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Senior Citizen Health & Medicine
Thousands Hit with Cardiac Arrest in Hospitals Not
Treated with Defibrillator in Time
Patients that are black, in small hospitals, not
monitored are among least likely to get treatment in recommended two minutes
 Jan. 3, 2007 – New evidence published today shows
thousands of people are dying due to delayed use of the defibrillator
when they suffer cardiac arrest in the hospital. Some evidence suggests
you are more likely to receive the life-saving electrical shock in a
timely manner if the ventricular arrhythmia hits you while working out
in the gym.
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An estimated 750,000 hospitalized patients
experience cardiac arrest and undergo CPR annually, and less than 30
percent of those leave the hospital alive, the study reports in the
January 3 issue of the New England Journal of Medicine.
In a paper published in the Jan. 3 issue of the New
England Journal of Medicine, researchers quantified the impact of
receiving a life-saving electrical shock (defibrillation) among
hospitalized patients experiencing a form of cardiac arrest known as
ventricular arrhythmia.
The researchers found that the chances of survival
for hospitalized patients improve dramatically if defibrillation is
administered within the expert-recommended two minutes following a
cardiac arrest (ventricular arrhythmia).
Analyzing data from the National Registry of
Cardiopulmonary Resuscitation, the authors concluded that 30 percent of
patients with cardiac arrest due to ventricular arrhythmia received
life-saving defibrillation more than two minutes after initial
recognition of their cardiac arrest, a delay that exceeds
guidelines-based recommendations.
The delayed defibrillation was linked to a
significantly lower probability of survival to hospital discharge - 22
percent vs. 39 percent when defibrillation wasn’t delayed - and a 26
percent lower likelihood among survivors of being discharged without
major neurological impairment.
The researchers also found that patients of the
black race were more likely than others do have delayed treatment.
“The association of black race with delayed
defibrillation is not intuitively obvious and raises potential issues of
disparities in care,” the study says.
“Further studies are warranted to determine whether
such variations are due to geographic differences in access to hospitals
with more resources (such as more monitored beds) or whether they
reflect actual differences in practice patterns according to race.”
The findings also revealed certain hospital
characteristics were associated with delayed defibrillation, including
small hospital size (fewer than 250 beds); occurrence of cardiac arrest
in hospitalized patients whose heart rhythm was not being constantly
monitored in specialized units; and occurrence of cardiac arrest
after-hours (5 p.m. to 8 a.m. or weekends).
“While several prior studies have shown an
association between defibrillation time and survival, these were
relatively small studies that typically included patients whose arrest
rhythms would not have benefited from defibrillation” said lead study
author Paul S. Chan, M.D, a cardiologist and researcher from Saint
Luke’s Mid America Heart Institute.
Dr. Chan was previously with the University of
Michigan, where he initiated the study with University of Michigan
cardiologist Brahmajee Nallamothu, M.D., M.P.H., the new paper’s senior
author.
The study used a larger, more statistically
significant registry of nearly 7,000 patients and focused exclusively on
appropriate patients with ventricular arrhythmia.
“We found that delayed defibrillation was common,
and that rapid defibrillation was associated with sizable survival gains
in these high-risk patients,” said Dr. Chan.
“However, the real work has yet to be done in this
field. We now have to develop systems of care within the hospital to
improve defibrillation times nationally.”
“These findings represent a real opportunity to
improve patient care,” said Dr. Nallamothu.
“We need to understand how delayed defibrillation,
which was more common after-hours and in unmonitored settings, relates
to the immediate availability of medical personnel or equipment, as well
as potential delays in recognition of ventricular arrhythmia.”
Editor’s Notes:
Saint Luke’s Mid America Heart Institute is a
member of Saint Luke's Health System, which consists of 11 area
hospitals and many primary care practices, and provides a range of
inpatient, outpatient, and home care services. Founded as a faith-based,
not-for-profit organization, our mission includes a commitment to the
highest levels of excellence in health care and the advancement of
medical research and education. The health system is an aligned
organization in which the physicians and hospitals assume responsibility
for enhancing the physical, mental, and spiritual health of people in
the metropolitan Kansas City area and the surrounding region.
Version from KaiserNetwork.org
Daily Health Report
Hospitals Do Not Deliver Defibrillation Shock
Within Recommended Two Minutes in 30% of Cardiac Arrests, Study Finds
[Jan 03, 2008]
Hospitals in almost one-third of sudden cardiac
arrest cases do not defibrillate patients in the recommended time, and
such delays increase their risk for brain damage and death, according to
a study published on Thursday in the New England Journal of Medicine,
the
New York Times reports. For the study, led by Paul Chan of
St. Luke's Mid America Heart Institute, researchers examined the
medical records of 6,789 patients at 369 hospitals enrolled in a
national registry on cardiac arrest established by the
American Heart Association (Grady, New York Times, 1/3).
According to the study, based on data collected between 2000 and 2005,
70% of participants received defibrillation to restart their hearts
within the recommended time of less than two minutes after their cardiac
arrest, with a survival rate of 39%. About 17% of participants received
defibrillation between three and five minutes after their cardiac
arrest, with a survival rate of 28%, the study found. Participants who
received defibrillation more than five minutes after their cardiac
arrest had a survival rate of 15%, according to the study (Winstein,
Wall Street Journal, 1/3).
The study also found that the likelihood of delays in defibrillation
increased by 23% for black participants, by 18% when cardiac arrests
occurred on nights or weekends and by 27% when cardiac arrests occurred
in hospitals with fewer than 250 beds (Sternberg,
USA Today, 1/3).
According to the study, additional research is
needed to determine whether delays in defibrillation for black
participants resulted because of "geographical differences in access to
hospitals with more resources or ... reflect actual differences in
patterns according to race" (Lemire,
New York Daily News, 1/3).
Researchers said that the study could underestimate the problem of
delays in defibrillation because the hospitals enrolled in the registry
have begun to implement practices to meet treatment guidelines for
cardiac arrest patients and probably performed more effectively than
average (New York Times, 1/3).
Comments
Chan said, "We found that delayed defibrillation was common and that
rapid defibrillation was associated with sizable survival gains in these
high-risk patients" (Maugh,
Los Angeles Times, 1/3). He added, "We know what works, what saves
lives. We have the technology available, and certainly the knowledge and
skilled personnel in the hospital to shock patients back to normal
rhythm" (New York Times, 1/3).
"We still have a lot to learn as to how
to deliver treatment in an effective way," Chan said (AP/Boston
Herald, 1/2). Chan recommended additional research on the practices
of hospitals that effectively treat cardiac arrest patients to help
other facilities improve their treatment of such patients (New York
Times, 1/3).
In an editorial that accompanied the study, Leslie Saxon, chief of
cardiology at the
University of Southern California, wrote, "It is probably fair to
say that most patients assume -- unfortunately incorrectly -- that a
hospital would be the best place to survive a cardiac arrest" (Los
Angeles Times, 1/3).
According to Saxon, "You're better off having your
arrest at
Nordstrom, where I'm standing right now, because there are 15 people
around me." Saxon recommended the installation of automatic external
defibrillators, which do not require special training for proper use, in
all hospital rooms and the use of heart monitoring for more patients
(New York Times, 1/3).
 An
abstract of the study is available
online.
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