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Hospitals Often Fail to Give Defibrillator Shocks in Time, Study Says

Jan 3, 2008 | Parker Waichman LLP Hospitals are failing to administer defibrillator shocks to patients who need them, and this malpractice could be costing many their lives.  Nearly one-third of all patients experiencing misfiring or quivering hearts in U.S. hospitals do not receive life-saving defibrillator shocks within the critical first two minutes of cardiac arrest, a study published on Wednesday said.  The American Heart Association recommends that the stopped hearts be shocked within two minutes.  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 piece indicating a person might be better off suffering cardiac arrest in a casino rather 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; however, 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 50 percent among those 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 U.S. annually; two-thirds occur in hospitals.  

The study of 6,789 hospital patients found that defibrillation took more than two minutes in 30 percent of patients.  Their chance of surviving and leaving the hospital was 22 percent, compared to a rate of 39 percent for those who received shocks quickly.  All patients suffered from either 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 delays exceeding 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."

Researchers found several reasons for the delays.  Some, Saxon said, were predictable:  A patient being treated for noncardiac-related reasons, being in a unit where hearts are not monitored, or suffering cardiac arrest on a weekend or between 5 p.m. and 8 a.m.  The Chan team found the risk of delay increased by 23 percent for blacks, saying more studies are needed "to determine whether such variations are due to geographical differences in access to hospitals with more resources—monitored beds—or whether they reflect actual differences in patterns according to race."

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