Each year an estimated 166,000 lives are claimed by Sudden Cardiac Arrest, an electronic malfunction that causes rapid and chaotic heart activity.
Only about 6 percent of out-of-hospital sudden cardiac arrest victims survive.
Fewer than 1/3 of cardiac arrest victims receive CPR.
Effective CPR can DOUBLE or TRIPLE survival rates.
A recent AHA survey shows few Americans are confident they could actually perform CPR and use an AED to help save a life in an emergency cardiac situation.
Listener Tim (our Australian nurse contact) sent me an article link about updates to the CPR guidelines in the news lately. The importance of compressions and adequate CPR is of paramount importance to survivability of cardiac arrest.
The article here talks about the importance of priming the heart before it will be receptive to shock. The article talks about 200 compressions being the magic number.
This has been in the works for some time and actually jives with what we’ve been implementing since the 2005 rollout. Studies show that when compressions stop for more than 10 seconds, the myocardium rapidly loses the ability to receive a shock. By association then, the unwitnessed arrests out there need to re-prime the cardiac muscle before a shock is delivered.
In the prehospital arena with EMTs and paramedics we accomplish this by getting right on the chest and performing good CPR while getting the pads on and checking the rhythm. The time to get the defibrillator out and deployed is at least two minutes (200 compressions at the CPR rate of 100 per minute).
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Two healthy 14 year old boys each playing a sport they loved, collapsed while playing sports. They were in cardiac arrest. Both boys died before a defibrillator arrived on an ambulance.
Now, their parents are pushing Congress for more funding for schools to equip their gymnasiums and athletic facilities with AEDs to help prevent such tragedies from happening again. They have joined a cardiologist to testify before a Senate committee about the startling number of such incidents that happen each year.
Some states have passed laws requiring public schools to have AEDs in place to treat sudden cardiac arrest in otherwise healthy young athletes. However, these parents want more. They wish to have mandatory funding for all secondary and elementary schools nationwide to be equipped with these lifesaving devices.
With AED prices getting lower each year (some now below $800), there seems to be no reason to not have an AED placed in a public building. I would like to see AEDs become part of the building code for a public building. Just like sprinkler systems, a conveniently placed AED would go a long way to providing rapid response and defibrillation to any sudden cardiac arrest. Many shopping malls and airports already have them in place and have been used successfully by bystanders to revive victims.
What about churches, supermarkets, large restaurant chains, travel centers? Each of these locations see people in sufficient numbers that they would surely benefit from an AED placed there. They could advertise it right alongside their sign for “Air Conditioned: Come on in, it’s cool!”
“Bring grandpa and his heart condition. We’ve got an AED!”
A study looking at ways to cut childhood obesity and hypertension found that by cutting dietary salt, they could cut down on the amount of sugared soft drinks consumed by children.
The study was released in Hypertension: Journal of the American Heart Association and was conducted by researchers at St. George’s University of London, England.
The researchers looked at 2000 people between the ages of 4 and 18 who participated in a 1998 dietary survey. They found that children who had low salt diets consumed less liquid. They correlated a decrease of 1 gram of salt with a decrease of 100 mL of fluid intake. The authors further offered that by cutting average salt intake in half, children would consume 2 fewer sweetened soft drinks per week (amounts to 250 kcal less per week).
This is an important look at how simple changes in lifestyle have major long term health effects. This change in food preparation and choices has a long term health effect on development of hypertension and obesity.
Somebody get me the can of worms so I can open it. I found this article based on research that points at cardiac medication non-compliance following myocardial infarctions and patient mortality. The authors of the study conclude that one way to increase compliance is to provide the 4 most commonly prescribed cardiac meds to patients for free following their cardiac event.
These meds include: Aspirin, ACE inhibitors, Beta Blockers, and Statins. While the cost of these medications is not the only reason for patient non-compliance, it is certainly a factor here in the U.S. The removal of the Medicare copay would improve patient outcome and quality of life for some of these patients if it encouraged them to buy their prescribed medications.
The study out of Harvard University, looks at a theoretical basis for its findings and the authors point out that while their findings appear significant and make medical sense, there should be actual trials set up where some patients randomly get their meds for free and others remain under the current system. Who would be more compliant with their meds?
The question is bound to come up sometime — When is the best time to have your heart attack or cardiac arrest when you are in the hospital (it’s important to plan ahead)?
There was a study a year or so ago that focused on the increased mortality rates for cardiac arrest patients in different facilities (rural, urban, suburban) and on different days of the week. Not surprisingly, the study found that small rural hospitals and most hospitals on weekends had poorer survivability from cardiac arrest.
What about the time of day? Well someone else thought to ask and that study has now been released. The authors found in their case review that 15% of cardiac arrest in hospitals survived between the hours of 11 PM and 7 AM compared to 20% during the daytime hours. Again, I’m not terribly surprised. After hours, staffing ratios fall as many patients are asleep. Often in small hospitals, the only doctor in the building is in the emergency department after 8 or 9 PM.
Try running a code simultaneously in the ICU at one end of a building and in the ED at the other. Difficult to do, right? It’s important to review this information for your facility and determine whether a different set of standing orders needs to be in place for after hours care in the onset of acute emergencies requiring ACLS interventions.
Many med-surg nurses don’t maintain their ACLS certifications (because they’re not required to) or perhaps never got them to begin with. There needs to be a code team in place to handle the onset of multiple cardiac events even in — or perhaps especially in — smaller hospitals so that patient care and survivability can reach its full potential.
A new study published in the New England Journal of Medicine looked at the number of heart attacks following both coronary artery bypass graft surgery (CABG) and the placement of drug coated stents.
The study found that people were more likely to suffer a follow up heart attack following stent placement than with the more invasive surgical option. The bypass of two or three coronary arteries offered a 30% or 20% better incidence of recurrence of myocardial infarction when compared to the placement of drug coated stents.
While there still may be some candidates with a better risk profile for stent placement, most patients may do better with the more invasive surgical option.
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