Hospitals Do Not Deliver Recommended Defibrillation Shock To Cardiac Arrests

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Cardiac Arrests

Hospitals in almost one-third of sudden cardiac arrest cases donot defibrillate patients in the recommended time, and such delaysincrease their risk for brain damage and death, according to a studypublished on Thursday in the New England Journal of Medicine,the New York Timesreports. For the study, led by Paul Chan of St.Luke's Mid America Heart Institute, researchers examined themedical records of 6,789 patients at 369 hospitals enrolled in anational registry on cardiac arrest established by the AmericanHeart Association (Grady, New York Times, 1/3).

According to the study, based on data collected between 2000and 2005, 70% of participants received defibrillation to restarttheir hearts within the recommended time of less than two minutesafter their cardiac arrest, with a survival rate of 39%. About 17% ofparticipants received defibrillation between three and five minutesafter their cardiac arrest, with a survival rate of 28%, the studyfound. Participants who received defibrillation more than fiveminutes after their cardiac arrest had a survival rate of 15%,according to the study (Winstein, Wall Street Journal,1/3).

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The study also found that the likelihood of delays indefibrillation increased by 23% for black participants, by 18% whencardiac arrests occurred on nights or weekends and by 27% whencardiac arrests occurred in hospitals with fewer than 250 beds(Sternberg, USA Today,1/3). According to the study, additional research is needed todetermine whether delays in defibrillation for black participantsresulted because of "geographical differences in access tohospitals with more resources or ... reflect actual differences inpatterns according to race" (Lemire, NewYork Daily News, 1/3).

Researchers said thatthe study could underestimate the problem of delays in defibrillationbecause the hospitals enrolled in the registry have begun toimplement practices to meet treatment guidelines for cardiac arrestpatients and probably performed more effectively than average (NewYork Times, 1/3).

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Chan said, "We found that delayed defibrillation was commonand that rapid defibrillation was associated with sizable survivalgains in these high-risk patients" (Maugh, LosAngeles Times, 1/3). He added, "We know what works,what saves lives. We have the technology available, and certainly theknowledge and skilled personnel in the hospital to shock patientsback to normal rhythm" (New York Times, 1/3). "Westill have a lot to learn as to how to deliver treatment in aneffective way," Chan said (AP/BostonHerald, 1/2). Chan recommended additional research on thepractices of hospitals that effectively treat cardiac arrest patientsto help other facilities improve their treatment of such patients(New York Times, 1/3).

In an editorial thataccompanied the study, Leslie Saxon, chief of cardiology at theUniversity of SouthernCalifornia, wrote, "It is probably fair to say that mostpatients assume -- unfortunately incorrectly -- that a hospital wouldbe the best place to survive a cardiac arrest" (LosAngeles Times, 1/3). According to Saxon, "You're betteroff having your arrest at Nordstrom,where I'm standing right now, because there are 15 people around me."Saxon recommended the installation of automatic externaldefibrillators, which do not require special training for proper use,in all hospital rooms and the use of heart monitoring for morepatients (New York Times, 1/3).

Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserDaily Health Policy Report, search the archives, andsign up for email delivery at kaisernetwork.org/email. The Kaiser Daily Health Policy Report ispublished for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.

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