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Posted: January 08, 2008

Many Hospitals Slow to 'Shock' Heart Patients Back to Life

Hospitals are slow to pull the trigger on defibrillation for cardiac patients in about a third of all cases, lessening the chances of survival and at least increasing the risk of brain damage or other permanent disabilities, researchers say.
Chances are highest for surviving cardiac arrest when the potentially life-saving shocks called defibrillation are given within the first two minutes of the heart stopping beating.
However, for reach minute that the electric shock is not administered, a patient’s chances of survival drop, according to a study published in the New England Journal of Medicine. Theoretically, a hospital should be the place with the highest chances of survival, because of the ready availability of defibrillators, but that’s not the case, experts say.
"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.
The proof is in the numbers. Researchers said they found that 39% of patients who were administered defibrillating shocks within two minutes of their heart stopping lived and eventually left the hospital. However, only 22% of those who received defibrillation more than two minutes after cardiac arrest survived.
"We still have a lot to learn as to how to deliver treatment in an effective way," said Dr. Paul S. Chan, of St. Luke's Mid-America Heart Institute in Kansas City, Missouri. Chan is the lead author of the journal article.
Chan and research colleagues used data from 369 hospitals that track response times and outcomes. Data included 6,789 cases where cardiac arrest was caused by an abnormal heart rhythm, which is typically the most responsive condition in being “jolted” back to a normal heartbeat. Researchers looked only at treatment given in intensive-care units or regular hospital wards, not in hospital emergency room or surgical settings.
The team said that what they found was eye-opening. While more than half of the cardiac patients received electric shock from a defibrillator in one minute or less after the heart stopped, it took between two and six minutes or more for about 30% of the subjects to receive defibrillation.
Researchers said they saw a correlation between response times and the size of a hospital in their study. For example, delays were more likely at smaller hospitals, after-hours or on weekends. They also saw sluggish responses when a patient wasn’t being monitored constantly or when they were admitted to the hospital for a reason that was not cardiac-related.
Chan also pointed out that delays also were more common in blacks, but he could not explain the reason, other than possibly the quality of hospitals sometimes used by the black cardiac victims.

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