Thursday, June 7, 2007

Cardiac Arrest and Peoria

In March 2007, Mickey Eisenberg, MD, PhD wrote an article “Improving Survival from Out-of-Hospital Cardiac Arrest: Back to the Basics”. It was published in Annals of Emergency Medicine.

The article states:

“A 2005 study by Rea et al summarized the cardiac arrest experience of 35 communities, representing 9% of the US population. Overall, the discharge survival rate for all cardiac arrests was 8.4%, and for ventricular fibrillation, 17.7%. Using these figures and projecting to the entire US population, the study estimated that 13,000 Americans are discharged every year after cardiac arrest. The 35 communities reported a range of discharge survival rates from ventricular fibrillation of 3.3% to 40.5%, a 12-fold difference.”

I wonder what Peoria’s “numbers” are? How does Peoria do compared to these 35 studied communities?

Several years ago, as documented on, I was unable to access any statistics from the Peoria Area EMS office at OSF or from our local IDPH office. The Matrix study that looked at fire and prehospital care in Peoria (and charged the City of Peoria $79,000 for their consulting efforts) did not publish any statistics regarding how Peoria’s prehospital patients did after suffering cardiac arrest or ventricular fibrillation.

Interestingly, Dr. Eisenberg was a co-author of a paper published in Prehospital Emergency Care, October 2004. The title is “Time to Intubation and Survival in Prehospital Cardiac Arrest”.

Quoting from the article’s introduction:

“In this study, we measured the interval from collapse until intubation in cardiac arrest over a 12-year period and compared this variable with survival.

…a correlation between intubation and survival would be an additional argument that advanced life support systems employing paramedics can significantly reduce mortality over non-intubation systems, which are common. Our purpose was to examine whether shorter time from collapse until intubation is associated with greater survival in prehospital cardiac arrest.”

In Peoria, the Peoria Fire Department paramedics are not allowed to intubate a patient unless asked to do so by Advanced Medical Transport.

The results of Eisenberg’s study revealed that in the quick intubation group (intubation time <12 minutes), 46% of the patients survived; in the slow intubation group (intubation time >13 minutes), 23% of the patients survived.

The mean interval time from collapse to intubation in the “quick” intubation group was 10.0 +/- 1.7 minutes.

What would be the outcome if the intubation time could be decreased even more? Would there be more survivors? Eisenberg’s study and common sense would say yes.

But how will we know in Peoria where we don’t have access to statistics and the PFD’s hands are tied as they are unable to perform quick and possibly life saving intubation of Peoria’s prehospital cardiac arrest victims?

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