Limitations of Automated External Defibrillators in Emergency: a Resuscitation Report From Cologne Street Carnival

History Without perceptible reason, a 25-year-old man collapsed in a street carnival and needed to be resuscitated. Cardio-pulmonary resuscitation (CPR) was started immediately by local medical service; an automated external defibrillator (AED) was used and advises a shock. This was followed by 71-minute resuscitation, including twelve shocks, resulting in return of spontaneous circulation (ROSC). Further examinations in hospital showed a repeating narrow complex tachycardia in ECG. Because of the optimal first-aid measures, immediate emergency care and continuous reanimation processes, the patient was able to leave the hospital without neurological deficit. The patient got discharged after placement of an implantable cardioverter defibrillator (ICD). To date, an underlying channelopathy has not been proven by genetic testing. Conclusion Although use of AED in emergency medicine appears reasonable, this report shows that a compression-free interval (no flow time) of 26 seconds under use of AED even by a well-trained team is highly unacceptable. This seems mostly due to the settings of the technical devices and their suboptimal adjustment to environment. Furthermore, manual defibrillation should always be preferred to automated defibrillation