Saturday, September 10, 2011

Staggering Cardiac Arrest Numbers

Matthew and Daniel,with Daniel on the right, opening gifts on Christmas 2007, the last Christmas Daniel was able to spend with us.

We know that having an AED and delivering CPR rapidly following the arrest, are the best chances we have to prevent a sudden death once a child or teen is IN cardiac arrest. However, I have included this article because the numbers of annual spontaneous arrests are staggering, and because some people don't make it, even with immediate CPR, just as Daniel did not.


Sudden cardiac death: Lessons from a study halted by the feds in Portland, nine other cities
Published: Thursday, September 01, 2011, 6:00 AM
Updated: Tuesday, September 06, 2011, 2:44 PM
By Joe Rojas-Burke, The Oregonian The Oregonian

Sudden cardiac arrest kills more than 180,000 people each year in the U.S. Despite years of research, refinements in resuscitation and widespread placement of automated defibrillators, 90 percent of those struck by cardiac arrest never regain consciousness. Since 2008, four large-scale clinical trials of potential new treatments for out-of-hospital cardiac arrest have failed to show improvement in survival.

The New England Journal of Medicine has now published details on the latest study, carried out in Portland and nine other cities. Among patients who had an out-of-hospital cardiac arrest, researchers found no difference in the outcomes with an extended round of chest compressions, compared with a brief period, before use of an electric deibrillator by medics. A device meant to boost blood flow during CPR also made no significant difference in survival.

Federal officials ordered an early halt to the study in 2009 because preliminary results showed none of the treatments improved survival. The study, the largest of its type ever attempted, enrolled more than 11,000 people felled by sudden cardiac arrest, and researchers hoped it would define a way to save more patients.

In cardiac arrest, the heart's rhythmic beat lapses into disorganized chaos. Survival hinges on rapid resuscitation and an electrical jolt from a defibrillator to restore a normal heart rhythm. How long to continue CPR chest compressions became a controversial question after studies suggested that continuing chest compressions for three minutes might help to prime the heart for pumping so that a defibrillator shock is more likely to restore a normal heartbeat. For many years, doctors assumed it was best to move quickly to defibrillation after about 30 seconds of chest compressions.

Dr. Mohamud Daya, an emergency medicine specialist at Oregon Health & Science University, in an interview with The Oregonian in 2009, said the clinical trials have a lesson to teach: Don't rely on hitting a technological home run. To boost overall survival, he said, communities must find ways to improve the basic practice of CPR and speed the use of defibrillators that jolt stopped hearts back to life.

"The focus has been on magic bullets, but in reality what matters is good quality CPR and timely defibrillation," Daya said.

Randomized, controlled trials may not be the best strategy for reducing deaths caused by sudden cardiac arrest, asserts Dr. Arthur B. Sanders at the University of Arizona's Sarver Heart Center in Tucson. Writing in the New England Journal of Medicine, Sanders says:

An alternative strategy is to use a continuous-quality-improvement model. An example of this model is the approach that has been taken in Arizona. After a statewide database of out-of-hospital cardiac arrests was developed, systemic changes that deviated from the standard guidelines were implemented, including an unconventional EMS protocol and layperson-administered compression-only CPR. As a result, the rate of survival nearly tripled, and bystander-administered CPR increased. This model has also been used in rural Wisconsin with similar improvements in the rate of survival.

Some researchers say prevention of cardiac arrest should be a top research priority. As long as the medical response remains limited to desperate resuscitation measures, "We're never going to have full success. But if you go after the causes, the triggers, then you can talk about making a major attack on this problem," Dr. Mickey Eisenberg told The Oregonian last year. Eisenberg is a medical professor at the University of Washington and director of emergency medical services for King County, renowned for its cardiac arrest survival rate.

On the prevention front, Portland residents are among the most closely watched populations in the world. Since 2002, researchers have gathered every relevant detail they can find on every case of sudden cardiac death that occurs in Multnomah County. The years of effort are starting to pay off with tantalizing clues in the search for strategies to prevent sudden cardiac arrest.

– Joe Rojas-Burke


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