Sudden cardiac arrest (SCA) survivor Chris Knight likes to say he died five times in one day and, in fact, he did. Knight’s heart stopped four more times after an initial SCA. Luckily for him, the city in Illinois where he was visiting equips all its police officers and first responders with automated external defibrillators (AEDs). His experience has made him into a crusader to have AEDs for all first responders in his part of the Texas Panhandle.
Knight and his staff at a local Texas television station have teamed with other businesses to provide 100 new AEDs per year over the next five years. You can read more about him in our Top Story section of this portal.
While Knight is to be commended, there is no reason one needs to wait until undergoing emergency PCI to enlist in a cause to make AEDs more readily available to emergency personnel. On the other hand, when should EMS providers cease resuscitation efforts in out-of-hospital cardiac arrest (OHCA) patients who do not respond?
Our other top story looks at this phenomonon. What should EMS providers do when such a patient does not respond to CPR, AED shocks or drugs? To the dismay of some in the emergency medical community, local, national and cultural systems and norms support transporting refractory OHCA patients to the emergency department rather than terminate resuscitation efforts.
Sasson et al have identified payors, legislators and community attitudes as the three largest barriers to adopting national consensus guidelines relating to termination of resuscitation. They have also identified several national organizations that can help spearhead efforts to change policies and approaches at the local, national and communal level.
The researchers contend that it’s better to spend the first 30 minutes with an arrest patient on-scene using whatever means available to achieve return of spontaneous circulation. The conventional paradigm is to rush the patient into the ambulance and provide resuscitative efforts while en route to the hospital, even though the patient may never regain circulation. Resources would be better spent, they say, trying to revive the patient on the scene and, if that is unsuccessful, do not transport the patient to the emergency department. However, current reimbursement policy pays more to transport that patient rather than use new technology, such as AEDs and hypothermia, on the scene.
While the American Heart Association (AHA) recommends hypothermia therapy for OHCA patients as a means to improve survival and neurologic outcomes, adoption of cooling therapies has been slow.
Looking into this phenomenon, Merchant et al found that cost effectiveness should not be an issue. Their mathematical model showed, even under extreme estimates for cost, that cooling blankets used in the hospital were cost effective and comparable with other widely accepted treatments.
Our understanding of responding to and treating patients who suffer an out-of-hospital cardiac arrest has improved in the last several years. It is now common wisdom that no one single method will increase survival and outcomes. It is the combination of many therapies and protocols in this setting that are helping to increase survival. But at each level, research and advocacy need to go hand-in-hand, sometimes to change public policy and sometimes to change public perception.
If you like to learn more about resuscitative care, go to our HealthCare TechGuide, where events, whitepapers and vendor information is a click away.
Also, please send any comments or suggestions to me. I look forward to hearing from you.
C.P. Kaiser, Editor