Few Survive Cardiac Arrest, Even With CPR

Study: Odds of Survival After Hospital CPR Haven't Improved in More than a Decade

(AP)  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 a decade, 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 Thursday'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.

Survival odds did not substantially change over time, they found. Blacks had survival rates about one-quarter lower than whites. Men, older patients, and people admitted from nursing homes also had lower survival rates after CPR. The study was funded by grants from the federal government and several foundations.

"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.

"Our performance in treating people with cardiac arrest is not improving," said Yale University cardiologist Dr. Harlan Krumholz. "Given that we know that there are delays to treatment across the country and those delays increase risk, there likely exists a big opportunity for hospitals to do better."

Dr. Gerald Buckberg, a surgeon at the UCLA Medical Center in Los Angeles, is trying radical approaches to improve survival, including use of a heart-lung machine to buy time while doctors try to fix the underlying problem that caused the cardiac arrest, such as clogged arteries triggering a heart attack.

By doing CPR independent of other steps to fix the underlying problem, "we have only treated the symptom of sudden death - we haven't treated the reason," Buckberg said.

Doctors have become too accepting of the fact CPR saves some patients, he said. "We should not accept the failure" that the vast majority die.

[riho08]

Survival after heart arrest is dependent upon many things, but the most important, how old are you? and do you have other complicating medical conditions. Those who come to hospital from nursing homes have a laundry list of medical problems, they get into further troubles, and are shipped to the hospital ER where they can be admitted to the ICU but, they die of course. The location changes, the outcome does not. Other people who do not respond to CPR performed in hospital by a highly trained "Code Team", (doctors, nurses, respiratory therapists, ICU nurses), most likely should have been in Hospice as they were hospitalized for complications from some serious medical problem like end stage cancer, stroke, kidney failure, etc. The major issue as I see it, families are unwilling to make dear old dad or mom a "Do Not Resuscitate" (DNR) as they can't face the inevitable fact that their loved one is actually dying, let alone dying right now. The statistics for in hospital successful resuscitation would go up dramatically if families would allow their dying family member to die in hospice, or better yet, in their own bed, in their own home, surrounded by their family; like in the olden days. What a concept, die peacefully; no hospital, no ICU, no CPR, just peacefully.

[toldyouso29]

The odds of surviving cardiac arrest after getting CPR in a hospital are slim and have not improved in more than a decade, 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."

How alarming, yet interesting. Because I personally know about 40 people who survived heart attacks and are still living though they may have had 2 or even 3 so far. This story is actually misleading. It is not a heart attack per se that kills a person, it depends on what artery blockage or circumstance causes the heart attack.

People survive mild heart attacks even with no intervention. They often show up on ekgs months or even years after they occurred. Most who have them thought it was a very bad case of heartburn at the time and never knew.
If a major artery blockage causes a heart attack or there is an arhythmia (irregular heartbeat) or tachycardia (irregular and very fast heartbeat) or drugs involved--then the disruption of beating (which is what a heartattack really is) can be so severe that a person cannot recover even with CPR. This is also true if the blocked artery somehow then pushes its job over to other arteries and they become overwhelmed resulting in a cascade effect. Usually, this does not happen...what usually happens is that the major artery is blocked, a myocardial infarction ensues, and that part of the heart muscle fed by that artery just dies. Over time, if the patient survives, new arteries may branch out to take over the function or not--then what a person has is congenital heart failure. You can live with THAT for years, provided enough of your heart is left to function (like over 70%)

In short, this is an alarmist article. That seems to say if you have a heart attack you probably won't survive--or if you go to the hospital with a heart attack your chances of coming back out are about 18%. but of the 40 or more people I know with heart conditions who have suffered a heart attack; I only know 2 of them that died of it and only 1 of those died from the first heart attack. The other, died not from the heart attack but from a botched surgery that elicited a 3rd massive heart attack--he survived the operation and the 6 artery heart bypass (that they never had permission to perform--it was supposed to be 2) but he did not survive the fact that they only left him with about 8% of his heart functioning after that attack. He died 2 years later--their response after the botched surgery? (which the family only found out about years later) "Well.. you don't seem to be doing too well--about the only thing I can recommend to you is a heart transplant"

Word to the wise, people with only 8% heart function are NOT eligible for heart transplants. You have to be very, very healthy or rich to get a heart transplant with such low function. So the man died. He was 49.

[toldyouso29]

What I said above is true, however, re-reading the article shows that this is not about heart attacks but heart arrest--that means the heart basically stops or gives up--I take back what I said about the article being misleading. I do apologize to the author. As for the actual content of the article; if this is true, then this is very grim, indeed.

I remember taking CPR classes using a dummy--the amount of force necessary to do it correctly is amazing, but I cannot imagine being able to perform over 100 chest compressions in a minute, because that would be almost 2 every single second--I doubt many are meeting that criteria if they were tested on it. But they are NOT tested on that.

Remember those compressions would not only have to be very fast, but very deep or hard for about 2 minutes? With that being necessary, no wonder they don't work--very few would be doing that properly...in fact, I've seen others do it on live persons--maybe...1 compression every 2 seconds or so...so only about 25% overall of what was really required?