A report published in the New England Journal of Medicine last year found that a person had a 70 percent chance of surviving a cardiac arrest in a Vegas casino equipped with portable defibrillators (hand-held devices that deliver shock to the chest) versus 30 percent in some hospitals.
This alarming statistic has given hospitals throughout the United States a new sense of urgency about improving resuscitation methods. Twenty-five hospitals across the country have recently installed bedside automated external defibrillators (AEDs) that remain connected to the patient and monitor the heart’s vital signs, including rate and rhythm. The machine can be set in two different modes. When it’s in the advisory position and a patient’s heart slips into a potentially lethal rhythm, the machine alerts the medical team to the problem. When the machine is set in the automatic defibrillation mode and a life-threatening rhythm appears, it can deliver a shock to the patient in less than 30 seconds–without any medical personnel adjusting knobs or applying paddles.
There are two major reasons why properly equipped casinos can do a better job at reviving cardiac arrest victims than many hospitals. First, casinos are typically crowded and loaded with cameras. When someone slumps over or falls to the ground during a massive heart attack, there’s a good chance someone will witness the event and call for help. The second reason is that most casinos are equipped with the portable AEDs, as are many airplanes, stadiums and other public places. (These are the machines you see used on television medical shows when the patient’s heart has stopped and doctors apply the paddles, yelling “Clear!”)
Cardiac resuscitation experts say a patient’s chances of surviving a heart attack are reduced by 10 percent for every minute it takes to revive him or her. In hospitals, however, it can take several minutes for medical personnel to assemble during what is typically called a code. With a bedside AED, however, there is no need to wait for the entire team to come together. Instead, the shock can be delivered in a matter of seconds, potentially charging the heart back to a regular rhythm.
That’s why hospitals are installing the devices throughout their facilities. The Maimonidies Medical Center in Brooklyn, N.Y., for instance, has placed 140 of the machines throughout the hospital. Patients can go to the bathroom or even walk around the hospital and remain connected to the defibrillator that monitor’s their heart activity around the clock. Ideally, these devices are first used for those at highest risk for heart problems–patients awaiting a heart transplant, those suffering from coronary artery disease and those who have undergone recent heart surgery. Some doctors, however, are questioning whether these machines might also be helpful on the general medical floors where patients aren’t typically on monitors and nurses are often short-handed.
While these machines have the potential to save lives, the devices are still being studied and doctors are still collecting data on there benefits and potential side effects. Some medical professionals have raised the possibility of the machine incorrectly identifying a normal rhythm as abnormal and delivering the shock inappropriately. But Dr. Gerald Hollander, chief of clinical cardiology at Maimonidies, believes that the chance of this happening is minimal. “The computers in these machines are often better than humans at recognizing abnormal rhythms. The chance that they make a mistake is minute at best.”
The American Heart Association has said that cardiac arrest victims should receive their first shock within three minutes. That’s a goal few hospitals can meet today. If this new technology can, in fact, deliver shocks faster and more safely than humans, it could be an important advantage for doctors and patients in their race against the clock to maintain life.
