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CPR in hospitals not improving
About 18 percent survive, leave hospital, study says
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Published: July 2, 2009
You don't have to be Michael Jackson to have this problem: The odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than 10 years, a big Medicare study concludes.
Only about 18 percent of such patients live long enough to leave the hospital, researchers found. Blacks fared worse than whites -- a disparity only partly explained by more of them being treated in hospitals that did a poorer job of CPR.
Results were published in today's New England Journal of Medicine.
Dr. Lance Becker, a University of Pennsylvania emergency-medicine specialist and an American Heart Association spokesman, called the findings "grim" and "a wake-up call that we need to redouble our efforts" to find better ways to treat cardiac arrest.
It occurs when the heart quivers or stops beating entirely, because of a heart attack, a sudden heart rhythm problem, a drug overdose or other cause.
CPR, rhythmic chest compressions, can help maintain blood pressure and flow until more advanced treatments can be tried. Those might involve using a defibrillator to shock the heart back into a normal rhythm. Big strides have been made getting bystanders to do cardiopulmonary resuscitation and to use defibrillators, but the new study suggests that less improvement is occurring in the nation's hospitals.
Researchers led by Dr. William Ehlenbach at the University of Washington
in Seattle analyzed the care of 433,985 Medicare patients treated from 1992 through 2005 around the United States.
"It's troubling. We have made a lot of progress in out-of-hospital cardiac arrest," including a near tripling of survival rates in the Seattle area after community and rescue-worker training efforts, said Dr. Paul S. Chan. He is a quality-of-care researcher at St. Luke's Mid America Heart Institute in Kansas City, Mo.
His own research, published in the New England journal last year, found that one-third of hospitalized patients do not get a potentially live-saving defibrillator shock within the recommended two minutes of suffering cardiac arrest.
Even when CPR is given by these highly trained hospital staffers, chest compressions often are too slow or too shallow to be effective, Chan said.
Guidelines recommend 100 chest compressions per minute, Chan said.
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