A relatively inexpensive tune-up of communities' emergency response programs can significantly increase the number of patients who survive cardiac arrest outside hospitals.
In a controlled trial set in 19 urban and suburban Ontario communities, researchers found that changes designed to ensure that portable defibrillators were on site within 8 minutes yielded a 33% increase in relative survival among cardiac arrest victims (JAMA 1999;281:1175-81). Survival to hospital discharge rose from 3.9% to 5.2%. Study author Dr. Ian Stiell says this is the equivalent of another 21 lives saved annually in the study communities, or approximately 1 life for every 120 000 residents.
Existing defibrillation programs were optimized by cutting times from call receipt to treatment, speeding up ambulance dispatch and having firefighters - who are typically the first on the scene - apply defibrillation. Establishing the rapid defibrillation program would cost an estimated $69 000 per life saved, with annual maintenance pegged at about $3500 per life saved.
Stiell and colleagues compared outcomes for 36 months before and 12 months after the rapid defibrillation program was implemented. Before the changes, 77% of victims received treatment within the 8-minute "window of opportunity"; after the enhancements, 92% of patients received defibrillation within this window. There were 4690 cardiac arrest patients in the "before" group and 1641 in the "after" group.
"We've shown quite clearly that just having the machines is not enough," says Stiell, a self-titled emergency medicine health services researcher with the Ottawa Hospital's Loeb Health Research Institute. "You have to get them [defibrillators] to victims quickly. I see this as a challenge to all North American communities with populations under a million. I suspect most don't know what their survival rates are, or response times, or even their CPR rates."
The study, phase II of the Ontario Prehospital Advanced Life Support (OPALS) project, was funded by the Ontario Ministry of Health. The communities involved, which had populations ranging from 16 000 to 750 000, were part of an umbrella emergency medical services system that offered basic life support and defibrillation. Stiell is now studying the additional impact on survival of advanced life support measures (intubation, intravenous lines and drugs).-[copyright sign] Greg Basky, Saskatoon