Defibrillation Doesn’t Always Come Soon Enough
Reported July 31, 2009
(Ivanhoe Newswire) -- The American Heart Association recommends that
defibrillation be performed within two minutes of cardiac arrest. Wait any
longer, and survival rates plummet.
Previous studies have found factors associated with individual patients,
such as being admitted to the hospital for a non-cardiac diagnosis, or
experiencing cardiac arrest on evenings and weekends, predicted delayed
defibrillation. However, less is known about whether differences among
hospitals are associated with these delays.
A new study finds that traditional hospital factors, such as case volume and
academic status, do not appear to predict whether patients with cardiac
arrest are likely to experience delays in receiving defibrillation.
Paul S. Chan, M.D., M.Sc., of the Saint Luke's Mid-America Hospital
Institute, Kansas City, Mo., and colleagues analyzed records from 7,479
adult inpatients, average age 67 years, who went into cardiac arrest at 200
hospitals included in the National Registry of Cardiopulmonary Resuscitation
(NRCPR). Hospitals participating in the NRCPR in 2006 were asked to complete
a detailed survey, including information about location, hospital teaching
status, number of patient beds and the availability of automatic external
Rates of delayed defibrillation—defined as longer than the two-minute
standard—ranged from 2.4 percent to 50.9 percent. Differences among
hospitals accounted for a significant amount of the variation between
patients; for instance, patients with identical characteristics had 46
percent greater odds of experiencing a defibrillation delay at one randomly
selected hospital compared with another.
"However, many of the individual hospital characteristics that we
explored—such as volume, academic status and hospital-wide mortality
rate—were unrelated to hospital performance in defibrillation time," the
authors were quoted as saying. Only the number of beds and the location of
the cardiac arrest (for example, in or out of the intensive care unit) were
associated with the rate of defibrillation delays. There was no association
between delays and geographical location, rate of cardiac arrest per 1,000
patient admissions, existence of an automatic external defibrillator program
or most other hospital-related factors.
Patients at hospitals with fewer defibrillation delays were less likely to
die in the hospital—the odds of survival were 41 percent higher in the 25
percent of hospitals with the fewest defibrillation delays.
"Given extensive differences in defibrillation time across institutions and
the recognized impact of delayed defibrillation on survival,” the authors
conclude, “new approaches to improve hospital performance in defibrillation
time could represent a critical area for quality improvement.”
SOURCE: Archives of Internal Medicine, July 27, 2009