Minimizing pauses when switching from compressions to defibrillation improves cardiac arrest survival rates, according to findings published June 20 in the journal Circulation.
Researchers analyzed 815 American and Canadian cardiac arrests treated by paramedics in Toronto, Ottawa, Vancouver, Seattle/King County and Pittsburgh, using either an automated external defibrillator or manual defibrillator. The likelihood of surviving until hospital discharge was much lower for patients whose rescuers paused for 20 seconds or more before delivering a shock (called the pre-shock pause), and for patients whose rescuers paused before and after defibrillation (the peri-shock pause) for 40 seconds or more, compared to patients with a pre-shock pause of less than 10 seconds and a peri-shock pause of less than 20 seconds.
Specifically, patients whose rescuers paused for 20 seconds before delivering a shock were 53 percent less likely to survive to hospital discharge compared to a shorter delay; patients who experienced peri-shock pauses of more than 40 seconds were 45 percent less likely to survive than those with peri-shock pauses of less than 20 seconds. Yet there was no association between the post-shock pause, or the pause between delivering a shock and restarting CPR, and survival to discharge.
“This led us to believe that a primary driver for survival was related to the pre-shock pause interval,” says Sheldon Cheskes, M.D., principal investigator of the study and assistant professor of emergency medicine at the University of Toronto, in a news release.
The study also found that patients treated with AEDs had pre-shock pause times nearly double those treated in the manual mode (18 seconds vs. 10 seconds), which researchers say is likely due to the time required for an AED to analyze the patient’s rhythm and to charge prior to delivering a shock. Researchers recommend that medics defibrillate in the manual mode to limit the pre-shock pause to an “optimal” five seconds.
Abused Women Frequently Visit EDs—But Few Get Help
Domestic violence victims rely heavily on emergency departments for medical issues, but about 72 percent of them are never identified as being victims of abuse, according to a study by researchers at the University of Pennsylvania School of Medicine.
Nearly 80 percent of women who reported having been abused to police came to an ED at least once during the four years after the assault. Most women sought help even more often—an average of seven times. Although hospitals typically have policies requiring screening and intervention for domestic violence, only 28 percent of the patients in this study were identified as abuse victims. That’s likely because most visits (78 percent) were for medical complaints, while less than 4 percent of visits were a direct result of the assault, according to a university news release.
The study, which cross-referenced court, police and ED records from eight hospitals to identify nearly 1,000 domestic violence victims in a semi-rural Michigan county between 1999 and 2002, was published online March 16 in the Journal of General Internal Medicine.
Racial Disparities in SCA Survival
African-Americans who experience cardiac arrest are more likely to die if they’re taken to hospitals that predominantly care for African-Americans than if they’re brought to hospitals that treat mostly Caucasians, according to new research from University of Pennsylvania School of Medicine researchers published in the April issue of the American Heart Journal.
Among more than 68,000 cardiac arrest admissions analyzed through Medicare records, only 31 percent of black patients treated in hospitals that care for a high proportion of black patients survived to discharge, compared to 46 percent of those taken to predominantly white hospitals. Results show that white patients, too, were less likely to survive when treated at hospitals that treat higher proportions of black patients, and that blacks were more likely to be taken to hospitals with low survival rates.
“Since cardiac arrest patients need help immediately and are brought to the nearest hospital, these findings appear to show geographic disparities in which minority patients have limited access to hospitals that have better arrest outcomes,” the researchers say. “For example, these hospitals may not utilize best practices in post-arrest care, such as therapeutic hypothermia and coronary artery stenting procedures. These findings have implications for patients of all races, since these same hospitals had poor survival rates across the board.”
Motorcycle Fatalities Drop
Motorcycle deaths dropped by an estimated 2 percent—from 4,465 to 4,376—in 2010 compared to the prior year, according to a report released April 19 from the Governors Highway Safety Association (GHSA), which uses data from 50 states and the District of Columbia.
Though good news, the decline is far less than the 16 percent drop in 2009, which followed 11 straight years of steady increases in motorcycle deaths. What’s more, the data show the 2010 decrease occurred in the early months of the year, with fatalities actually increasing by about 3 percent in the third quarter compared with the same quarter in 2009.
With surging gas prices, motorcycle travel is expected to increase. And alarmingly, motorcycle helmet use dropped from 67 percent in 2009 to 54 percent in 2010, according to the GHSA.
No ‘Weekend Effect’ in Regionalized Trauma Systems
People who suffer traumatic injuries during the night or on the weekend are at no greater risk of death than people injured on weekdays, provided they receive care from a “mature” regionalized trauma system, new research finds. In fact, people treated on weekends at one of Pennsylvania’s 32 accredited Level 1, II or III trauma centers actually had a slightly increased chance of survival.
Previous studies have documented a so-called “weekend effect” for the victims of heart attack and stroke, according to researchers from the University of Pennsylvania School of Medicine published in the March 21 issue of Archives of Surgery. But for traumatic injuries, a trauma system’s “unique organization” is equally prepared to treat patients no matter the day or time, researchers say. “Whether patients have an emergent illness or a severe injury, the common denominator is time. Patients must rely on the system to quickly get them to the place that’s best prepared to save their lives,” says lead author Brendan G. Carr, M.D., an assistant professor in the departments of emergency medicine and biostatistics and epidemiology, in a news release. “Trauma systems have been designed to maximize rapid access to trauma care, and our results show that the system also offers special protection for patients injured during periods that are known to be connected to worse outcomes among patients with time-sensitive illnesses.”
Researchers analyzed data on more than 90,000 trauma patients treated from 2004 to 2008. About one-fourth of patients arrived at the hospital on weeknights; 40 percent arrived on weekends.
Risk of Death Higher Several Years After Trauma
About 16 percent of people treated for trauma die within three years of their injury—a much higher rate than the expected population death rate of 6 percent. Researchers from the Harborview Injury Prevention and Research Center in Seattle analyzed data from the Washington State Trauma Registry on nearly 125,000 adult trauma patients treated from 1995 through 2008. The average age of the patients was 53 years; 59 percent were male.
While the percentage of people who died in the hospital improved between 1995 and 2008, there was no improvement in the percentage who died after discharge. Discharge to a skilled nursing facility was associated with a higher risk of death following the injury. Researchers say that better follow-up and care after discharge could help save lives.
The study is in the March 9 issue of the Journal of the American Medical Association.
