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 “We thought there might be something here because once somebody
collapses into cardiac arrest, their chance of survival decreases
really quickly,” said lead author Ian Drennan, a paramedic with York
Region Paramedic Services and a researcher with Li Ka Shing
Knowledge Institute at St. Michael's Hospital in Toronto.
“If you find them in a shockable heart rhythm then most of the time
you can reset the heart and get a pulse back. If you wait too long,
the chance of finding that rhythm deteriorates,” he said.
With other time-sensitive conditions, like heart attack or stroke,
minutes count, but with cardiac arrest a difference of just a few
seconds can determine survival, Drennan told Reuters Health by
phone.
The researchers studied 7,842 people who had cardiac arrest in
private residences and were treated by first responders after a 911
call. Less than four percent of people survived to be discharged
from the hospital.
Of the 5,998 people who lived below the third floor of their
buildings, 4.2 percent survived, compared to 2.6 percent of those
living above the third floor. Less than one percent of those living
above the 16th floor survived, and none of the 30 patients who lived
above the 25th floor survived, the researchers reported in CMAJ.
Regardless of floor, an automated external defibrillator (AED)
device, which can shock the heart back to pumping regularly in some
cases, was rarely used.
The time it takes for a first responder arriving at the building to
reach the patient having a cardiac arrest increases when the patient
lives on a higher floor, the researchers found.
On average, it took responders about six minutes from the time of
the 911 call to arrive at the building. But it took them an average
of three minutes between arriving at the building and first contact
with the patient for those lived on the first or second floor,
compared to an average of almost five minutes for those who lived on
or above the third floor.
“A cardiac arrest is a condition when the heart actually stops
beating,” said Dr. Robert A. Silverman of Long Island Jewish Medical
Center, who was not part of the Canadian study. “The body can only
go for a short period of time without the heart pumping blood;
therefore it is essential that CPR (chest compressions) and other
medical assistance be given as quickly as possible.”
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Medics need to go through one or more outer doors and possibly
encounter an intercom system, navigate the lobby, locate the
elevators - which may take time to arrive or stop at other floors
before the patient’s floor - then locate the correct apartment, all
of which delay care, Silverman told Reuters Health by email.
Buildings and residents can help expedite the process by having an
emergency response plan, being sure the responders can get in the
building immediately and can access the elevators immediately,
Drennan said.
“Having some kind of response plan will minimize avoidable delays,”
he said.
It also helps to have people in the building trained in CPR and in
using AEDs, and having the devices available in the lobby, on
certain floors or even in the elevators, he said.
For bystanders who witness a cardiac arrest, in which the patient
has no pulse, “the best thing to do is call 911 and do what you can,
follow CPR guidelines, get an AED,” he said.
Although most high-rise residents shouldn’t be concerned about these
findings, and don’t need to move based on them, people who are very
sick may want to consider floor number when they move, Drennan said.
He added, “It’s the same thing as if you’re trying to move out to
the country, you think if I get into trouble, is this the best spot
for me?”
SOURCE: http://bit.ly/1SZ3n6v CMAJ, online January 18, 2016.
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