RNS: Cardiac arrest study
Running time: 2:59
Saving lives more efficiently: Cardiac arrest study may help EMS and ERs
Radio News Service lead/blurb: A new study led by a University of Michigan emergency physician may help ambulance crews nationwide figure out the best way to handle one of the most common and deadly heart-related emergencies: cardiac arrest.
Script:
When someone’s heart suddenly stops beating – a condition called cardiac arrest -- there’s a lot that bystanders and ambulance crews can do to get it started again. But if the victim doesn’t respond, when should such efforts stop?
And when should emergency crews rapidly transport a patient to a hospital with lights and sirens on, potentially endangering the lives of paramedics and other motorists and pedestrians — even though the care provided by the emergency crew is the same as what can be provided in the emergency department?
Currently, there’s no one “right” answer to these questions. But a new study from the University of Michigan and two other institutions may help lead to a consistent answer for emergency crews across the country.
Dr. Comilla Sasson, an ER doctor at U-M who led the study, explains why it’s so important to develop a way to tell who is most likely to survive cardiac arrest:
There’s about 166-thousand cases of cardiac arrest in the United States each year. About 60-percent of these are actually treated by emergency medical services. The nationwide median survival rates of out-of-hospital cardiac arrest are only about 7-percent, so that means 9 out of every 10 patients will not survive a cardiac arrest event outside of the hospital
Dr. Sasson and her colleagues showed that EMS teams can use either a simple five- or three-part rule to determine when they should discontinue efforts to revive cardiac arrest patients. The same rule will also tell them when they should keep trying to resuscitate the patient while transporting him or her to the nearest ER. The three-part rule may be sufficient to identify 99.8 percent of those who need to be transported to the hospital for further care, the researchers say.
The two rules basically have five criteria. The first rule basically says that if an arrest is witnessed by an EMS provider, if a patient has a shockable rhythm, meaning that we can actually put the paddles on and give them a shock in the out-of-hospital setting, or if they have a pulse in the out-of-hospital setting then they should be transported to the hospital. The second rule just added two extra criteria and basically said that if a patient had bystander CPR or had an arrest that was witnessed by a bystander then it would meet the criteria to actually be transported to the hospital.
When we applied these two rules to our own cardiac arrest registry we found that we were able to predict almost 100-percent of the time which patients should be transported to the hospital and only misclassified less than 0.2 percent of people who would not survive.
Now, the researchers hope that their findings will be used by national groups to develop a clear standard for all EMS crews to use. And that may help more than just the victims of cardiac arrest. In fact, it could help all of us, by making sure that ER teams, ambulances and other healthcare resources are used in the most efficient way possible.
The benefit of increasing our utilization of these termination of resuscitation rules in the out-of-hospital setting is that we can actually save resources for our entire healthcare system at large.
And that may ultimately mean a shorter wait for you or your loved on the next time you have to go to an emergency room.
Kara Gavin, U-M Health System News.
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