A new study published today in the NEJM (Ventricular Tachyarrhythmias after Cardiac Arrest in Public versus at Home) confirms what we have known for years, that lives would be saved if more AEDs were available in more public places. The real interesting aspect of the study, however, was its finding that patients who suffer cardiac arrest at home are much less likely to have a shockable rhythm than patients who arrest in a public place. Quoting from the study:

"For cardiac arrests at home, the incidence of ventricular fibrillation or pulseless ventricular tachycardia was 25% when the arrest was witnessed by emergency-medical-services (EMS) personnel, 35% when it was witnessed by a bystander, and 36% when a bystander applied an AED. For cardiac arrests in public, the corresponding rates were 38%, 60%, and 79%."

The lack of a shockable rhythm translates, as expected, to a lower survival rate: 6% for in-home cardiac arrest versus 17% for cardiac arrest in public. Overall survival was 7%. The study's authors suggest that the reason why patients at home are much less likely to have a shockable rhythm is that they are generally older and suffer from more chronic diseases than patients encountered in a public setting.

Although nothing in this study suggests we need to consider changes in cardiac arrest management, it may help EMS providers establish reasonable expectations for the success of their efforts.

On Oct. 18, 2010, the American Heart Association (AHA) will publish new guidelines for CPR and emergency cardiovascular care (2010 Guidelines). In talking with other professionals around the state--EMS service chiefs, EMS coordinators, instructors and providers--I realized there is considerable confusion about how and when the new 2010 Guidelines will be implemented in New Hampshire EMS agencies and emergency departments.

Who is affected?
 

All healthcare providers delivering emergency medical care--nurses, EMTs, paramedics and physicians--will be affected by these changes.

What areas of care are affected?

• CPR, AED, BLS, ACLS and all other aspects of cardiac arrest management
• ACS Acute Coronary Syndromes, including:
  • AMI Acute Myocardial Infarction
• Bradycardia, Tachycardia and other Dysrhythmias
• Pediatric-specific Treatments, including PALS and neonatal resuscitation
• Stroke
• Anaphylaxis, Hypothermia and others

How will I learn about the changes?

Eager to know about the new Guidelines?  The AHA will publish a Guidelines Summary that will be made available on the Internet. See the links below (here is the 2005 Guidelines Summary).

Refresher Classes  Most healthcare providers will learn about the changes when they take their next CPR, ACLS or PALS class.

AHA Instructors  You will be participating in online updates in Nov / Dec that will explain how to integrate the new Guidelines into upcoming classes. New AHA textbooks will be published in 2011. It’s important to register with the online AHA Instructor Network to be able to access the updates.

How and when will these new changes go into effect?

EMS and Fire Organizations  In New Hampshire, EMTs and first responders will start using the new Guidelines when the Bureau of EMS issues the new EMS Protocols in Spring 2011 (note: the EMS Medical Control Board may issue interim guidance on using the new Guidelines). You will want to make arrangements to have your EMTs and Paramedics receive updated training in the new Guidelines by qualified AHA instructors.

Emergency Departments   Each hospital will decide how to roll out the new Guidelines internally. To avoid inconsistent care, some organizations may accelerate AHA refresher classes for all of their emergency department (or hospital) staff.

Where can I obtain more information?

• Guidelines Information
• Guidelines Home

Subject: Infant Sleep Positioners Pose Suffocation Risk

In a joint statement today, the Food & Drug Administration, the Consumer Product Safety Council (CPSC) and the American Academy of Pediatrics warned parents to avoid the use of infant sleep positioners.