TELEGRAM STAFF WRITER
Scott & White Memorial Hospital employees have been looking at its response to cardiac arrest through its resuscitation committee for some time. Interesting, considering a new study indicates a slow response in hospitals treating patients whose hearts stop beating.
About one-third of patients nationwide don’t get a potentially live-saving shock within the recommended two minutes, a new study found.
“In November, Scott & White had only one code outside of its ICU units,” said Dr. Stephen Sibbitt, associate chief medical officer at Scott & White. “That’s phenomenal.”
The success comes from giving medical staff the OK to call a rapid response team 24/7 if a patient is exhibiting any signs of instability, Sibbitt said.
Scott & White adopted a rapid response process that brings individuals with ICU training to the bedside of patients exhibiting signs of instability in order to get the patient to the ICU before cardiac arrest takes place, Sibbitt said.
Those who don’t get prompt defibrillation are more likely to die or end up brain damaged or disabled, the study showed. For every minute of delay, the chances of survival worsens, researchers reported in Thursday’s New England Journal of Medicine.
“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,” Dr. Leslie A. Saxon, a cardiologist at the University of Southern California, wrote in an editorial in the journal.
In large academic medical centers there are many individuals, in addition to physicians, who are trained in advanced cardiac life support and are competent to deliver the first shock and the other necessary steps in responding to a cardiac arrest situation, Sibbitt said.
Scott & White is looking at response time to defibrillation, time to first chest compression and time to first delivery of specific medications used in these ventricular arrhythmias, not just delivery of the shocks, he said.
“We are trying to reduce the number of codes that occur within the hospital, particularly in non-ICU and non-emergency room areas,” Sibbitt said.
Also, the Temple medical center is creating a central telemetry monitoring station in the hospital that will monitor all patients at all times, he said.
“If a patient exhibits any sign of instability a code can be called immediately,” Sibbitt said.
Recent attention has focused on getting quicker treatment for heart attacks that occur outside hospitals, and adding defibrillators to public places like airports and schools. For the study, the researchers instead looked at what happens inside hospitals and how response time affects survival.
The study found that 39 percent of those quickly treated survived to leave the hospital, compared with only 22 percent of those whose treatment was delayed past the two-minute guideline.
The study used data from a national registry of 369 hospitals that track response times and outcomes. It included 6,789 cases of cardiac arrest caused by an abnormal heart rhythm, the kind most responsive to getting shocked back to a normal heartbeat. Only cases that occurred in intensive-care units or regular units were included, not those in the emergency room or during surgery.
More than half of the patients got a jolt from a defibrillator in one minute or less, but it took more than two minutes - sometimes more than 6 minutes - for about 30 percent to get zapped.
The research showed delays were more likely at smaller hospitals, after-hours or on weekends, and for patients who weren’t constantly being monitored or were admitted for non-heart problems.
Delays were also more common for black patients, which couldn’t be explained by the information used for the study, said lead author Dr. Paul S. Chan of St. Luke’s Mid America Heart Institute in Kansas City, Mo. He said the difference may be more a reflection of the quality of the hospitals than discrimination.
“This study is an indication of how the medical field is evolving to evidence-based medicine,” Sibbitt said.
Ten to 15 years ago expert opinion was used to determine medical practices, he said.
One potential way to speed up response times, Chan suggests, is to make automated external defibrillators, or AEDs, available throughout hospitals so that nurses could readily use them instead of waiting for doctors to deliver shocks.
“We have them outside the hospital setting already today. Is there any reason not to have these (in hospitals)?” Chan said.
On the Net: New England Journal: http://www.nejm.com
