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Defibrillation Comes Late in 30 Percent of Hospital Cases
Date:1/3/2008

ed defibrillation was more likely in hospitals with fewer than 250 beds; in hospital units where patients were not continuously monitored; for patients admitted with diagnoses other than heart disease; during "off hours" (nights and weekends); and for black patients, the study showed.

"But we found delays across all types of hospital beds and units," Chan said. It's not clear what can be done to speed up the response across-the-board in all hospitals, he said.

Monitoring all patients' heart function might make a difference, he said, "but we can only speculate because we don't have interventional trials to see if that would make a difference."

Changes in practice at some hospitals might also lead to improvements, Chan said. For example, some hospitals do not allow nurses who detect a problem to use a defibrillator; they must call a physician or a specially trained nurse, he said.

"We might make external defibrillators available to more units," Chan said. "That is one potential solution that might have a significant impact over time. And hospitals might set up emergency teams to intervene when there is a cardiac arrest code."

The effect of such measures will have to be tested in real life, Chan said. Trials of rapid intervention teams are being planned, he said.

A different approach to the problem is proposed in an accompanying editorial in the journal by Dr. Leslie A. Saxon, chief of cardiology at the University of Southern California -- continuous monitoring of all hospitalized patients.

"We have to monitor them wherever they are," Saxon said. "They don't have to be in a specialized unit. We can go to an automated system with electrodes for rapid detection of heart arrhythmias. The detection development devices are out there."

The study is important, she said, "because it points out a need in hospitalized patients. You've got to have these things [defibrillators] in every patient's room.
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