Cardiac Save Guidelines??

[whit72]

Medic26 wrote:

My boss is very black and white, if he changes something he wants to be able to back it up with research, documentation, etc.

If he is, he is in the wrong field. EMS and medicine as a whole are more gray then they will ever be black and white.

As far as awards for saving peoples lives. I don't understand it. That is an aspect of your job. Now if he rescued a bus load of drowning children, alright give him an award, because thats not in his job description. Awards are for going above and beyond the the aspects of your profession. Not for performing whats expected of you.

[Dustdevil]

I understand the whole, we would have all done the same thing bit, I am just trying to help improve a poor process we have here.

And plus 5 for that.

[whit72]

I looked around a little I couldnt find any statistical data on save rates.

[mediccjh]

It's only a save if they walk out of the neurologically intact.

It's like deja-vu all over again.

[AnthonyM83]

You cant find any info, because the minuscule percentage of survival to discharge without sever disability is about 0%. Give or take 0%

Where are you getting these stats from?

[Lilacmedic]

So many factors decide what will be a good discharge from hospital.. It seems unfair to hand out awards to those who have had luck on their side-as those who didn't have their patient discharged from hospital or even had to declare on scene did just as much effort in trying to pull the patient through.

One can but hope that the Amiodarone will touch sides, dfib was early enough and that the water was cold enough...

According to the stats I was able to find(Blackwell) the rate of a success of a resus is <5%-this is when early dfib and CPR are done within the first few minutes.

Add to that the minefield of added controversies that insue...cardiac/thoracic pump theories, the whole BVM dilemma and all the other little issues that seem to add to the ods.

It would be so much easier to risus a patient with hindsight but we don't have that luxury-all we can do is give it our all and hope that we made a difference...the award should go to being dedicated and fighting for our patients when the odds are stacked against us.

[Dustdevil]

So many factors decide what will be a good discharge from hospital.. It seems unfair to hand out awards to those who have had luck on their side-as those who didn't have their patient discharged from hospital or even had to declare on scene did just as much effort in trying to pull the patient through.

<snip>

It would be so much easier to risus a patient with hindsight but we don't have that luxury-all we can do is give it our all and hope that we made a difference...the award should go to being dedicated and fighting for our patients when the odds are stacked against us.

Well said. :thumbright:

[crazycanuck]

whit72 Posted: Sun Jul 08, 2007 10:57 pm Post subject:

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I looked around a little I couldnt find any statistical data on save rates.

This is going to vary dependent on the study parameters and so many factors. You will find a pretty wide range of numbers depending on the operational definitions used....

AnthonyM83 Posted: Mon Jul 09, 2007 3:32 am Post subject:

whit72 wrote:

You cant find any info, because the minuscule percentage of survival to discharge without sever disability is about 0%. Give or take 0%

Where are you getting these stats from?

Did you not know that 98.376% of statistics are made up.

This percetage survival to discharge of 0% is false. Though the OHCA survival rate is poor, it is more constructive to do as Medic26 is here, to educate oneself on the definitions, process, and outcomes in attempt to improve it.

This attitude sucks. Plain and simple. If you expect 0% guess what you will get???....0%

Here's a few references for OHCA survival figures.

1) High Discharge Survival Rate After Out-of-Hospital Ventricular Fibrillation With Rapid Defibrillation by Police and Paramedics.

Annals of Emergency Medicine, Volume 28, Issue 5, Pages 480-485

R. White, B. Asplin, T. Bugliosi, D. Hankins

http://linkinghub.elsevier.com/retrieve/pi...196064496701099

2) Predicting survival from out-of-hospital cardiac arrest: A graphic model.

Annals of Emergency Medicine, Volume 22, Issue 11, Pages 1652-1658

M. Larsen, M. Eisenberg, R. Cummins, A. Hallstrom

http://linkinghub.elsevier.com/retrieve/pi...0644(05)81302-2

3) Cardiac arrest and resuscitation: A tale of 29 cities.

Annals of Emergency Medicine, Volume 19, Issue 2, Pages 179-186

M. Eisenberg, B. Horwood, R. Cummins, R. Reynolds-Haertle, T. Hearne

http://linkinghub.elsevier.com/retrieve/pi...0644(05)81805-0

4) Outcome of out-of-hospital cardiac arrest in New York City. The Pre-Hospital Arrest Survival Evaluation (PHASE) Study

http://jama.ama-assn.org/cgi/content/abstract/271/9/678

5) Improved Out-of-Hospital Cardiac Arrest Survival Through the Inexpensive Optimization of an Existing Defibrillation Program

OPALS Study Phase II

http://jama.highwire.org/cgi/content/abstract/281/13/1175

6) Incidence of cardiac arrest: A neglected factor in evaluating survival rates.

Annals of Emergency Medicine, Volume 22, Issue 1, Pages 86-91

L. Becker, D. Smith, K. Rhodes

http://linkinghub.elsevier.com/retrieve/pi...0644(05)80257-4

[Medic26]

Thanks for the additional info!!

[whit72]

Crazycanuck wrote:

This percetage survival to discharge of 0% is false. Though the OHCA survival rate is poor, it is more constructive to do as Medic26 is here, to educate oneself on the definitions, process, and outcomes in attempt to improve it.

This attitude sucks. Plain and simple. If you expect 0% guess what you will get???....0%

I am thoroughly educated in the outcome of cardiac arrest patients. If your response times are not under 4 minutes and there isn't a bystander attempting CPR, then your survival rates will be around 0%.

Put all the fancy dressing on it you want. People die, and if not for the actions of ordinary bystanders, with the ability to defibrilate or administer CPR, they stay dead.

In the few instances where you witness the arrest or arrive on scene in 1 to 2 minutes, then yes. you have a good chance at a decent outcome, however those instances are rare and based on luck.

We should spend out time educating the public on the importance of CPR and AED training. Educate them to understand they can be a significant help in increasing the survival rate in cardiac arrest patients.

As far as my attitude sucking, its not an attitude its reality. Yes my expectations have everything to do with the outcome of arrest patients, give me a break. Maybe I should say a little prayer for them too, or work the arrest with my fingers crossed. That might help.

We know what saves arrest pts. I explained it above. So if we are not going to put an ambulance on every corner, or educate the public. You will never see your arrest survival percentages rise.