Improving survival from sudden cardiac arrest
Progress will happen in small, precise improvements that when added up, could produce survival rates from ventricular fibrillation of 75 percent
By Arthur Hsieh
I recently had the opportunity to see Dr. Mickey Eisenberg present at the West Region EMS conference in Ocean Shores, Wash.
Dr. Eisenberg is one of the original pioneers in emergency cardiac resuscitation, and is highly respected among his peers. Nevertheless, his message about improving survival rates from cardiac arrest is clear: Progress will happen in small, precise improvements that when added up, could produce survival rates from ventricular fibrillation of 75 percent.
To contrast, the best survival rates range from 46 percent in the Seattle Medic One system, to zero percent in Detroit. Nationally, overall survival rate has hung around 9 percent for quite some time.
So, what was Dr. Eisenberg's prescription? This is what says:
1. Participate in a cardiac registry. You have to know whether your patients survive cardiac arrest, in order to measure progress right? Many EMS systems don't have reliable access to that information.
2. Provide high performance CPR. The American Heart Association 2010 Guidelines builds on the fact that we really have to circulate blood during CPR in order to improve cardiac arrest outcomes. To do that, we have to train in the same way, with real emphasis on helping people improve their technique.
3. Voice record the resuscitation. While digital data recording captures a lot of information, it can't identify all scene events, such as when the patient is being moved, with resulting gaps in compression signals.
4. Debrief each event. Try to determine where something could be improved in the management of the cardiac arrest. It's just like any other after action plan — lessons learned can be applied to the next code.
5. Provide aggressive telephone CPR instructions. While it's important to train laypersons in CPR, the fact is that in most sudden cardiac arrests, someone will call 911 as soon as possible, which means that someone can be taught compression only CPR quickly, improving the patient's chance of survival.
6. Establish a telephone CPR QI program. Like a registry, you have to know what is being said by the dispatcher in order to know whether it is effective. There are certain phrases and questions that should be said to maintain clear communications with the frantic caller.
7. Promote and target public access defibrillation (PAD) programs. Early defibrillation is as important as early CPR. Communities need to have AEDs in places where people congregate. Ironically, PADs may work better in public places than in homes; healthier people tend to be walking outside and suffer sudden cardiac arrest, while those confined to their homes may have more confounding factors that lowers the chances of survival, even with near immediate response.
8. Rapidly dispatch emergency units. Seems like a no brainer, but think about it: do you know how long it takes for a call to be transferred from the initial PSAP, to the secondary PSAP, to perhaps even a third one?
When you consider that survival rate decline is measured in one and two minute intervals, these transfers represent significant delays to providing care.
We've come of age in resuscitation. EMS plays a massive role in it. It's critical that we do what we can to improve our community's health.