Decrypting Defibrillation: What Hollywood Gets Wrong

I saw the movies "Chicago Med", "Doctor Strange", and many more, and in lots of scenes the defibrillator was used. It was used even in cases of flattened heart rate to bring back pulses to the heart. Hollywood has portrayed this in so many scenes where a person is losing their heart beat, then the heartbeat goes flat only for a person to hold that complicated machine, rub it against one another and pass electric charges through the person. All of a sudden, the heart comes back to life, and the supposedly dead patient continues to live their life.

In the cinematic world, defibrillators are often portrayed as magical devices that can bring a lifeless heart back to its rhythmic dance. The classic scene involves doctors frantically yelling "Charge!" and rubbing the paddles together before delivering a shock that magically restores the patient's heartbeat. Are these scenes actually true, and can people who's heart beats were flattened get pulse back, or has Hollywood been portraying these scenes incorrectly for years, giving us some false ideas about how defibrillation works especially in the case of restarting the heart.

^{Image from Wikimedia Commons}

For easy understanding, a defibrillator is an electronic device that is used to treat cardiac arrest as a result of heartbeat irregularities known technically as cardiac arrhythmias. Cardiac Arrhythmias can manifest in different ways including the heart beating too slowly, too fast, or irregularly. Some form of arrhythmias aren't dangerous but in rare cases, it can be problematic leading to other issues such as stroke, heart failures and death.

We know that the heart uses electric charges to pump itself and this is why the heart can still pumped even when not connected to the brain. In the normal heart beat, the Sinotrial node is responsible for producing the electrical charge which is received by electrical conducting cells in the heart in the process known as Cardiac Conduction System. It is this heart beat that the heart uses in getting blood to every part of the body.

When a person has Cardiac Arrhythmias, it is regarded as a medical emergency, and in its severe case people can faint and stop breathing within seconds. When patients have these cardiac arrythmias, the defibrillator is used to send therapeutic electric shock which then depolarizes the electrical conductive cells in the heart, resetting it at once so they can function normally. Although the mechanism of this physical instrument and its effect on the heart isn't understood fully, it helps to re-establish a synchronous rhythm.

That said, you must have seen in movies where doctors will clamor "Charge" then will rub the hand peddles together till it is charge after which they will exclaim "Clear" then charge the person. Let me correct the notion that rubbing the defibrillator paddles together isn't what charges them, rather it is rubbed together so as to spread conductive gel together so as to avoid burning the patient. People should not be defibrillated when they are conscious as well as when they have a pulse as this could lead to cardiac arrhythmias, cardiac arrest, or death of the patient.

^{Image from Wikimedia Commons}

It is important not to mix the interpretation of a cardiac arrest and a heart attack together. A heart attack is caused when the heart is starved of blood and oxygen as a result of a clot, which means that it is a circulatory problem where the patient experience pain, pressure, and a burning sensation. Patients suffering from a heart attack and are conscious doesn't need CPR nor Defibrillation but then we should know that a heart attack can lead to cardiac arrest where the electrical signals in the heart begin to malfunction which can lead to lack of blood to the brain and to the rest of the body. In the case of a cardiac arrest, CPR and defibrillators can be required.

Finally, let's address the Hollywood myth of using a defibrillator during asystole or a flatlining heart. Contrary to movie plots, a defibrillator cannot resurrect someone with a flatlined heart. It is effective in resetting irregular heartbeats but cannot revive a heart that has ceased to beat.

While medical dramas entertain and educate, they often take creative liberties with reality. Understanding the actual functions of medical devices like defibrillators is essential for separating fact from fiction.

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https://www.welmedical.com/2021/08/12/
https://www.livescience.com/flatlining-death-heartbeats-continue
https://www.sciencedirect.com/science/article/abs/pii/S0300957214007461
https://www.lhsc.on.ca/critical-care-trauma-centre
https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/expphysiol.2005.030973
https://www.jems.com/patient-care/cardiac-resuscitation
https://www.heart.org/en/news/2019/02/15
https://www.heart.org/en/health-topics/heart-attack