrillator has a built-in computer that can assess a hearts rhythm, determine whether or not defibrillation is required, and then administer the necessary level of electric shock.

As heart diseases continue to be one of the leading causes of death in the country, defibrillators have a large role to play in saving lives. Over time, the defibrillator has taken on several forms, including transvenous and implanted defibrillators that can sit inside the body to deliver an electric shock as necessary, but the automated external defibrillator (AED) has become the most popular version of the device.

Often seen in hospitals, emergency sites, or other public places in order to treat sudden cardiac arrest, the modern defibrillator has a built-in computer that can assess a heart’s rhythm, determine whether or not defibrillation is required, and then administer the necessary level of electric shock. The latest advancement includes, but is not limited to, having a more consistent shock with a higher confidence level.

Yet another advancement that can be seen currently is the ability to deliver more current. These features are important because these devices need to be reliable as they deal with matters of life and death. In addition to wearable devices, advances in defibrillation have been centered around adding more capabilities to existing AEDs, such as storing information about a patient’s heart rate to pass on to medical professionals, and regulations around where defibrillators must be present. Defibrillators have also improved significantly in terms of cost, size reduction, and ease of operation.

Indian Market Dynamics
 The Indian market for defibrillators in 2015–2016 is valued at 7500 units, at Rs. 99.85 crore. The year saw an increase across all segments, albeit the maximum growth continues to be exhibited by biphasic ones. Monophasic defibrillators are still in demand in smaller cities. The spiraling growth anticipated in the AED segment, will only happen once the government takes a firm decision to make this life-saving device available in all public places, as is happening in the western world.

The prices remained stagnant over 2015–2016, unlike in 2014–2015 and 2013–2014, when they fell appreciably. The discerning buyer is no longer buying a defibrillator by itself; he is opting for one built into the patient monitoring system. The tenders from the government too showed preference for these.

2015–2016 saw orders from the governments of Rajasthan, Chattisgarh, and West Bengal, PGI-Chandigarh, and Tamil Nadu Medical Services Corporation Ltd. (TNMSC). Private procurement included purchases by Apollo, AIIMS, Safdarjung Hospital, Fortis, and Max Group.

Schiller and Philips continue to dominate this segment, with a combined market share in the vicinity of 65 percent. BPL, Mindray, and Nihon Kohden are aggressive in this segment. Zoll, Stryker – earlier Physio Control, GE, Cardiac Science (marketed by AMDL), Nasan, and Metrax are other players.

Technology Updates
MRI-compatible cardiac implantable electronic devices. Following the FDA approval of the first ICD system approved for use during MRI scans in late 2015, 2016 saw the expansion of additional FDA-approved MRI-conditional CIED and lead systems, additional pacing systems, and some conventional pacing leads approved for MRI use with MRI-compatible devices.

In May 2017, US FDA granted market clearance for Medtronic’s cardiac resynchronization therapy (CRT)-pacemakers that improve therapy delivery for patients with heart failure. These devices also allow patients to receive MRI scans in either 1.5 or 3 Tesla machines. In August 2016, Boston Scientific received US FDA approval for the MRI S-ICD system, as well as MR conditional labeling for all previously implanted S-ICD systems.

Advances in AED. Surge in the demand for AEDs is driving the competition amongst the market leaders and the launch of technologically advanced defibrillators for gaining a competitive edge. AEDs are designed in a way to make them useful to both life-support trained personnel and the general public. Newer AEDs guide the user by either giving signals to the rescuer to deliver shock or the system will automatically deliver the shock.

Optogenetics defibrillator. Current treatments for arrhythmia involve administering an intense burst of electricity from a defibrillator in times of cardiac arrest, but these pulses are painful and potentially harmful. The ongoing advancements in optogenetics and research trials in mice and human heart models pave the way to implantable optical defibrillators that provide a gentle and safe alternative to a harsh electric shock.

Quadripolar lead devices. The introduction of quadripolar lead devices is another promising advancement in the field of defibrillators, which in turn would allow more programming operations in pacing and overcoming other issues such as cardiac resynchronization therapy defibrillator (CRT-D). As more patients with cardiac conditions are living longer, the leading market players continue to invest in research and development to bring solutions to the market that improve quality of life for patients.

Advances in ICD. Modern ICDs are sophisticated devices that are able to perform two general functions: record the heart’s activity and treat dangerous ventricular arrhythmias with a shock. Most defibrillators also work as a pacemaker, should marked slowing of heart rate occur, and can deliver antitachycardia pacing should VT occur to terminate it without delivering a shock.

Defibrillation technology has certainly left its mark in healthcare, but the advent of modern AEDs has allowed defibrillation to move outside of hospitals, away from the watchful eye of healthcare professionals, into the public sector. Since their inception, AEDs have become widespread. With technological improvements, operating a defibrillator has become very easy for a by-stander post induction of proper training. Inbuilt audio and video support with combined CPR and defibrillator facility have encouraged people to use them at public places and at homes as well in turn posing a threat to advanced life support (ALS) defibrillators.

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