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For hospital patients, defibrillation delays mean lower survival
January 03, 200830 percent of patients receive life-saving defibrillation more than two minutes after cardiac arrest
KANSAS CITY, Mo. - An estimated 750,000 hospitalized patients experience cardiac arrest and undergo CPR annually, and less than 30 percent of those leave the hospital alive.
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. They 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.
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 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 (i.e., nights and 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."
University of Michigan Health System
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 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 (i.e., nights and 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."
University of Michigan Health System
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Constant compressions critical to CPR
Interrupting chest compressions during resuscitation reduces the chances of heartbeat return after defibrillation. New research published in the open access journal BMC Medicine shows that for every second of a pause in compressions there is a 1% reduction in the likelihood of success.
Penn study: Chances of surviving cardiac arrest depend on where patients are treated
Efforts to fight the toll of cardiac arrest have typically focused on pre-hospital factors -- bystander CPR education and improvement, public defibrillation programs, and quicker EMS response. But new research from the University of Pennsylvania School of Medicine reveals that the hospital where patients are cared for after being resuscitated plays a key role in their chances of survival following these incidents, which takes the lives of more than 300,000 Americans each year.
Sleep Apnea May Be Risk Factor for Sudden Cardiac Death, Mayo Clinic Research Concludes
After studying the sleep characteristics of nearly 11,000 adults in an overnight sleep laboratory, Mayo Clinic researchers suggest that obstructive sleep apnea (OSA) - and, in particular, the low nighttime oxygen saturation of the blood it causes - may be a risk factor for sudden cardiac death (SCD).
Mayo Clinic study finds risk of sudden cardiac death highest early after attack
People who survive a heart attack face the greatest risk of dying from sudden cardiac death (SCD) during the first month after leaving the hospital, according to a long-term community study by Mayo Clinic researchers of nearly 3,000 heart attack survivors.
Study findings help EMS respond to cardiac arrest emergencies more safely and efficiently
When cardiac arrest patients cannot successfully be resuscitated by emergency medical services in the field, lifesaving attempts to race them to a nearby hospital via ambulance often prove to be futile.
Evidence that stun guns may stimulate the heart
On the eve of the British Columbia inquiry into the death of Robert Dziekanski, a review of scientific data in CMAJ (Canadian Medical Association Journal) finds that in some cases, stun guns may stimulate the heart in experimental models. This evidence is contrary to current views that stun guns only affect skeletal muscles.
Automated External Defibrillators and CPR Are Equally Helpful for Sudden Cardiac Arrest in the Home
The first study to explore the use of automated external defibrillator (AEDs) in the home has found that although the safe and easy-to-use devices are effective for certain types of cardiac arrest, they were underused.
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