Defibrillator Delays In Hospitals Lead to Death

In a study published yesterday in the New England Journal of Medicine, the authors concluded that in nearly one-third of cases of sudden cardiac arrest occurring in hospitals, the staff takes too long to respond, greatly increasing the risk of brain damage and death. The authors research indicates that these delays contribute to thousands of deaths a year in the United States alone.
The study was based on the records of 6,789 patients at 369 different hospitals whose hearts suffered from conditions that could be reversed by the use of an electronic defibrillator.
Experts say that the defibrillator shock should be administered to the patient within two minutes after the heart stops beating. But, the study found that it took longer in 30% of the cases. The results of the delays were striking. When the defibrillator was delayed, only 22.2% of patients survive long enough to be discharged from the hospital as opposed to 39.3% when the shock was administered properly.
The delays were found to be more likely in patients who suffered heart stoppages at night or on the weekends, or who were admitted for a non-cardiac illness in a hospital with fewer than 250 beds and in units without heart monitors.
The authors of the study surmised that the problem may be even more widespread than their study revealed. They pointed out that the hospitals which were part of the study have joined a national registry on cardiac arrest which means there have already adopted special efforts trying to meet guidelines involving the use of debibrillators. Thus, they feel that these hospitals actually performed better than the average hospital.
The authors estimated that 370,000 to 750,000 hospitalized patients have a cardiac arrest every year in the United States. They reported that in a third to one-half of the cases, the cardiac arrest is caused by an abnormal rhythm that can be corrected by a shock from a defibrillator.
The reasons for the delays were varied. Sometimes, especially at night and weekends, it was felt that not enough personnel were available in smaller hospitals. Also, in some hospitals, nurses other than those in intensive care units, were not allowed to use defibrillators. Another factor that the authors pointed out was that the traditional defibrillators used in hospitals require that a doctor or nurse look at the patient’s heartbeat, verify that the problem is correctable by the defibrillator, adjust the machine and deliver the shock. In contrast, the automatic defibrillators that have come into use in public places are meant to be used by laymen. They can be connected to the chest of someone who has collapsed, the machine will sense electro activity in the heart and deliver a shock only if it is needed. These devices are designed to be almost foolproof, but so far they have not been used widely in hospitals.
One expert in the field commented that some patients would be better off having a cardiac event in a shopping mall than in a hospital.