Journal Says Cardiac Arrest Survival Rates Are Improving

Nov. 15--Stephanie Toppino hadn't been at the hospital for more than a few minutes when her heart stopped pumping. After suffering a heart attack, the Kansas City woman was in cardiac arrest.

Doctors at St. Luke's North Hospital repeatedly shocked her heart with paddles, then dosed her with drugs. It took them an hour to get her heart beating steadily again.

Toppino regained consciousness several days later.

"It was all about the timing and the people there. They were right on it," said the 42-year-old mother of three. "Being at the hospital, that's what saved me."

More and more people like Toppino are living to tell such tales of survival.

A national study published today in The New England Journal of Medicine finds that over the past decade the number of hospital patients who survive cardiac arrest -- although still less than one in four -- has been rising steadily. Meanwhile, the percentage of patients who suffer the significant neurologic disabilities that often come with survival has declined.

"I think we're getting smarter and faster," said Paul Chan, a heart specialist and researcher at St. Luke's Hospital. "Cardiac arrest is an atrocious disease where most people die. Hospitals are taking it more seriously."

Chan, along with John Spertus, also a St. Luke's cardiologist, and researchers at Yale, the University of Iowa and the University of Michigan conducted the study.

Using data that 374 hospitals fed into an American Heart Association registry from 2000 through 2009, the researchers tracked the histories of 84,625 patients who suffered cardiac arrest while in intensive care units and inpatient wards.

In the first year of the study, 13.7 percent of the patients survived cardiac arrest at least until they were discharged from the hospital, "an abysmal rate," Chan said. By the end of the study, survival had increased to 22.3 percent.

Cardiac arrest cuts off oxygen to the brain and can lead to severe brain damage or death within minutes. But among the survivors in the study, the rate of neurologic impairment requiring round-the-clock care decreased from 32.9 percent to 28.1 percent.

"The patients we were saving were doing just as well as before. We weren't just committing them to rehabilitation and life-long care," Chan said.

While the study didn't look at the reasons for the improved survival odds, Chan says much of the gain has come from having better training and treatment plans. Doctors and nurses may be arriving at patients' bedsides faster to provide immediate cardiopulmonary resuscitation. Hospitals are running more practice drills and analyzing them to see where improvements can be made.

About 200,000 patients per year in the United States go into cardiac arrest while in a hospital for heart diseases or other conditions. An additional 170,000 people experience cardiac arrest at home or in other locations; while their chances vary greatly by place, typically less than 10 percent survive.

Chan estimated that the lives of an additional 17,200 cardiac arrest patients were saved in 2009 compared with 2000 because hospital care has improved. More than 13,000 cases of severe neurologic disability were avoided.

Monica Kleinman, chairwoman of the American Heart Association's emergency cardiovascular care committee, called the study's findings encouraging. But more needs to be done, she said.

"It's still not even one quarter of patients (surviving). There's lots of room for improvement. I'm confident we'll see more."

Some credit goes to recent treatment guidelines for cardiac arrest that place more emphasis on high-quality CPR, Kleinman said. "Twenty years ago, one would look at CPR as an exercise in futility. It was rarely successful."

But research has shown that CPR done well, "compressing (the chest) fast enough and deep enough and avoiding interruptions," is critical to restoring blood circulation, Kleinman said.

A technique that has proved valuable for patients who survive cardiac arrest but don't immediately regain consciousness is therapeutic hypothermia, Kleinman said. Chilling the body with an ice-water blanket for 12 to 24 hours appears to protect the brain from injury, she said.

Stephanie Toppino received therapeutic hypothermia while she was hospitalized in April. She's been told to expect a full recovery.

"It's just a miracle that everything works," she said. "I'm appreciating every day."

To reach Alan Bavley, call 816-234-4858 or send email to abavley@kcstar.com.

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