Early Care Crucial After Heart Attack: Study
Sydney Morning Herald
Thursday February 15, 2007
SURVIVAL rates for people who have a heart attack away from hospitals are very low, but two studies show that early treatment and having an intensive care paramedic on the scene can be life-saving.
One study, led by Dr Winston Cheung of Concord Repatriation Hospital, found that only 24 per cent of patients survived past the day of their heart attack, 12.6 per cent after four weeks, 12.2 per cent after three months and more than 11.5 per cent were still alive after a year. The study, published in the journal Critical Care and Resuscitation, analysed Ambulance Service of NSW records for all patients who went into cardiacarrest away from hospitals in the 12 months from June 2004. It matched the names of patients with NSW Registry of Births, Deaths and Marriages records to determine if, and for how long, they survived. A quick response by witnesses and medical professionals was vital for survival, said Cheung, an intensive care doctor. "There are three things which increase a person's chance ofsurvival: good quality basic life support, or CPR; early notification of the ambulance and then early defibrillation."Another study found that the presence of a highly skilled intensive care paramedic was crucial. The study was conducted by the Queensland-based Australian Centre for Prehospital Research. It examined cases of cardiacarrest attended by the Queensland Ambulance Service from 2000 to 2002 and found that patients had a 43 per cent greater chance of surviving if an intensive care paramedic was on the scene, as opposed to a paramedic trained only in basic life support.In cases where patients were treated by a paramedic, 8.5 per cent had a pulse on arrival at hospital, compared with 21 per cent of those treated by intensive care paramedics, who receive an extra year of training. The survival rate of these patients, regardless of who treated them, was still low. The study, published in the Emergency Medicine Journal, did not draw conclusions about what produced the increased survival of those attended by intensive care paramedics and recommended further research. Dr Jason Bendall, an intensive care paramedic educator at the Ambulance Service of NSW, said the state had a two-tiered paramedic system similar to Queensland's and that survival rates for patients in NSW treated by intensive care paramedics would likely correspond to the Queensland rate. "The difficulty is, which of the elements of the intensive care paramedic makes the difference? That's the hard part to know." Previous research has been unable to link an increase in patient survival to advanced life support techniques. The Queensland study suggested the advanced procedures used by intensive care paramedics did not affect the improvement in survival. However greater levels of education and training might enable the delivery of more effective emergency treatment. "It's not economical to train everyone up to that level but what is important is to have enough of these intensive care paramedics trained so that they can be available to support those in really severe acute cases," said the study's lead author, John Woodall. Bendall said there was a danger in overtraining staff because cardiac arrests were a very small part of the ambulance service's overall work. "There is evidence around that shows if you don't do enough of particular procedures that you might not be able to maintain the skills that you have been trained in," Bendall said.The Ambulance Service of NSW welcomed any new research into the area. However it still saw defibrillation and CPR as the most important factors in increasing a patient's chance of survival after a heart attack, he said.
© 2007 Sydney Morning Herald