AED In Hospitals WSJ 8/3/01

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Hospitals Use New Device For Cardiac Arrest Patients

By TARA PARKER-POPE, THE WALL STREET JOURNAL, August 3, 2001
AN ESTIMATED 100,000 people who die from sudden cardiac arrest every year are in a hospital when it happens. Although many of those people are severely ill and have little chance of recovery, a large number of them -- estimates range from 10,000 to 50,000 people -- might have been saved by earlier medical intervention. The grim reality is that the chance of surviving cardiac arrest while in a hospital is an abysmal 15% to 30%. Statistically, you're better off having a cardiac arrest at a Las Vegas casino. There, people are under constant surveillance and employees have been trained to shock people with automatic defibrillators, resulting in survival rates as high as 70%.

In a bid to improve their track records, some hospitals have begun using a device called Powerheart, which monitors the heart rhythm of high-risk patients and, if necessary, administers a shock within seconds of a cardiac arrest -- all without human intervention. Last month, Maimonides Medical Center in Brooklyn contracted for 100 of the machines, made by Cardiac Science of Irvine, Calif.

"We think there is room for improvement," says Gerald Hollander, director of clinical cardiology at Maimonides. "There have been people who have been lost that you think we might have gotten back if they'd been shocked earlier."

A CARDIAC ARREST -- often described as a massive heart attack -- occurs when the lower chambers of the heart start beating rapidly. It is sudden and unpredictable, and renders the patient unconscious. A person is most at risk for cardiac arrest in the moments and days following a heart attack, which occurs when a blocked blood vessel stops oxygen flow to the heart.

To recover from cardiac arrest, the heart must be shocked back into a normal rhythm with a defibrillator. For every minute delay, a person's chance of living falls by 10%.

Even so, hospitals have a surprisingly cumbersome process for dealing with cardiac arrest. Generally, a doctor or nurse must first notice a patient having an arrest, then call the hospital operator to alert a cardiac-arrest team, which will bring a cart to the bedside. The patient is then shocked with a defibrillator.

Even a patient in an emergency room with chest pains could suffer cardiac arrest and not be noticed right away.

Although much research has been conducted on response times when cardiac arrest happens outside a hospital, no one knows how fast teams are responding to cardiac arrests inside the hospital.

"It's not like 'ER' where doctors and nurses are standing beside the bedside of the patients every minute of every day," says University of Toronto professor of medicine Paul Dorian, the lead investigator of an ongoing study measuring hospital response times to cardiac arrest. "There are so many human factors that have to happen. The response team receives a call, but they may be in the cafeteria or six floors away."

A recent study of 445 patients who suffered cardiac arrest at the Cleveland Clinic shows that surveillance and monitoring of patients makes a significant difference in whether they survive cardiac arrest. Only 7% of patients whose arrest was not witnessed survived, compared with 25% survival for witnessed arrests. A cardiac arrest between midnight and 6 a.m., when fewer doctors and nurses are around, has a survival rate of about 14%, compared with 27% for a daytime arrest.

ALTHOUGH THE DATA include some patients with late-stage disease who likely couldn't have been saved anyway, the study author says the research shows that some patients need closer monitoring. "That's where the need is, but there are not enough nurses out there," says John A. Dumot, assistant staff gastroenterologist at the Cleveland Clinic.

So far, there are no data to indicate whether Powerheart can improve cardiac-arrest survival rates. But some hospitals, including Maimonides, Arizona Heart Hospital in Phoenix and Western Medical Center in Santa Ana, Calif., have begun using the machine to find out.

Powerheart is hooked up to high-risk patients, such as someone who is complaining of chest pains or who has recently suffered a heart attack or undergone heart surgery. Pads on the patient's chest monitor heart rhythm, and if a cardiac arrest occurs, the machine will automatically shock the patient 30 to 60 seconds after the problem starts.

At the Arizona Heart Hospital in the past year, eight patients attached to Powerheart suffered cardiac arrest and four of them survived. "This is one cause that really only technology can address," says Thomas Mattioni, director of electrophysiology. "When you look at why there is a delay in delivering a life-saving shock, they are mainly human factors."

Because cardiac arrest is so unpredictable, the biggest dilemma for hospitals is in deciding who gets hooked up to the Powerheart. The monitors shouldn't be used to resuscitate people with late-stage disease whose life would be prolonged for only a short time, says Jerome Hoffman, UCLA professor of emergency medicine.

Others say the more immediate problem is hospitals' reluctance to adopt the latest technology for responding to cardiac arrest. "It's almost comical; people are grabbing carts and running to the bedside," says Dr. Hollander. "Shouldn't we be set up better for something like that?"