But the notable variations in survival between hospitals offer some hope, Nallamothu says, that more lives might be saved if hospitals with below-average survival rates adopted some of the strategies of those with better survival rates. Tony Williams was one of the lucky ones.
He was undergoing minor elective surgery in to remove some large cysts from his back and shoulder, and shortly after the anaesthesia began, his heart stopped. Three minutes and several shocks later, his heart had been restarted. Only one out of five cardiac arrests can benefit from an electric shock. For this minority of patients, their chance of surviving to leave the hospital are roughly double that of the other four-fifths, according to US registry data. But speed is vital: the sooner you start getting shocked, the better your odds.
One study found that nearly one-third of defibrillations started more than two minutes after arrest. And, throughout the process, continuous chest compressions are vital. Now any pauses are as short as possible, ideally just five seconds to check for a pulse, or to step back right before the next shock is delivered. While CPR and defibrillation are going on, doctors and other clinicians are striving to figure out what triggered the arrest.
It could be a heart attack or a severe condition like sepsis or a toxic exposure, among other possibilities. He stayed in the ICU in a medically induced coma for several days afterwards. His shaken anaesthesiologist came by to visit him after he was transferred out of intensive care. Survival has been improving, at least in the US, based on data coming out of a voluntary registry of hospitals set up two decades ago by the American Heart Association.
By , 22 per cent of patients survived to hospital discharge, up from 14 per cent in Those strides, though, may not reflect US hospitals overall. Databases and registries of in-hospital cardiac arrests have been launched in other countries in recent years, including in Japan and the UK.
But the US registry has one of the longest track records, yielding numerous studies and insights. For instance, slightly more than half of these arrests occur at night or the weekend. But your shot at survival then is markedly lower, likely in large part because there are fewer staff around.
The ongoing research has exposed a fundamental truth. One analysis, which sorted hospitals from the registry into ten groups based on survival, found that 12 per cent of patients survived in the worst-performing group versus 23 per cent in the top group. Even among similar types of hospitals, such as academic ones or rural ones, there were wide variations in survival rates.
In recent years, Chan, Nallamothu and other researchers have conducted interviews and onsite visits at hospitals with above-average results, including the hospitals where Dahart and Heegeman work. Add to that the enormous time pressures — to perform perfectly, instantaneously.
Compared with treating a heart attack, where the goal is to open that blocked vessel within the first hour, the crux of cardiac arrest treatment ideally should be completed within a far tighter time frame, Chan says.
Hospitals with better survival results often have dedicated teams, with members like Dahart who can drop whatever they are doing and race to a code, as cardiac arrests are known in medical parlance. Dahart, a nurse for nearly three decades, says that being part of this team is something that she was born to do.
I love the adrenaline. Dahart is among those who educate other clinicians about signs that a patient could be imminently vulnerable to an arrest, ideally so the patient can be moved to the ICU before it happens. When Heegeman started working to improve cardiac arrest survival rates more than a decade ago, he got push-back from some clinicians, who said they already knew how to resuscitate someone.
For example, a clinician might arrive to a call but then wait for a leader to assign their role. Sometimes there could be confusion, with two people told to get a defibrillator while another task was left undone. Or too many clinicians could flood the area, making it noisy and difficult to manoeuvre in an already high-pressure crisis. He told her family that she had less than a 1 per cent chance of waking up, Olga says.
It is probably the most used drug in all of anesthesia. Every day essentially, when patients go under general anesthesia that whole state is a reversible coma. It's a difference in dosage. How does a medically-induced coma differ from a natural coma? The body doesn't usually decide to enter a coma. A coma is a profound shutdown of brain function. It typically results from profound trauma, brain injury, a drug overdose, stroke—some very gross insult.
There isn't a natural analogue for [a medically induced coma]. Are there after effects? It's hard to sort out, because if you're going to these extremes you're already dealing with a very dire situation. If there are effects later on, it's an extremely difficult distinction to make whether it is an effect of the drug-induced coma. People who do this are very mindful of watching and monitoring. They make every effort to only use this option for as long as they need to. David Biello is a contributing editor at Scientific American.
Follow David Biello on Twitter. Already a subscriber? Sign in. Thanks for reading Scientific American. Create your free account or Sign in to continue. See Subscription Options. Go Paperless with Digital. Get smart. To better facilitate research on appropriately determining prognosis after cardiac arrest and to establish better treatments for recovering from brain injury, a working group composed of a Johns Hopkins Medicine physician and American Heart Association AHA experts have released a scientific statement that provides best practices on how to predict recovery in comatose survivors.
The statement was released in the July 11 issue of Circulation. Because of low quality, flawed research, decisions related to current policies may result in prediction errors that may forecast a poor outcome for patients who may have a good outcome, or vice versa.
Moreover, the lack of standards for predicting outcomes has made it all but impossible to properly study therapies that could potentially heal the brain and the rest of the body after being resuscitated from cardiac arrest. To develop this scientific statement, the AHA Emergency Cardiovascular Care Science Subcommittee formed an international panel of experts in the adult and pediatric specialties of neurology, cardiology, emergency medicine, intensive care medicine and nursing.
Currently, many physicians wait 48 hours after a cardiac arrest for a patient to awaken from a coma, and some even opt to wait 72 hours.
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