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For hospital
patients, Defibrillation delays mean low
survival
Newswise — 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.”
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.
