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Hospital response to cardiac arrest

    A recent study involving more than 6500 patients at 369 hospitals showed that many lives could be saved if all hospitals responded appropriately to a patient's heart-stoppage.  Frequently, such a stoppage can be addressed through the immediate application of electical shock with a defibrillator.  Widely available in many environments, defibrillators can restore normal cardiac electric function immediately and if the underlying systemic condition is then addressed, the patient can survive the incident.  Hospitals call responding to this kind of an incident a "Code Blue" and they have protocols for rapid response with a properly-stocked "crash cart" and trained personnel.

   The New England Journal of Medicine found a widely divergent outcome in "shockable" abnormalities in heart rhythm.  According to the authors, the electric shock needs to be administered within two minutes to be effective.  They found, unfortunately, that in thirty percent of all cases, the shock could not be administered that quickly.

     While 39.3 percent of shockable patients survive to be discharged if they are defibrillated in a timely manner [within two minutes], only 22 percent survive if the shock is delayed.   Such delays are most likely to occur if the abnormality occurs at night or on the weekend, if it occurs in a hospital with fewer than 250 beds  or in a unit without cardiac monitors, or if it happens to a patient who was not admitted for an identified cardiac problem.  The authors noted that since the study involved patients from hospitals who had agreed to a national registry for cardiac arrest, it is likely that the results reported are better than the actual average accross the country.  Since these hospitals were already attempting to meet a higher standard in cardiac care, it is likely that they address cardiac incidents better than the average hospital which is not participating in the national registry.

      The authors point out that betwen 370,000 and 750,000 hospital patients suffer cardiac arrest and are resuscitated each year.  Between one-third and one-half are caused by arrhythmias that could be successfully treated with electric shock.  Thus, the study suggests that more than 30,000 theoretically "preventable" deaths occur each year to hospitalized patients.

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