Using AEDs with VNS

What is a Vagus Nerve Stimulator (VNS)?

Using AEDs on Patients with VNS: Pros vs Cons

The Pros of using AEDs with VNS patients:

• Life-saving potential: AEDs are designed to restore a regular heart rhythm in cases of sudden cardiac arrest. With or without a VNS, defibrillation can often mean the difference between life and death.
• Automated decision-making: AEDs have built-in algorithms that analyse the heart rhythm and decide if a shock is necessary. This technology is helpful when the patient’s status is unclear.
• Minimal interference in most cases: Many experts suggest that the AEDs electrical pulse should not significantly interfere with the VNS’s function or vice versa, particularly if the electrodes are placed away from the VNS implant site.

The Cons of using AEDs with VNS patients:

• Potential interference: Although rare, there is a possibility of interference between the AED’s electrical pulses and the VNS. The AED’s shock might disrupt the device’s functioning or vice versa, potentially reducing the efficacy of either or both devices.
• Risk of burns or skin irritation: Due to the close proximity of the VNS to the AED electrode placement, there’s a small chance of burns or irritation at the implant site, especially if not positioned properly.

What are the Possible Side Effects of AED Use on VNS Patients?

The overlap between AED usage and VNS functionality can present some unique side effects. Awareness of these helps first aiders anticipate and manage complications effectively. Some side effects include:

• Muscle spasms: Since both devices work by sending electrical signals, the combination could potentially amplify muscle contractions near the implant area, resulting in temporary discomfort or spasms.
• Device malfunction: In rare cases, the VNS might temporarily stop functioning or misfire if affected by AED use, possibly impacting seizure control or other symptoms.
• Skin burns: Incorrect AED electrode placement can lead to minor burns at the VNS implant site. To mitigate this, avoid placing electrodes directly over the VNS location, typically near the left upper chest.

Legal Responsibilities of First Aid Responders in Australia

In Australia, the legal responsibilities of first aid responders, particularly concerning the use of AEDs, are governed by a few critical principles. Here’s what first aiders should consider:

• Duty of care and standard of care: As a responder, a duty of care is established when you choose to assist. Your actions must meet the standard of care that a reasonable first aider would provide in similar circumstances. Using an AED when appropriate meets this standard, even if the patient has a VNS.
• Good Samaritan protections: Australian law typically protects first aiders from legal liability, provided they act in good faith and without gross negligence. As long as you follow basic training and place AED pads correctly, this legal protection will likely cover your actions. However, misuse or improper application could expose a responder to legal risk.
• Documented procedure compliance: Following your first aid training and any available protocol is critical. AED training often includes information on special circumstances, such as patients with VNS devices, so following these instructions aligns with both legal and ethical expectations.

Practical Tips for First Aid Responders

If you encounter a patient with a VNS and need to use an AED, here are some practical steps to ensure safe and effective care:

• Identify the VNS location: VNS devices are usually located in the upper or neck area. Avoid placing AED pads directly over or close to this area if possible. In most cases, standard pad placement—one on the upper right chest and one on the lower left—will avoid the VNS site.
• Follow AED prompts: AEDs are designed to analyse the heart rhythm and provide prompts. Trust the device and proceed if the AED instructs you to deliver a shock, even if the patient has a VNS.
• Document the situation: Make a note of the VNS presence, AED usage, and any observations regarding device interference if applicable. This can be helpful for medical personnel and provide essential information should any questions arise.

In summary, for first aid responders in Australia, understanding the intersection of AED use and VNS presence is essential in emergency care. While AEDs generally provide life-saving benefits without substantial interference to VNS devices, careful pad placement and adherence to first aid guidelines are essential for optimal results. Additionally, knowing your legal protections as a first aider can help you act confidently and compassionately. Remember, by following training protocols and keeping the patient’s welfare in mind, you are fulfilling your duty of care and potentially saving a life.