A Technological Advance Regresses?

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You know those signs you see in restaurants and airports (among many other places):  Automated External Defibrillator?   Well, as Paul Harvey used to say, here’s the rest of the story.

Drs. Chan, Krumholz, Spertus, Cram, Berg, Peberdy, Nadkarni, Mancini, Nallamouthu, and Mr. Jones from a variety of institutions (and the National Registry of Cardiopulmonary Resuscitation)) published a report in the Journal of the American Medical Association.  It seems that the new high tech equipment found in hospitals- the ones that cost a fortune to acquire- save fewer folks than the older, low-tech units- to the tune of 965 additional cardiac deaths annually (in the US alone).  The older, high tech units yielded a 19.3 % survival rate; the newer units provide 16.3% survival rates.

Some 100,000 automated units were installed in hospitals over the last decade, at a price of about $ 1600 apiece; the older units ran $ 10K apiece.  (14,000 are expected to be sold in 2013.)  Of these, more than 10,000 were recalled due to product failure.

So, you ask, “Why were they acquired?”  The reasoning seems to have been based upon the hope that response times would be better, since lower-skilled hospital workers (nurses on the wards) could operate the high tech units; the response rate was thought to be the critical parameter.  The newer devices provide voice (step-by-step) instructions, so they were considered a “breeze” to operate.  And, there may be even more to the story.

Of the 11 advisors on the committee that endorsed the acquisition of the new gear, three were “consultants” or “business associates” of the firms (Agilent, Medtronic, PhysioControl) that made the (new type) defibrillators.  The recommendations made a decade ago (2000) were based upon the fact that the units in non-hospital settings did save lives.

This research tracks 11,695 patients through 204 hospitals. Of these, it was found that most of the patients in hospitalsare sicker than the average victim, with complex problems affecting the heart function.  As such, when their heart fails, it tends to be immune to the actions provided

English: Semi-automated external monitor defib...
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by the defibrillators- to the tune of some 82% of all those studied.  Instead, CPR is required, with a defibrillator employed mostly to monitor the action of the heart- and the automated units require longer periods of interruptions to yield these data, than did the older, lower-tech units.

Moreover, the hospitals failed their human factors analyses- it seems that the nurses are much less likely (or more intimidated) to operate these defibrillators in the first place, meaning the time prior to shock is longer than it was before the automated units were adopted.  I don’t think its less likely a hospital nurse would use it than a passerby in an airport; I think it’s relatives and friends of the affected,  who use the AER’s in hospitals and restaurants.

Since the association updates it guidelines every five years, don’t expect any changes until 2015.  Nor has the association had any time to review this Chan et. al. article.  It also may demand more data (another publication), prior to changing its guidelines, as well.

 

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10 thoughts on “A Technological Advance Regresses?”

    1. Actually, we would be useful using health- and the potential user/recipient of the service. Providing child dosages to adults doesn’t work; providing defib meant to restart the occasional heart failure is different than needing it for clearly damaged cardiac cases…

      Thanks for the visit, Roberta…
      Roy

    1. Eugene:
      If there were an earth-shaking revelation (this is mighty close), then a panel would be convened. The problem with having a more frequent schedule is both costs and logistics. Costs because there has to be space rented and/or phone time acquired, vetting of panel members (which seems to have been somewhat lacking on this one), designation of a chair and secretary, reporting, and the printing of standards. Logistics for the members (who also must donate their time or be paid) getting to and from the meetings or having time available that is congruent with other members, etc.
      Having served on more than my fair share of standards committees (that is NOT a complaint, by the way), I understand the issues involved. And, recognize that five years may be just about right. One of the committees with which I was involved actually decided to pass the 5 year time by on one cycle, since there were not many significant changes. The next cycle was, indeed, a more complete revision and analysis.

      Roy

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