Hospitals delay response to cardiac arrest
From usatoday.com
January 4th, 2008

The first major study of how quickly hospitals respond to in-house cardiac arrests found delays in almost a third of cases, doctors report Thursday.

Medical guidelines recommend shocking such patients' hearts back to life within two minutes using defibrillator paddles. A two-minute delay cuts a patient's odds of surviving his arrest in half. When delays stretch to six minutes or more, the odds of going home alive are just a quarter of those of someone treated promptly.

"The longer the delay, the less likely it is you'll survive," says lead author Paul Chan of St. Luke's Mid America Heart Institute in Kansas City, Mo.

Delays were seen most often in blacks and in hospitals with fewer than 250 beds. Delays often occurred after-hours and on weekends, doctors report in Thursday's New England Journal of Medicine.

No one knows precisely how many patients go through cardiac arrest and resuscitation. Estimates range from 370,000 to 750,000, the researchers report. Only about 30% survive long enough to go home.

"We should be able to cut the mortality for in-house cardiac arrest by 30% to 40%," says co-author Harlan Krumholz, a cardiologist at Yale University. "In the hospital should be the best place to have a cardiac arrest." Yet, he adds, few hospitals track these deaths as a way to measure performance.

"I think this was largely an invisible issue until now," he says.

Cardiologist Robert Bonow of Northwestern Memorial Hospital, who wasn't involved in the study, says it confirms "how important it is to have a rapid response. Even when trained personnel are present and a defibrillator's available, there can be major delays."

The heart's pumping power comes from coordinated muscle-cell contractions triggered by small, precisely timed electrical pulses. Unlike a heart attack, which results from a clogged coronary artery, cardiac arrest occurs when the heart's electrical system misfires.

"The best thing you can do is treat cardiac arrest with electricity," Krumholz says.

The new study involved 6,789 patients who had cardiac arrest in 369 hospitals and whose medical records were submitted to an American Heart Association registry between 2000 and 2005.

Overall, hospital staff took an average of a minute to apply the paddles. But in nearly one-third of the cases — 2,045 — it took longer than the recommended two.

Heart shocks jolted 4,168 patients, or 61%, back to life. A total of 3,372 patients, almost 50%, survived for at least 24 hours; 2,318, or 34%, survived long enough to go home.

Odds of a late response were 23% higher for black patients, 18% higher if the arrest happened after-hours and 27% higher in hospitals with fewer than 250 beds.

Krumholz says the data shed no light on why black patients waited longer than others.

"We couldn't figure it out," he says. "I think it bears more investigation. I just can't believe somebody is dragging their feet because of the color of the skin of the person in the bed, but this is a disturbing finding."

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