>From this weeks Nature:
Medicine: Cardiac arrest can be less of a gamble
TIM LINCOLN
There is no good place to suffer cardiac arrest. But if you do, a
hospital is obviously one location where quick treatment is likely
to increase the chances of recovery. As described in two papers in
The New England Journal of Medicine, certain casinos in Nevada and
Mississippi, and some airlines, also make recovery a better bet.
The type of cardiac arrest concerned is that caused by ventricular
fibrillation, in which contraction of heart-muscle fibres becomes
uncoordinated. The key to treatment is the use of defibrillating
equipment, and swiftly: with each minute that passes, the possibility
of recovery falls rapidly.
T. D. Valenzuela et al. (N. Engl. J. Med. 343, 1206-1209; 2000) report
the results of a programme in which defibrillators were installed
in casinos and security staff were trained to use them. The overall
success rate, judged by a patient's eventual discharge from hospital,
was 53%. The national average is just 5%.
The other study (R. L. Page et al. 343, 1210-1216; 2000) involved
American Airlines. Like some other aircraft operators, American
Airlines has introduced defibrillators on its planes and trained
flight attendants to use them. Here the rate of survival was 40%,
which compares well even with the rates achieved by quick-response
emergency services in other circumstances. The authors calculate that
if all commercial aircraft carried the equipment, 93 people would
survive who would otherwise have died each year.
The authors also point to a study showing that age need not be
a barrier to the effective use of defibrillators. Twelve-year-old
children took only 27 seconds longer to carry out defibrillation than
medical personnel, albeit in simulations.
But perhaps a safer approach is to avoid flying or gambling
altogether. Cardiac arrest is more common in these situations than
in most other public places - although, in the case of casinos,
it is not clear whether the
Hal
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