by Leigh Hopper, Houston Chronicle Medical Writer
Many people think a hospital is a giant, emergency medical service unit – the ideal place to be if they suffer a sudden cardiac arrest. But it’s not.
A study out Monday suggested that hospitals need to follow the example of casinos, airports and shopping malls by training and equipping nonemergency personnel with easy-to-use automatic external defibrillators (AEDs).
When a cardiac arrest occurs, the heart often goes into a state of fibrillation, or chaotic rhythm, resulting in a quivering, ineffective muscle. Pumping stops, depriving organs of vital blood flow. For every minute that passes, survival is reduced by 10 percent.
Of the 270,000 people who experience cardiac arrest each year, only an estimated 1 percent to 5 percent survive. Although cardiopulmonary resuscitation can keep a minimal amount of blood flowing to the heart, early defibrillation – an electric shock that can restore the heart to its normal rhythm – is considered the single most important step in saving the lives of cardiac-arrest victims.
Broader use of AEDs in public settings by firefighters, police or other first-response teams has resulted in increased survival for people who suffer sudden cardiac arrest.
"Hospitals are lagging way behind in utilizing this data," said Dr. Mary Ann Peberdy, an assistant professor of medicine at Medical College of Virginia, speaking at the American Heart Association meeting here.
While survival rates for out-of-hospital heart attacks have improved, thanks to AED use, she said, survival rates for in- hospital heart attacks have remained stagnant for the past 30 years.
Traditionally, defibrillation required a lot of training and its use was limited to doctors. Many studies showed that patients who suffered cardiac arrest in the hospital had to wait five minutes or more for a doctor to perform the procedure, Peberdy said.
Peberdy and her colleagues decided to see what would happen if noncritical care nurses at one hospital were trained to use AEDs.
Over a five-year period, 210 cardiac arrests were recorded at Miriam Hospital in Rhode Island. The nurse team treated 36 percent of those patients vs. 64 percent treated by the conventional hospital team.
The results were striking: More patients (69 percent) got defibrillation in less than one minute by the nurse team vs. the group treated by conventional hospital teams.
Researchers also found a trend toward higher survival rates among those treated by the nurse team. Forty-five percent of cardiac- arrest victims treated by the nurse team lived to be discharged from the hospital vs. 31 percent of patients treated the traditional way.
"It is our hope that hospitals will incorporate this," Peberdy said. "We hope this time next year we won’t have to ask if we’d rather have a heart attack in a casino, or in a hospital setting."
Battery-powered and about the size of a lunch box, the device costs about $3,000 and comes with voice prompts and paddles with illustrations that show where on the body to place the paddles. Training takes about four hours, and one small Seattle study demonstrated that even sixth-graders could be taught to use the device.