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August 10, 2016

Why a casino could be safer than a hospital if you're in cardiac arrest

Daily Briefing

Cardiac arrest can be hard to spot—and hospital clinicians often don't start chest compressions as quickly as they should, Robin Tricoles reports for The Atlantic.

The effects of cardiac arrest are sudden and pronounced. A patient loses consciousness in seconds, and they may gasp reflexively. But those breaths can be deceptive, Tricoles writes, lulling onlookers into thinking a patient is undergoing a different medical problem, such as a seizure.

It's important to start chest compressions as soon as possible, Tricoles writes, and recognizing the signs of cardiac arrest is half the battle. Clifton Callaway, a professor of Emergency Medicine at the University of Pittsburgh, told The Atlantic, "If anyone is unconscious and not breathing normally, think about cardiac arrest, and get on the chest and start chest compressions."

Yet even though cardiac arrest is quite prevalent—according to the American Heart Association, there were more than 200,000 in-hospital cardiac arrest cases in 2013—doctors aren't always prepared to leap into action, Tricoles says.

A cautious culture

For instance, primary care physicians may not have much experience with cardiac arrest and may miss the signs.

Jason Persoff, an assistant professor of Internal Medicine at the University of Colorado Hospital, said that clinical studies show providers "do an awful job of knowing" when a patient is in cardiac arrest. According to Persoff, you are more likely to survive cardiac arrest in a casino or on an airplane than in a hospital. Flight attendants and other staff in those settings are trained to see the signs of cardiac arrest and quickly leap into action.

Advanced emergency care for cardiac arrest may cost lives

Doctors, on the other hand, are trained to be cautious and prudent. "The biggest delay that occurs in doing resuscitative efforts is that people are afraid to do chest compressions unless the patient is clearly in cardiac arrest," Persoff said. "But it's one of the few times in medicine that it's far more important to begin treatment and ask questions later."

Focusing on prevention

The best way to combat cardiac arrest may be to prevent it from happening in the first place, said Dana Edelson, the Executive Medical Director for Inpatient Quality and Safety at the University of Chicago Medicine. "In hospitals, we tend to have signs of clinical deterioration hours, if not days, before it happens," she said. "Our focus has to be on identifying the early signs of clinical deterioration and intervening on those rather than waiting for the arrest to happen."

Signs of 'sudden' death may appear weeks before the heart stops

Edelson and her colleagues have developed a system called the electronic Cardiac Arrest Risk Tool, or eCART, which tracks a patient's vital signs and predicts how likely they are to experience cardiac arrest in the next 24 hours.

"We are running that algorithm in real time," Edelson explained, "and we send automatic pages to our rapid response team who will go and see the patient and treat the underlying cause or move the patient to the ICU if they need a higher level of care than they are getting."

Persoff stressed there are lower-tech solutions that can also improve outcomes. "I believe most physicians and nurses need only a small amount of training to correctly be able to resuscitate a patient," he said (Tricoles, The Atlantic, 8/8).

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