Delayed Defibrillation Common in Hospitals: Study

A study of 6,789 hospitalized patients whose cardiac arrest was caused by ventricular fibrillation or pulseless ventricular tachycardia found that delayed defibrillation, which occurred in 30.1 percent of the cases, significantly lowered those patients' likelihood of surviving to hospital discharge. The results was published online today by the New England Journal of Medicine.

The study's authors, headed by Dr. Paul S. Chan of the Saint Luke's Mid-America Heart Institute in Kansas City, Mo., examined cases from 369 hospitals participating in the American Heart Association's National Registry of Cardiopulmonary Resuscitation. They examined the association between delayed defibrillation (more than 2 minutes) and survival to discharge after adjusting for differences in patient and hospital characteristics.

The overall median time to defibrillation was one minute. Characteristics associated with delayed defibrillation included black race, non-cardiac admitting diagnosis, and that the cardiac arrest occurred at a hospital with fewer than 250 beds, in an unmonitored hospital unit, and after hours (5 p.m. to 8 a.m. or weekends). The probability of surviving to hospital discharge was 22.2 percent for delayed patients versus 39.3 percent for those whose defibrillation was not delayed. Each minute of delay reduced survival rates, and delayed defibrillation is common, they concluded.

Separately, a randomized controlled trial reported in AHA's Hypertension journal in December showed that patients who self-measured their blood pressure at home used less anti-hypertension medication and thus cost less to treat than those given office pressure (OP) measurement without causing significant differences in systolic or diastolic OP values or target organ damage. The lead investigator was Willem J. Verberk of the Department of Internal Medicine, University Hospital Maastricht, in the Netherlands (willem.verberk@intmed.unimaas.nl).

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