Improving Cardiac Arrest Resuscitation Outcomes: A Valentine worth Sending

Improving Cardiac Arrest Resuscitation Outcomes: A Valentine worth Sending

Death by Cardiac Arrest is still the number one cause of death in the United States. CITATION GoA14 l 1033 (Go AS, 2014). With his in mind I chose to review a paper about improving cardiac arrest resuscitation outcomes CITATION JoA15 l 1033 (JoAnn Grif Alspach, 2015). The following paper will review the article entitled “Improving Cardiac Arrest Resuscitation Outcomes: A Valentine worth Sending” which was written by JoAnn Aslpach. This is as important topic for many reasons; as noted cardiac arrest is the number one cause of death. Furthermore it is something that can be prevented with proper medical techniques. It is felt that this is a very important topic and as such the above noted paper is worthy of review.

A Review of “Improving Cardiac Arrest Resuscitation Outcomes: A Valentine worth Sending”
Introduction
Valentine’s Day has always been a day when we think of the heart, perhaps not literally, so it makes it a good time to consider cardiac arrest. It is with that in mind that the article reminds us that we should extend the sentiments of Valentine’s Day throughout the year and think about the heart. Cardiac arrest is the sudden stop of blood circulation through the body due to hearth failure. Cardiac arrests can occur suddenly with no warning. The study of interest looks at the survival rates of people who suffer cardiac arrest and looks at what critical care nurses can do to prevent the loss of life that often occurs.

Furthermore the study looks at what we as a society could do to save more lives.
Methods
The article looks at aggregate statistics and looks at some of the important differences in treatments. Thus this study is not a true experiment in the sense that the researches actually conducted controlled trials; the study was observational. The purpose of the paper is to look at post hoc data and look at some of the interesting findings. Thus the data is all medical data in the United States related to cardiac arrest. What treatment each patient received and the survival rates. The downfall of this data is that you can’t control for all meaningful differences and thus conclude that one treatment is better or worse than the other. Rather the purpose seems to be to gather interesting difference which could then be used to construct controlled experiments. The article also reviews data from another study CITATION San14 l 1033 (Sanghavi P, 2014) that was conducted at Harvard. This study was also observational and looked at rural data. Thus they looked at patients that suffered out of hospital cardiac arrests.
Results
There are a few very interesting results to report. The paper categorizes the results into two basic categories: “Doing More” and “Doing Less”. The idea is that often it appears we actually over treat cardiac arrest and does too much. It is important to consider this as it might be possible to save more lives well actually doing less. While in many other cases we do too little. Thus there might be important changes and additions that need to be made to treating cardiac arrest.
In the category of doing less the study found that there was a fairly significant difference in survival rates between patients who received Basic Life Support (BLS) and Advanced Life Support (ALS) while looking at out of hospital cardiac arrest (OHCA). The results are as follows “An intriguing study reported by Sanghavi and colleagues at Harvard University used a nationally representative sample of Medicare beneficiaries from nonrural areas of the United States that included 1643 patients managed with BLS and 31292 managed with ALS. The researchers concluded that OHCA patients had higher survival at discharge (BLS 13.1% vs ALS 9.2%, 95% CI, 2.3–5.7), higher survival at 90 days (BLS 8.0% vs 5.4% for ALS; 95% CI, 1.2–4.0), and lower rates of poor neurological functioning (BLS 21.8% vs ALS 44.8%; 95% CI, 18.6–27.4) when they received only BLS rather than ALS from emergency medical services” CITATION San14 l 1033 (Sanghavi P, 2014). The writers caution that these results are not that conclusive. There are many elements of this data that might be spurious and lead one to falsely conclude that patients should be given only BLS. These results might be due to many factors including timing issues; usually BLS is given early and thus it the results might just be due to BLS been given to less serious cases of cardiac arrest. The authors conclude “Despite that customary admonition, the results are thought-provoking and worthy of further consideration and repeat testing” CITATION JoA15 l 1033 (JoAnn Grif Alspach, 2015). It does seem possible, though more analysis needs to be done, that in fact critical nurses are overreacting cardiac arrest and that perhaps just BLS is needed rather than ALS.
In the category of doing more the article focuses on by stander CPR. The author writes “The Doing More strategy recognizes that 92% of the 360 000 Americans who suffer an OHCA each year will die, that a majority of those deaths might have been avoided if timely and effective interventions known to improve survival from cardiac arrest had been provided, and that one of those timely and effective interventions is provision of bystander CPR”. The article notes that survival rates from OHCA are higher in communities that have expanded and promoted basic CPR programs. These findings point to a clear a policy implication: we should promote and fund CPR classes. CPR is a proven technique and thus it seems clear that promoting it more would save lives.
Conclusion
The results presented in this paper are clearly to be taken with caution. The results that suggest we should promote more CPR training seem quite straight forward and it is hard to argue with it. Clearly CPR is a proven technique and with more CPR we would save more lives. However the finding with regards to only doing BLS vs ALS when someone is found to be having a cardiac arrest is much more unsubstantiated. While it could certainly be the case this is true there simply needs to be more research. There are too many conflicting and spurious variables that could have led to this result.

References
BIBLIOGRAPHY Go AS, M. D. (2014). for the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics—2014 update: a report from the American Heart Association. Retrieved from http://circ.ahajournals.org/content/129/3/399.full?ijkey=68d3a804e357962291aedc08d774465f813873b0&keytype2=tf_ipsecsha
JoAnn Grif Alspach, R. M. (2015). Improving Cardiac Arrest Resuscitation Outcomes: A Valentine Worth Sending. Critical Care Nurse.
Sanghavi P, J. A. ( 2014). Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. JAMA Intern Med.