In a sudden cardiac arrest, the events that take place even before responders arrive play an important role in the patient’s outcome, says Dr. David Slattery, the EMS medical director for Las Vegas Fire and Rescue.
Slattery, who is passionate about the studies of cardiovascular emergencies, has spent years researching the seconds and minutes immediately following cardiac arrests. He’s concluded that much of the fate of a cardiac arrest victim is sealed long before EMS gets on the scene.
“The chance of survival goes down by 10% for every minute that goes by without care,” said Slattery, who was one of the presenters at the 2011 EMS World Expo held August 31–September 2 in Las Vegas, NV. “A lot has been determined even before you get there.”
Slattery said patients in arrhythmia or ventricular tachycardia might be salvageable, but those in asystole are not. “The key is CPR and early defibrillation,” Slattery said.
One area of particular interest to Slattery is automatic external defibrillators in casinos—a natural focus given his location in Las Vegas. Slattery said it’s worth noting that survivability of a cardiac event in a casino is significantly greater than nearly any other location, and there are a couple of reasons for that.
First, every square foot of a casino, inside or out, has closed-circuit cameras that are monitored 24 hours a day. So, if a person experiences a medical emergency, virtually anywhere on or in the property, it’s likely someone has witnessed it and can dispatch a security guard or attendant within seconds of the event. The immediate administering of CPR and early defibrillation buys time and gives EMS providers a salvageable rhythm.
“It’s kind of like it takes a village to educate a child,” Slattery said. “It takes a community to make a difference in cardiac arrest.”
The probable survival rate for cardiac arrest victims in casinos is about 70% compared to other locations, where it could be 9% or less.
Slattery is a firm believer in early CPR. In his mind, if there’s any question about the presence of a sustainable heart rhythm, start chest compressions immediately. “Get on the chest as soon as possible,” Slattery said. “If they push you off, stop.”
When EMS providers arrive on scene, it’s important to “keep on the chest” and continue effective CPR. He advocates minimal distractions from CPR in favor of continuous fast and hard chest compressions with no interruptions. “I suggest you intubate while doing CPR,” Slattery said, noting that any interruption in chest compression reduces chance of survival. “Try it. It’s easier than you think. You can’t lose with this approach.”
Slattery is also an advocate of mechanical chest compression devices that provide consistent, uninterrupted CPR, which is far more effective than pushing on a victim’s chest, one-handed, while pushing the stretcher to the ambulance or the ED, he said. If mechanical devices are used, they should continue to be used even in the ED, Slattery said, noting that too often, emergency room doctors want the machines off at the hospital. “Resist the temptation to take off the chest compression device,” he said.
When it comes to improving outcomes for sudden cardiac arrest victims, "off-chest time" should be avoided at all costs, Slattery said.
“That costs precious time, time that you can never get back,” Slattery said.
Ed Ballam is a staff writer for the EMS World news team.