Hospital Defibrillation

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Defibrillation Comes Late in 30 Percent of Hospital Cases

01.02.08, 12:00 AM ET

WEDNESDAY, Jan. 2 (HealthDay News) -- About a third of patients who suffer

cardiac arrest in hospitals don't get a defibrillator- delivered shock to start

the heart beating again within the two minutes recommended by the American Heart

Association, a new study found. This delay significantly reduces a patient's

chance of survival, the study authors said.

" Until now, the recommendation for defibrillation within two minutes was based

on expert opinion, " said Dr. S. Chan, who led the study while at the

University of Michigan and now is a cardiologist with Saint Luke's Mid-America

Heart Institute in Kansas City, Mo. " There were no clear standards established.

This study helps support the two-minute recommendation. "

The study findings are published in the Jan. 3 issue of the New England

Journal of Medicine.

Cardiac arrest is a too-common hospital problem. An estimated 750,000 patients

experience cardiac arrest in U.S. hospitals each year, the study authors said.

Chan and his collaborators identified almost 6,800 people who had cardiac

arrest at 369 hospitals participating in the National Registry of

Cardiopulmonary Resuscitation. Overall, the response time seemed impressive,

with defibrillation typically beginning an average of one minute after the heart

stopped.

But defibrillation did not begin for two or more minutes in 2,045 cases, 30.1

percent of the total. Just 22.2 percent of that subgroup of patients survived to

leave the hospital, compared to 39.3 percent of those who got early

defibrillation, the study found.

" If we had the ability to look at all the hospitals across the country, the

numbers probably would be worse, " said Chan, referring both to the time

defibrillation begins and chance of survival. " These are the better-performing

hospitals, ones that issue quarterly reports. "

Delayed defibrillation was more likely in hospitals with fewer than 250 beds;

in hospital units where patients were not continuously monitored; for patients

admitted with diagnoses other than heart disease; during " off hours " (nights and

weekends); and for black patients, the study showed.

" But we found delays across all types of hospital beds and units, " Chan said.

It's not clear what can be done to speed up the response across-the-board in all

hospitals, he said.

Monitoring all patients' heart function might make a difference, he said, " but

we can only speculate because we don't have interventional trials to see if that

would make a difference. "

Changes in practice at some hospitals might also lead to improvements, Chan

said. For example, some hospitals do not allow nurses who detect a problem to

use a defibrillator; they must call a physician or a specially trained nurse, he

said.

" We might make external defibrillators available to more units, " Chan said.

" That is one potential solution that might have a significant impact over time.

And hospitals might set up emergency teams to intervene when there is a cardiac

arrest code. "

The effect of such measures will have to be tested in real life, Chan said.

Trials of rapid intervention teams are being planned, he said.

More information

For more on defibrillators, visit the American Heart Association.

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