2 Comments:

 Mic said...

Mike,

I agree that the incidence of sudden cardiac arrest may be falling for all the reasons you mention. There are a few items I think we should all keep in mind to keep your comments in proper context.

First, people will still have cardiac arrests - even with great primary and cardiovascular care. Medicine is helping people live longer - but at some point, fate catches up. So, the incidence of sudden cardiac arrest falls but not the overall incidence of arrests.

But even we go on fewer cardiac arrest calls because more of them are not the of unexpected variety, the survival rates for the ones we do attempt resuscitaiton on should not be going down. There have also been dramatic improvements in our understanding of resuscitation physiology, particularly in how to improve blood flow with better BLS. By reducing the amount to interruptions of chest compressions; by using compression metronomes and other devices to optimize rate; and the using technology built into some monitors to optimize the depth of compressions - BLS is getting much better.

So, we should keep tracking survival rates and with good BLS protocols, training, and QI, survival rates should be improving.

--- Mic

Mic Gunderson
Consultant, IPS
[email protected]
www.onlineips.com/publicsafety

Wed Mar 18, 11:52:00 AM EDT  

 mwd101 said...

Mike,

Interesting and stimulating commentary as always, but I think a bit off the mark. While there seems to be a decrease in the number of survivable primary ventricular fibrillation cardiac arrests among young or otherwise healthy people, no one knows all of the reasons for this decrease. Medicine has made great inroads at the prevention of coronary artery disease; we are a long way from the world you describe. Nowhere is this of greater concern than the fire service. Cardiac arrests frequently occur in patients who have no known cardiac disease, in fact, as many as half of the firefighters that suffer cardiac arrest have no known cardiac history.

We must still work to improve our skills and our systems to treat those patients who suffer cardiac arrest, even while our colleagues in primary care and cardiology work to prevent cardiac arrest. We must not ignore that the differences in our EMS systems and some have rates of return of spontaneous circulation approaching 50%, and others below 10%. If a system moves from having a dismal rate to having a drastically better rate we must trumpet their success.

The chain of survival is real. Across the USA the links are not as strong as they could be. The first link must be prevention, championed by the healthcare community, as you assert. The next link must be community recognition, so no heart attack is missed, and then 911 activation, BLS, and ALS. There must be another link as well, retrospective review. Each case should be a data point that is entered in a National registry, such as the CARES at Emory, and studied the same way in every community. As Mic says, the rates should not be going down--and they won't, if we compare "apples to apples."

Are we ready to declare the war won and cardiac arrest no longer an issue for EMS? No. In fact, as you and I look at systems maturing across New York, not yet. Maybe someday.

Michael

Michael Dailey, MD
Regional EMS Medical Director
REMO
[email protected]

Sun Mar 22, 11:06:00 PM EDT  

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