Frequently Asked Questions About Surviving Cardiac Arrest
Is there a national requirement to report cardiac arrest survival in my community?
No. There is no national mandate though some states are beginning to suggest and even require reporting of this information. Regardless of any requirement I believe that determining your experience in managing cardiac arrest is the very first step in improving matters.
Can’t I just estimate survival based on what I learn from the incident reports?
No, estimates are next to worthless. You must define cases of witnessed VF and determine how many are discharged alive from the hospital. These are facts and must be measured. Estimates just wont cut it.
How do I know if the patient was in VF if I do not have a copy of the rhythm?
In most communities today the first shock is delivered by EMTs using AEDs. Thus if the AED delivers a shock it is safe to assume that the rhythm was VF. AEDs (with rare exception) only deliver a shock when VF is present. If manual defibrillators are used instead of AEDs to deliver the shock then VF is defined by the action of the EMS rescuer. If he or she thinks VF is present and delivers a shock the this is a VF case. Of course, you should always try to download the AED data (relatively easy to do) and obtain a copy of the rhythm if a manual defibrillator is used.
Isn’t the definition of VF somewhat subjective?
There is a subjective component when the interpretation is being made visually. The problem is distinguishing fine VF from asystole. VF typically starts out with a coarse pattern with amplitude of 1 cm or more. As VF persists for 15 minutes or more the amplitude diminishes and becomes less than 1 mm. At this point most cardiologists would consider the rhythm to be asystole. But the bottom line is what did the EMS rescuer do for the rhythm. If he or she provided a shock before administering medications then it is presumptive VF.
Is it considered a discharge if the person was sent to a rehabilitation center or nursing home?
Yes, if the patient leaves the hospital alive (even if transferred to another facility) it is considered a discharge.
Sometimes the spouse reports s/he awoke when the patient made a sound. Can this be considered witnessed?
Yes. The sound associated with the cardiac arrest was directly heard.
If a cardiac arrest patient was seen alive in the past few minutes can this be considered witnessed?
No. Witnessed must be seen or heard directly.
What about measuring the neurologic recovery of patients who are discharged?
Some academic centers measure the neurologic recovery of patients using a 4-point CPC scale. 1 is full recovery, 2 is minor or moderate neurologic deficits, 3 is major deficits, and 4 is comatose. Most researchers consider 1 and 2 to be good recovery and sometimes include this information in reporting cardiac arrest survival.
How long does VF last?
VF last up to 30 minutes. Clearly the longer the patient is in VF the less the likelihood of survival.
What if the paramedics start a resuscitation and learn it is a DNAR patient?
If the resuscitation has continued for more than a minute or two we would consider this a cardiac arrest case. If the paramedics (or EMTs) stop within a couple of minutes once additional information becomes available, we would consider this a DNAR case and not include it in the cardiac arrest registry.
How do I obtain the CPC score on discharged patients?
The CPC score can be obtained from either the hospital discharge summary or from an interview with the patient (or spouse or partner or care giver). CPC can be subjective but in general scores of 1 or 2 are considered a successful neurological recovery. Scores or 3 or 4 are not a good outcome. Many communities find it difficult to obtain the CPR score. Clearly the resources and availability of data may be limiting factors.
Doesn’t the CPC score often improve after discharge?
Yes, it frequently does. Some researchers recommend determining the score at a fixed interval from the cardiac arrest, say 1, 3 or 6 months following the event. In King County we determine it at discharge (from hospital records) as well as at one month (generally from a phone interview with the patient).
What if I want to publish information obtained from the cardiac arrest registry in my community?
If you intend to publish information, you must obtain human subjects permission from the relevant agency. This approval is done by a human subjects committee or institutional review board. This may be obtained from a university, health department, city administration, hospital or other public agency. There is a formal request and review process. If these categories do not fit your agency one can contract with private human subject approval companies. It is important to obtain human subjects approval since private and personal information is being published (even if individual patients cannot be identified). If patients can be identified then those patients must consent to using personal information. The path toward publication can be challenging and the best recommendation is to confer with a colleague who has published in the past.