Electrical cardioversion

A new study has determined that hospital staff is late in responding to one-third of sudden heart attacks in the hospital, causing added risk of brain damage and death. Thousands of deaths a year result from these delays.

The researchers studied the medical records of 6,789 patients at 369 hospitals who suffered cardiac arrests. The heart could have been revived with a defibrillator, which administers an electrical shock to stimulate the heart into pumping again.

The American Heart Association recommends that in case of cardiac arrest, electrical shock should be applied within two minutes.

As discovered in the study published in the New England Journal of Medicine, the consequences of delayed response were critical.  When the shock was administered on time, 39.3 percent of patients survived and were eventually discharged from the hospital. But when it was delayed, only 22.2 percent of patients lived. The chances of delay were greater when:

* the cardiac arrests occurred at night or on the weekend
* the patients were admitted for reasons other than a cardiac condition
* the hospitals were small (less than 250 beds)
* the patients were in units that had no heart monitors

There are no firm figures available, but researchers believe between 370,000 and 750,000 patients admitted into a hospital every year suffer a cardiac arrest. In one-third to one-half of these, the arrest is for causes that can be corrected with electrical shock (some cases need other forms of treatment). If shock is delayed in 30 percent of them, as determined in the study, at least 36,000 lives are lost each year which could otherwise have been saved.

Many people assume that the best place to suffer a cardiac arrest is in the hospital. This may not be a correct assumption, looking at the study results.

The researchers believe some of the reasons for the delays are:

* not enough personnel on duty at night or on weekends
* nurses are not authorized to use defibrillators and must wait for a doctor
* small hospitals may have only one doctor on duty in the emergency room

The type of equipment available in hospitals may also be to blame. Hospital defibrillators require that the doctor first examine the patient’s electrocardiogram to verify that electric shock is indicated before they administer it.

By contrast, there are automatic defibrillators installed in public places (e.g., airports and casinos) that ordinary laymen can use. Once it is connected to a person’s chest, the machine has sensors that determine if the heart has electrical activity or has stopped, and if needed, delivers the electrical shock.

These automatic defibrillators have not yet found their way into hospitals. These are sold for only about $500.

Cardiac arrests are different from heart attacks. Heart attacks are due to clogged coronary arteries; cardiac arrest occur when the heart’s electrical system malfunctions.

Safety Tip:
* Request for a heart monitor in your room. If you’re admitted into a hospital and there’s reason to fear cardiac arrest anytime, ask the nurse for a heart monitor.