Cardiac Arrest Study May Help EMS Crews and ERs

Simple guideline can identify which patients should be brought to hospitals when emergency efforts to revive them aren't working

ANN ARBOR, Mich. , Sept. 23 /PRNewswire-USNewswire/ -- When someone's heart suddenly stops beating -- a condition called cardiac arrest -- there's a lot that bystanders and ambulance crews can do to get it started again. But if the victim doesn't respond, when should such efforts stop?

And when should emergency crews rapidly transport a patient to a hospital with lights and sirens on, potentially endangering the lives of paramedics and other motorists and pedestrians -- even though the care provided by the emergency crew is the same as what can be provided in the emergency department?

Currently, there's no one "right" answer to these questions, which arise in the majority of the cardiac arrests that strike 166,000 Americans each year -- and kill 93 percent of them. As a result, emergency medical services crews and hospital ER teams spend countless hours and healthcare resources on patients who have no chance of making it home alive -- at the expense of other patients who need an ambulance or have spent hours in an ER waiting room.

Now, a new study in the Journal of the American Medical Association shows that a single standard guideline could help EMS and ER teams determine which cardiac arrest victims might benefit from a trip to the hospital, while at the same time reducing futile efforts on patients who have no chance of surviving a cardiac arrest.

The study shows that EMS teams can use either a simple five- or three-part rule to determine when they should discontinue efforts to revive cardiac arrest patients on the scene where their heart stopped beating. The same rule will also tell them when they should keep trying to resuscitate the patient while transporting him or her to the nearest ER. The three-part rule may be sufficient to identify 99.8 percent of those who need to be transported to the hospital for further care, the researchers say.

The study was performed by a team from the University of Michigan Health System, Emory University and the Henry Ford Health System, using data from 5,505 cardiac arrest patients treated in eight metropolitan areas around the U.S. It did not include patients who suffered a cardiac arrest after a non-heart incident such as drowning. It was funded by the Centers for Disease Control and Prevention.

Comilla Sasson , M.D., M.S., is the study's lead author and a Robert Wood Johnson Clinical Scholar at the U-M Medical School. An emergency physician herself, she began the study after many frustrating experiences in a Chicago ER where she had to stop caring for other critically ill patients whenever a cardiac arrest patient came in the door -- no matter how futile it might be to try to bring the patient back, and no matter how time-sensitive the needs of the other patients in the ER.

Now at the U-M Department of Emergency Medicine, Sasson teamed up with an Emory University group that has been tracking cardiac arrest response. The Emory effort, called CARES, helps EMS crews and hospitals find ways to improve care.

"Many cardiac arrest patients are successfully resuscitated at the scene, with the help of automated external defibrillators and CPR, and the hospital is the right destination for them," Sasson says. "The question has been what to do about patients who fail to respond, despite the best efforts of an EMS team. This study confirms previous findings, and shows that a standard rule could ensure that the right patients get to the hospital while allowing us to use scarce resources wisely."

Sasson notes that many advanced EMS crews now have nearly all the tools and training that ERs have for reviving cardiac arrest patients, including artificial airways, heart-starting injectable drugs and more. Many have radio contact with an emergency doctor at the local medical control authority. In addition, automated external defibrillators (AEDs) are now available in many public places for bystanders to use to restart a stopped heart, in the crucial minutes before an EMS team arrives.