Reducing the damage caused by cardiac arrest

Cardiac arrests outside of a hospital setting are very common and many patients who have been resuscitated die. The medical community has responded with educational programs in CPR and installation of Automated External Defibrillators to provide a bridge to hospital care. Once the patient makes it to the hospital, recent work in hypothermia to prevent brain damage shows some promise.

Three papers presented at the 2006 Society for Academic Emergency Medicine Annual Meeting, May 18-21, 2006 in San Francisco explored important aspects of these topics. Latinos Less Likely to Receive CPR

Bystander CPR (BCPR) is known to provide improved outcomes for survivors of cardiac arrest. However, there is data showing that African-Americans are less likely to receive BCPR than Whites. In the first reported study of Latino victims of cardiac arrest, it was demonstrated that Latinos received BCPR in only 12.8% of cases, compared with Caucasians who received it in 23.9% of the cases. Even after adjusting for socioeconomic indicators such as income and education, the disparity persisted.

The data come from a retrospective analysis of the Cardiac Arrest Resuscitation Evaluation in Los Angeles (CARE-LA) database combined with the California Death Statistical Master File (CDSMF). There were 1239 cases analyzed.

Lead investigator Peter C. Benson, MD, commented that "The Latino population is the fastest growing population in the United States and clearly it is of paramount importance to identify disparities affecting any historically underserved population. It is our hope that this study will bring about additional research specifically directed to addressing healthcare disparities in underserved populations."

The study is entitled "Latino victims of cardiac arrest are less likely to receive bystander CPR than Caucasians in Los Angeles" and will be presented by Peter C Benson, MD. His co-authors are Marc Eckstein MD and Sean O Henderson MD. This paper will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Saturday, May 20, 2006 at approximately 2:45 PM in Salons 1-3 of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.

Should Defibrillators be Made Available Everywhere?

While the effectiveness of rapid defibrillation for cardiac arrest is undisputed, little is known regarding the cost-effectiveness of wide-scale implementation of public access defibrillation (PAD). In a study of almost 7700 cardiac arrest incidents in the Ontario area from 1995 to 2000, researchers found that only three types of locations were cost-effective.

Decision analysis compared costs and life expectancy of treating patients with and without an on-site defibrillator by location. Costs were based on resource utilization, coupled with a model for survival and disease progression. Using a threshold of $50,000 per year of life gained, only casinos ($542), non-acute hospitals ($30,750), and nursing homes ($45,926) met the cost-effectiveness criteria. Costs in other locations spanned a wide range, with shopping malls at $67,690, hotels at $143,530, restaurants and bars at $347,954, medical offices at $955,614, and stadiums and fairgrounds at $1,910,193.

Valerie J. De Maio, MD, concludes, "Less than 15% of cardiac arrests occur in public venues. PAD programs that target public venues are unlikely to lead to significant overall survival benefit. There is a much greater opportunity to improve survivability by focusing on the delivery of good-quality basic CPR and programs designed to increase awareness among the community."

The paper is "Location-Specific Cost Effectiveness of Public Access Defibrillation" by Valerie J De Maio MD, Doug Coyle PhD, Ian G Stiell MD, Kathryn O'Grady MSc, Christian Vaillancourt MD, Lisa Nesbitt MHA, and George A Wells PhD. This paper will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Friday, May 19, 2006 at 10:00 AM in Salon 8 of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.

Reducing Brain Damage after Cardiac Arrest

Much of the damage from cardiac arrest is neurological. As the brain is starved for blood flow and oxygen, severe brain injury can result. Data from controlled studies in Europe and Australia suggest that controlled hypothermia may reduce mortality and neurological damage.

In the first North American report on the clinical use of hypothermia as a post-cardiac arrest therapy, researchers from Virginia Commonwealth University have confirmed the benefits of this treatment. Although the sample was limited to 15 patients, 80% survived compared to only 40% survival in the same types of patients before hypothermia was started. A higher number of patients recovered with intact neurological function using the Cerebral Performance Category assessment compared to controls. However, on the Overall Performance Category assessment, there was no significant difference.

Marcus Ong MD states, "Data from our clinical program offers further evidence that hypothermia post-resuscitation is effective in reducing mortality and preserving cerebral function. It is hoped this will encourage other centers to consider adopting hypothermia protocols in their ICU's."

The presentation is "Controlled Therapeutic Hypothermia Post-Cardiac Arrest Compared To Standard Intensive Care Unit Therapy" by Marcus EH Ong MD, Mary Ann Peberdy MD, Renata Sampson RN, and Joseph P. Ornato MD. This poster will be presented at the 2006 SAEM Annual Meeting, May 18-21, 2006, San Francisco, CA on Sunday, May 21, 2006, from 12:00 PM until 2:00 PM in the Exhibit Hall of the San Francisco Marriott. Abstracts of the papers presented are published in the May issue of the official journal of the SAEM, Academic Emergency Medicine.

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