Pittsburgh Medics Set Local Record Revival Rate For Cardiac Arrest
July 03--Pittsburgh paramedics have set a city record for the resuscitation of patients in cardiac arrest, and now officials are weighing strategies for further boosting the survival rate.
Mayor Luke Ravenstahl said one possibility is encouraging bystanders to start CPR before rescue workers arrive at a call, something believed to have helped Seattle post high resuscitation rates.
For the 12-month period that ended Sept. 30, city paramedics responded to more than 300 calls for patients whose hearts had stopped beating. In 16.4 percent of those cases, the patients were resuscitated and ultimately discharged from the hospital, said Clifton Callaway, professor and executive vice chairman of University of Pittsburgh's Department of Emergency Medicine.
The 16.4 percent resuscitation rate is not a national record; Seattle paramedics, for example, have posted such numbers. But the figure is a record for Pittsburgh.
"It is a high-water mark," Dr. Callaway said.
He said Pittsburgh's rates once were as low as 5 percent to 7 percent. Mark Pinchalk, a city paramedic involved in resuscitation research, said the number once was as low as 3 percent.
The data are "important because we're showing we can improve patient outcomes," Tony Weinmann, president of the Fraternal Association of Professional Paramedics, said. He said city firefighters contribute to the rate by arriving before paramedics on some calls and administering initial care.
Seattle Fire Department Capt. Jonathan Larsen, who oversees paramedic operations, said the 16.4 percent resuscitation rate "really is terrific."
The figures are tracked by the Resuscitation Outcomes Consortium, a network of paramedic services, hospitals and research centers in the United States and Canada. Pitt's Department of Emergency Medicine is a member of the network, and Dr. Callaway is principal investigator here and a co-author of journal articles on consortium research. Funders include American Heart Association and the National Heart, Lung and Blood Institute.
Mr. Ravenstahl last week congratulated paramedics and hospitals for the improved performance but said the city should strive to do even better.
Merely sustaining the 16.4 percent rate may be a challenge.
Dr. Callaway said he could not provide resuscitation data for the period after Sept. 30 for fear of influencing a new clinical trial. Mr. Pinchalk, the crew chief for Medic 14, Downtown, estimated that the city paramedics had a 13 percent to 14 percent resuscitation for calendar year 2011.
For a patient in cardiac arrest to be resuscitated and survive to hospital discharge, "a hundred little things" have to go right, beginning at the time the 911 center receives the call for help, Dr. Callaway said. The consortium studies ways to improve the resuscitation process -- such as whether to interrupt CPR to insert an airway and how to protect the brain once the heart has resumed beating.
Consortium cities generally don't share resuscitation rates, forcing each to use its own data as benchmarks for improvement, Dr. Callaway said.
In 2009, however, Dr. Callaway and other researchers published an article in Journal of the American Medical Association showing that survival rates among consortium members ranged from 3 percent in Alabama to 16.3 percent in Seattle, with the average being 8.4 percent. In that study, Pittsburgh's survival rate was 7 percent. The article was for emergency calls answered from 2005 to 2007.
Mr. Weinmann said he would support a campaign to encourage Pittsburgh residents to learn CPR and use it when they see someone stricken. Seattle has trained tens of thousands of residents in CPR.
"We did it in stadiums," Capt. Larsen said.
Joe Smydo: jsmydo@post-gazette.com or 412-263-1548.
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