Defibrillator shocks often late in U.S hospitals
By Gene Emery
BOSTON, Jan 2 (Reuters) - Nearly a third of patients with misfiring or quivering hearts in U.S. hospitals do not get the life-saving defibrillator shocks they need within the critical first two minutes of cardiac arrest, a study published on Wednesday said.
The study confirming the importance of the two-minute period for survival was published in the New England Journal of Medicine, which also ran an accompanying editorial indicating a person might be better off suffering cardiac arrest in a casino than a hospital.
Researchers from 369 hospitals in the National Registry of Cardiopulmonary Resuscitation found that being black or having a cardiac arrest outside of regular weekday working hours also significantly delayed the time it took for hospital workers to shock the heart.
"We now have to develop systems of care within the hospital to improve defibrillation times nationally," said Paul Chan of the Mid-America Heart Institute in Kansas City, Missouri, who led the study in the New England Journal of Medicine.
Thirty-four percent of those studied lived to be discharged from the hospital. But in an editorial accompanying the study, Leslie Saxon of the University of Southern California in Los Angeles said that survival rate is disappointingly less than the 50 percent rate among people who collapse in an airport, casino or some other location where automated external defibrillators (AEDs) are readily available for emergency use.
"It is probably fair to say that most patients assume -- unfortunately, incorrectly -- that a hospital would be the best place to survive a cardiac arrest," Saxon said. "Surely we can do better to fulfill this expectation by better using existing technology and the lessons learned from public-access defibrillation."
There are about 750,000 cardiac arrest cases in the United States a year and two-thirds of those occur in hospitals. The American Heart Association recommends that the stopped hearts be shocked within two minutes.
The study of 6,789 hospital patients found that defibrillation took more than two minutes in 30 percent of patients. Their chance of surviving to leave the hospital was 22 percent, compared to a rate of 39 percent for those who received shocks quickly.
All had suffered from ventricular fibrillation, where the heart's main pumping chambers begin to flutter ineffectively or ventricular tachycardia, in which the heart beats so rapidly it can no longer pump properly.
The Chan team found the odds of survival dropped off steadily after a delay of more than two minutes.
Saxon said that because "delays in defibrillation have been successfully overcome with AEDs, these devices could be placed in every patient's room to enable the first responder to deliver timely defibrillation."
The researchers found several reasons for the delays. Some delays, Saxon said, were predictable, such as a patient being in the hospital for a reason unrelated to a heart problem, being in a unit where hearts are not monitored or having a cardiac arrest on the weekend or between 5 p.m. and 8 a.m.
For blacks, the Chan team found, the risk of having a delay increased by 23 percent. They said further studies are needed "to determine whether such variations are due to geographical differences in access to hospitals with more resources (such as monitored beds) or whether they reflect actual differences in patterns according to race."
(Editing by Will Dunham and Bill Trott)
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