Where to have a heart attack

From: hal@finney.org
Date: Fri Nov 17 2000 - 09:50:45 MST

>From this weeks Nature:

   Medicine: Cardiac arrest can be less of a gamble


   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


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