Hospitals Do Not Deliver Defibrillation Shock Within Recommended Two Minutes In 30% Of Cardiac Arrests, Study Finds

Main Category: Cardiovascular / Cardiology
Also Included In: Public Health
Article Date: 04 Jan 2008 - 10:00 PDT

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Hospitals in almost one-third of sudden cardiac arrest cases do not defibrillate patients in the recommended time, and such delays increase their risk for brain damage and death, according to a study published on Thursday in the New England Journal of Medicine, the New York Times reports. For the study, led by Paul Chan of St. Luke's Mid America Heart Institute, researchers examined the medical records of 6,789 patients at 369 hospitals enrolled in a national registry on cardiac arrest established by the American Heart Association (Grady, New York Times, 1/3).

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

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

Researchers said that the study could underestimate the problem of delays in defibrillation because the hospitals enrolled in the registry have begun to implement practices to meet treatment guidelines for cardiac arrest patients and probably performed more effectively than average (New York Times, 1/3).

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Chan said, "We found that delayed defibrillation was common and that rapid defibrillation was associated with sizable survival gains in these high-risk patients" (Maugh, Los Angeles Times, 1/3). He added, "We know what works, what saves lives. We have the technology available, and certainly the knowledge and skilled personnel in the hospital to shock patients back to normal rhythm" (New York Times, 1/3). "We still have a lot to learn as to how to deliver treatment in an effective way," Chan said (AP/Boston Herald, 1/2). Chan recommended additional research on the practices of hospitals that effectively treat cardiac arrest patients to help other facilities improve their treatment of such patients (New York Times, 1/3).

In an editorial that accompanied the study, Leslie Saxon, chief of cardiology at the University of Southern California, wrote, "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" (Los Angeles Times, 1/3). According to Saxon, "You're better off having your arrest at Nordstrom, where I'm standing right now, because there are 15 people around me." Saxon recommended the installation of automatic external defibrillators, which do not require special training for proper use, in all hospital rooms and the use of heart monitoring for more patients (New York Times, 1/3).

An abstract of the study is available online.

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