Defibrillator: AED, manual or combined – which to choose?

A defibrillator is not chosen primarily on its datasheet, but on the person who will use it. A lay rescuer in an entrance hall and a resuscitation team at a patient's bedside do not perform the same actions or need the same information. This question determines the type of device; the intended use and the functions come next.

Three types of device

• The automated external defibrillator (AED) analyses the heart rhythm itself and tells the user, through voice or visual prompts, whether a shock should be delivered.
• The manual defibrillator lets the clinician read the ECG trace, decide on the shock and set the energy.
• The combined defibrillator brings both modes together in a single device, and may add patient monitoring and cardiac pacing.

Who will use the device?

If the device must be usable by someone who is not a doctor – reception staff, administrative staff, porters, trained first-aiders – AED mode is essential: the device interprets the rhythm and guides each step. The decisive criterion then becomes the clarity of the guidance, not the range of settings.

The BeneHeart C series is designed for this situation. Its description highlights step-by-step guidance for the novice rescuer through animations and voice prompts, advice adapted to the time taken to complete each operation, and a technology designed to shorten the delay before the first shock, with charging taking place during ECG analysis.

When the device is in the hands of a medical team – emergency physicians, cardiologists, intensivists – a manual mode becomes necessary: reading the trace, selecting the energy, synchronised cardioversion, pacing. A combined device still retains the benefit of AED mode: in a department where nurses, junior doctors and senior physicians take turns, the same device can be used in automatic mode by some and in manual mode by others.

Where will the device be used?

• Crash cart: the device must be ready at all times, accessible and easy to move from one room to another. Regular checks of the battery and consumables are part of how the department is organised.
• Clinical department (emergency department, cardiology, intensive care unit): the device is also used to monitor an unstable patient, which affects the screen size, the number of waveforms displayed and the parameters measured.
• Intra- or inter-hospital transport: battery life, weight and resistance to splashing water become priorities.
• Areas open to the public: entrance hall, waiting room, administrative offices. This is where the AED belongs.

Functions to compare

Once the type has been chosen, devices are distinguished by concrete functions. The examples below are taken from the brochures for the BeneHeart D3 and the BeneHeart D6, two combined defibrillators that bring together monitoring, manual defibrillation, AED and cardiac pacing.

• Shock energy: the D6 brochure states, in AED mode, an “energy level: 100 to 360 J, configurable”.
• Pacing: if the department needs it, compare the setting ranges and the battery life in this mode. The D6 states a pacing rate of “40 ppm to 170 ppm, ±1.5 %”; the D3, a battery life of “Pacing mode: 2 hours, 50 ohm load impedance”.
• Monitoring: both devices accept “3-lead ECG, 5-lead ECG, ELECTRODES/PADDLES”. The D6 displays “max. 4 channels” on an “8.4 inch (21 cm)” screen, while the D3 has a “7 inch” screen.
• Recording: the D3 recorder is specified at “Max.3 channels”.
• Weight and size: the D6 states “Main unit: 6.6 kg”; the D3 measures “288 mm (W) x 203 mm (D) x 275 mm (H)”.
• Robustness: the D3 is rated “IPX4 (without external power supply)” and specified “Operating: 0 to 45 °C”.

These values illustrate what to look for; they do not make one device better than the other. A larger screen and more waveforms suit an intensive care bed; a more compact device lends itself better to mobile use. The full datasheets can be downloaded from each page of the defibrillator range.

What about the electrocardiograph?

A defibrillator's ECG monitoring is used to watch the rhythm and decide on a shock. It does not replace the electrocardiograph, which produces a diagnostic trace that is printed or archived and, depending on the model, interpretation support. In an emergency department or cardiology unit, the two devices are complementary.

The ECG range includes the BeneHeart R3 and the BeneHeart R12. The R3 description mentions an interpretation algorithm that highlights critical findings such as acute myocardial infarction or ventricular fibrillation, and its brochure states a battery life without recording of “6 hours of continuous operation”. The R12 description mentions saving ECGs to a USB stick and transferring them to a PC.

Questions to ask before requesting a quote

• Who will use the device, and have they been trained in manual defibrillation?
• Where will it be installed, and will it need to accompany the patient during transfers?
• Does the department need pacing, multiparameter monitoring, recording?
• How many devices are needed, and should they share the same electrodes and accessories?
• Who will provide user training and maintenance?

Once written down, these answers form the basis of the specifications. For a priced request, state the department, the number of devices and the intended use in the request a quote form.