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London Ambulance Service - Parliament receives lifesaving equipment

London Ambulance Service - Parliament receives lifesaving equipment | First Aid Training | Scoop.it

Visitors and employees at the Houses of Parliament can now be assured of receiving the very best in service from the first aid team, following the installation of 16 new defibrillators.

Part funded by the British Heart Foundation, defibrillators are machines that can deliver a shock to restart a patient’s heart should they suffer a cardiac arrest – when the heart stops pumping blood around the body.

The newly qualified six-strong HeartStart training team and the current first aid team at the Houses of Parliament will now be on hand to deliver this lifesaving care 24 hours a day.

London Ambulance Service is responsible for over 800 public-access defibrillators around the capital, placed in tourist attractions, transport hubs, shopping centres and sports facilities.

Last year the scheme helped to save 11 patients who had suffered a cardiac arrest to be discharged from hospital. Overall in London, almost a third of patients suffering cardiac arrest survived in 2011/12 – the highest in the country.

 

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British Heart Foundation - Footballer lends support

British Heart Foundation - Footballer lends support | First Aid Training | Scoop.it
Fabrice Muamba has helped to deliver our 100,000-strong ELS petition to Downing Street...
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Cardiac arrest more common in young than thought

Cardiac arrest more common in young than thought | First Aid Training | Scoop.it

Cardiac arrest is relatively rare in young people, but it may be more common than experts have thought, according to a new study.

Using 30 years of data from King County in Washington, researchers found that the rate of cardiac arrest among children and young adults was about 2.3 per 100,000 each year.

That's not a big risk. But the figure is substantially higher than the "widely accepted" estimate for young athletes (not just young people in general), said senior researcher Dr. Jonathan Drezner.

According to that estimate, one in 200,000 young athletes (up to age 35) suffers cardiac arrest each year.

Cardiac arrest occurs when the heart suddenly stops pumping blood to the rest of the body. It is fatal within minutes without immediate treatment.

A major cause of cardiac arrest is ventricular fibrillation, where the heart's main pumping chamber starts to quiver chaotically. A device called a defibrillator can "shock" the heart back into a normal rhythm - though even with treatment, cardiac arrest is often deadly.

The good news from the current study is that young people's survival of cardiac arrest got much better over the 30-year period. It rose from 13 percent in the 1980s, to 40 percent between 2000 and 2009.

"It's very gratifying to see that our efforts are paying off," said Dr. Dianne L. Atkins, a pediatric cardiologist at the University of Iowa in Iowa City.

Research over the years has allowed experts to figure out the best way to perform cardiopulmonary resuscitation (CPR), and public campaigns have been done to encourage more people to learn CPR.

CPR cannot "restart" the heart, but it can keep blood and oxygen moving through the victim's body until medical help arrives.

"Learn CPR and be willing to do it," said Atkins, who wrote an editorial published with the study in the journal Circulation.

The true rate of cardiac arrest among kids and young adults has long been debated.

Drezner said he thinks his team's findings come closer to the "real" figure than most past studies, because of its methodology.

The findings come from a cardiac arrest database kept by King County in Washington State. Emergency medical services report all cases of cardiac arrest to the registry.

Drezner's team also used other records, like autopsy reports and hospital records, to try to figure out the cause of each cardiac arrest.

Between 1980 and 2009, there were 361 cases of cardiac arrest logged for children and adults age 35 and younger - including 26 toddlers under 3, most of whom had congenital abnormalities.

That amounted to a rate of 2.28 cases for every 100,000 young people each year.

Atkins agreed that this study gives a clearer picture of the true incidence of cardiac arrest in young people. "It's the best data we have."

And, she said, researchers should know how common the problem is before widespread screening programs, if any, can be put in place.

The idea of screening kids for heart problems that could cause cardiac arrest is controversial. Some countries, including Italy and Israel, have mandatory electrocardiogram (EKG) screening for young athletes. The U.S. is not one of them.

For now, Atkins suggested that parents be aware that cardiac arrest can strike children -- but also keep the risk in context.

"It is still a very uncommon event," she said. "I don't think the message is that parents should be so frightened that they don't let their kids go out for competitive sports."

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Cardiac arrest survival after about 18 minutes of CPR

On the morning of July 10, attorney Jerald Gale was reading an e-mail in his office on the 20th floor of a Koreatown high-rise. That's the last thing the 58-year-old husband, father and avid cyclist remembers before losing consciousness.
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Prolonged CPR Efforts May Be Beneficial, Study Says

Prolonged CPR Efforts May Be Beneficial, Study Says | First Aid Training | Scoop.it

When a hospital patient goes into cardiac arrest, one of the most difficult questions facing the medical team is how long to continue cardiopulmonary resuscitation. Now a new study involving hundreds of hospitals suggests that many doctors may be giving up too soon.

The study found that patients have a better chance of surviving in hospitals that persist with CPR for just nine minutes longer, on average, than hospitals where efforts are halted earlier.

There are no clear, evidence-based guidelines for how long to continue CPR efforts.

The findings challenge conventional medical thinking, which holds that prolonged resuscitation for hospitalized patients is usually futile because when patients do survive, they often suffer permanent neurological damage. To the contrary, the researchers found that patients who survived prolonged CPR and left the hospital fared as well as those who were quickly resuscitated.

The study, published online Tuesday in The Lancet, is one of the largest of its kind and one of the first to link the duration of CPR efforts with survival rates. It should prompt hospitals to review their practices and consider changes if their resuscitation efforts fall short, several experts said.

Between one and five of every 1,000 hospitalized patients suffer a cardiac arrest. Generally they are older and sicker than nonhospitalized patients who suffer cardiac arrest, and their outcomes are generally poor, with fewer than 20 percent surviving to be discharged from the hospital.

“One of the challenges we face during an in-hospital cardiac arrest is determining how long to continue resuscitation if a patient remains unresponsive,” said Dr. Zachary D. Goldberger, the lead author of the new study, which was financed by the American Hospital Association, the Robert Wood Johnson Foundation and the National Institutes of Health. “This is one area in which there are no guidelines.”

Dr. Goldberger and his colleagues gathered data from the world’s largest registry of in-hospital cardiac arrest, maintained by the American Heart Association, identifying 64,339 patients who went into cardiac arrest at 435 hospitals in the United States from 2000 to 2008.

The researchers examined adult hospital patients in regular beds or intensive care units, excluding patients in the emergency room and those who suffered arrest during procedures. They calculated the median duration of resuscitation efforts for the nonsurvivors rather than the survivors, in order to measure a hospital’s tendency to engage in more prolonged resuscitation efforts.

One of the first surprises was the significant variation in duration of CPR among the hospitals, ranging from a median of 16 minutes in hospitals spending the least amount of time trying to revive patients to a median of 25 minutes among those spending the most — a difference of more than 50 percent.

The researchers initially thought they would find that some patients were being subjected to protracted resuscitation efforts in vain, said the senior author, Dr. Brahmajee Nallamothu, an associate professor at the University of Michigan and a cardiologist at the Ann Arbor VA Medical Center.

But as it turned out, those extra minutes made a positive difference. Patients in hospitals with the longest CPR efforts were 12 percent more likely to survive and go home from the hospital than those with the shortest times.

Dr. Nallamothu and his colleagues found that neurological function was similar, regardless of the duration of CPR.

The patients who got the most added benefit from prolonged CPR were those whose conditions do not respond to defibrillation, or being shocked. The extra time spent on prolonged CPR may give doctors time to analyze the situation and try different interventions, they said.

“You can keep circulating blood and oxygen using CPR for sometimes well over 30 minutes and still end up with patients who survive and, importantly, have good neurological survival,” said Dr. Jerry P. Nolan, a consultant in anesthesia and critical care medicine at Royal United Hospital NHS Trust in Bath, England, who wrote a commentary accompanying the article.

Dr. Stephen J. Green, associate chairman of cardiology at North Shore-Long Island Jewish Health System, who was not involved in the study, said hospitals might have to modify their practices in light of the new research.

“You don’t want to be on the low end of this curve,” Dr. Green said. “Hospitals that are outliers should reassess what they’re doing and think about extending the duration of their CPR.”

Still, he and other experts worried that the new findings could lead to protracted efforts to resuscitate patients for whom it is inappropriate because they are at the end of their lives or for other reasons.

“There isn’t going to be a magic number,” Dr. Green said. “If you’re in there 10 to 15 minutes, you need to push higher, but as you get up higher and higher, you get to the point of very little return.”

The study authors acknowledge that their research does not indicate that longer CPR is better for every patient.

“The last thing we want is for the take-home message to be that everyone should have a long resuscitation,” Dr. Goldberger said. “We’re not able to identify an optimal duration for all patients in the hospital.”

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