"Save" percentage ??

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dropdeded

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Is there a percentage, or average # of saves resulting from our attempts to revive full arrests??

(full of questions this morning)

ed
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dropdeded said:
Is there a percentage, or average # of saves resulting from our attempts to revive full arrests??

(full of questions this morning)

ed
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It is surely less than 10% (at least in my experience)
 
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Personally, I've only had 2 codes in the field walk out of the hospital to discharge with minimal neuro deficits. One was completely fine. Shocked him about 2 minutes after he had witnessed arrest. He woke up immediately and said "What happened?"

The other was at a golf club and witnessed arrest with immediate bystander CPR by anesthesiologist who was on scene. He was discharged with some minor memory problems and difficulty swallowing.


Other than that..........probably somewhere between 50-100 pre-hospital codes i've been involved with in some way or another and 2 is all i've had survive and not be gorked.

later
 
I'm working with a couple of my colleagues on an article about the ethics of prehospital cardiac arrest resuscitation. The articles I have as references cite survival rates of anywhere between less than 1% and about 14% for realistic definitions of "survival" meaning the patient does not wind up as Terri Schiavo v2.0.

Put it this way, I've been in medicine for 8 years, both in and out of hospital, and I've probably worked somewhere in the neighborhood of 500 codes overall (ballpark estimate), and I only know of 8 people (1.6%) who I count as a "save". Granted one needs to keep in mind that for the longest time I worked in a rural setting so our survival rates are going to be lower than average, all other things being equal.

This is why one of the ACLS guidebooks carries the admonition: "Prevent when possible, treat effectively when challenged, and support humanely when death is imminent." Good advice for medical providers regardless of setting or specialty. :thumbup:
 
seattle EMS is now currently pushing 40%. The only other place that surpasses that percentage are the casinos in las vegas.
 
docB said:
Really? I've never heard that before.
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seattle= everyone with cpr training and aed's everywhere. best trained medics in the country(3000 hrs after a regular medic program) with protocols for everything. you have a better chance for surviving cardiac arrest on a st corner in seattle than in an icu almost anywhere else due to rapid time to 1st shock....really, there was a study done....
casino's= aed within spitting distance of every slot machine....
 
Depends what you consider a save. I've had ROSC. A true "save" to me is the patient walking out of the hospital and returning to a normal life.
 
emedpa said:
seattle= everyone with cpr training and aed's everywhere. best trained medics in the country(3000 hrs after a regular medic program) with protocols for everything. you have a better chance for surviving cardiac arrest on a st corner in seattle than in an icu almost anywhere else due to rapid time to 1st shock....really, there was a study done....
casino's= aed within spitting distance of every slot machine....
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jkelly2 said:
And Surveillance and Security personnel watching your every move.
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I don't know. I've been in Vegas for 7 years and I don't think I've ever had a patient brought in to me who was AEDd back in a casino. I remember one from the airport.
 
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docB said:
I don't know. I've been in Vegas for 7 years and I don't think I've ever had a patient brought in to me who was AEDd back in a casino. I remember one from the airport.
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one of the current aha aed training videos is camera footage from a casino. guy goes down at slot machine, security is there within 1 min applying aed and doing cpr, shocked x 1, fast forward to medics rolling the guy out and he's reaching for his bucket of quarters....
 
docB said:
I don't know. I've been in Vegas for 7 years and I don't think I've ever had a patient brought in to me who was AEDd back in a casino. I remember one from the airport.
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they probably all sign out ama to keep playing the slots.....
 
can someone post the study on the Seattle save rates???
 
MedicFL said:
can someone post the study on the Seattle save rates???
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And their guidelines. If they only work witnessed arrests or people with electrical activity that's different then working everyone without presumptive signs of death.
 
graphyte said:
seattle EMS is now currently pushing 40%. The only other place that surpasses that percentage are the casinos in las vegas.
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Gotta link to back that up? I know Seattle is good...when I was a paramedic in Vancouver we used Seattle as a model to strive towards. With a big change in resuscitation guidelines back in 2005/6 we had a 30% increase in survival rate to hospital discharge the following year. I frequently fly out of SeaTac and they've got an AED every 100 feet. The only airport I've been in with more is Atlanta. That said, Vancouver has quite a few AEDs as well in the airport, but seemingly nobody around including police and firefighters know how to recognize an apneic and cyanotic patient (who was also pulseless...refer to the Robert Dziekanski fiasco a few years back).
 
The guidelines are done by Medic One based out of Harborview, designed by Dr. Copass who ran the ER there for decades.
Cooling protocol got its big jump start here in Seattle and is expanding throughout the region to smaller medic services and community hospitals.

I don't know how its done in other cities but here they have iced 1L NS bags in the vans, and that is what they instill into the patient instead of room temp NS to get the core temp down very fast. Once arrival to ED, cooling pads are placed and Arctic Sun cooling machine gets them down to 33 C in <1hr. Thats for the benefit of those post-asystolic arrest.

I'm not sure what the rate of AED presence is here but man, I see them everywhere.
As stated above, the medics here are top notch, they get mad respect from everyone. Also the police officers have AEDs in all of their cruisers.
 
I've heard of survival rates as high as 30-40% of witnessed arrests. Such rates for all arrests would be quite impossible. I believe LAFD showed a poster at ACEP with 29% survival after changing protocols to avoid transport until ROSC is achieved and minimize interruption in compressions.

EDIT: Here is a good paper comparing stats from 10 cities. In Seattle, 39.9% of v-fib arrests survived to discharge, which is impressive, but note that only 8% of all arrests assessed by EMS there survived.
http://jama.ama-assn.org.proxy.library.vcu.edu/cgi/content/full/300/12/1423

There is another paper with a figure of 46% survival, but again restricted to witnessed v-fib arrests.
http://circ.ahajournals.org/cgi/content/abstract/114/25/2760

CmePaddlin said:
I don't know how its done in other cities but here they have iced 1L NS bags in the vans, and that is what they instill into the patient instead of room temp NS to get the core temp down very fast. Once arrival to ED, cooling pads are placed and Arctic Sun cooling machine gets them down to 33 C in <1hr. Thats for the benefit of those post-asystolic arrest.
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Hypothermia has been very beneficial in reducing the neurologic deficit after successful resuscitation. I believe the data are still unclear on whether there is any effect on survival. Certainly it has no effect on ROSC. Also, I believe the benefits of hypothermia apply to all arrests, not specifically asystolic ones (indeed probably less so for those given the extremely low rate of ROSC).
 
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pseudoknot said:
Hypothermia has been very beneficial in reducing the neurologic deficit after successful resuscitation. I believe the data are still unclear on whether there is any effect on survival. Certainly it has no effect on ROSC. Also, I believe the benefits of hypothermia apply to all arrests, not specifically asystolic ones (indeed probably less so for those given the extremely low rate of ROSC).
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The best evidence is actually in arrests of cardiac etiology, from VF/VT.
 
I anticipate a lot of EMS agencies going on line with pre-hospital, post arrest hypothermia soon. It's good to look at that in the light of some other EMS interventions that may be falling into disfavor.

In other words, we may quit doing procedures on certain penetrating trauma patients, we may quit intubating as frequently as we do now, and we will face other changes. But everyone needs to understand that the same science that forces us to "lose" these things (if you look at changing practice due to scientific advances as a "loss") will bring new therapies on line to satisfiy everyone's desire to help their patients.
 
docB said:
I anticipate a lot of EMS agencies going on line with pre-hospital, post arrest hypothermia soon. It's good to look at that in the light of some other EMS interventions that may be falling into disfavor.

In other words, we may quit doing procedures on certain penetrating trauma patients, we may quit intubating as frequently as we do now, and we will face other changes. But everyone needs to understand that the same science that forces us to "lose" these things (if you look at changing practice due to scientific advances as a "loss") will bring new therapies on line to satisfiy everyone's desire to help their patients.
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We do post arrest hypothermia at the service I work for. I also saw mentioned earlier about non-transport unless you get a ROSC, which we also do. I'll be honest though, I haven't seen a big increase in the number of "saves". Although I agree with a post above in I don't really consider it a save unless they walk out of the hospital.
 
atkinsje said:
We do post arrest hypothermia at the service I work for. I also saw mentioned earlier about non-transport unless you get a ROSC, which we also do. I'll be honest though, I haven't seen a big increase in the number of "saves". Although I agree with a post above in I don't really consider it a save unless they walk out of the hospital.
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We're supposed to remain on scene until ROSC but in my experience it seemed people still wanted to go to the hospital after losing a shockable rhythm. Since compressions are so important, it just makes sense that nobody is going to survive while you're doing poor quality 1-handed CPR in the back of a bumpy ambulance in between all of the points when you're transferring the patient and doing no compessions at all.
 
emedpa said:
they probably all sign out ama to keep playing the slots.....
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LOL; you joke, but we had this problem a couple of months ago when two buses headed for the casino crashed on the highway. I suggested installing blackjack and bacarrat tables in the trauma bay to encourage retention :)
 
leviathan said:
We're supposed to remain on scene until ROSC but in my experience it seemed people still wanted to go to the hospital after losing a shockable rhythm. Since compressions are so important, it just makes sense that nobody is going to survive while you're doing poor quality 1-handed CPR in the back of a bumpy ambulance in between all of the points when you're transferring the patient and doing no compessions at all.
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I don't understand this. This to me seems like backwards logic. I could see if it were the other way around and you went from a non-shockable to shockable.
 
It's because if you show up and they are in asystole and stay there it is much easier to stay on scene and call it vrs having a shockable rhythm and then lose it. When you lose that rhythm you think "we almost have them, if we get going maybe they are still salvage by the ED." When you show up and they are non shockable you are basically going through the motions, the chances of them converting to shockable rhythm from asytole are pretty low.
 
atkinsje said:
I don't understand this. This to me seems like backwards logic. I could see if it were the other way around and you went from a non-shockable to shockable.
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Once a patient loses a shockable rhythm, or if they never had a shockable rhythm, then the thought was that the doctors at the hospital would be the only remaining people who could possibly do something to get the patient back. That is why we transported after the rhythm was non-shockable.

Now the maxim has changed to stay on scene with a patient regardless of cardiac rhythm, because they're going to have the best chance of survival by you running the entire code on scene with or without ACLS care. Nothing the hospital does is going to improve their outcome, and like I said, the interruption in CPR and the poor CPR during transport and the time it takes to transport to hospital all will probably reduce their chances of survival. The same guideline holds true even for BLS-only care, because defibrillation, bystander CPR, and therapeutic hypothermia are the only things that have demonstrated a better survival rate. Rushing the patient to the ER for ACLS drugs is really an exercise in futility, and if an ALS crew is on scene, then things are even more pointless. What we do here is call the emerg doc after about 10 minutes of resuscitation and discuss the case with them and see if they feel there is something more they could do for the patient by bringing them in. Otherwise, the next call about 20 minutes later will be to ask for permission to stop CPR.
 
How do you find out who survived without deficits? I only worked for a transfer service for a short time span, before one of the paramedics was like "look kid, if you want to get into medical school, 0.01 more GPA is worth more than this place."

But from what I saw, we would dump the patients off and that would be that - I don't know what happened to any of them.
 
JohnDeer said:
How do you find out who survived without deficits? I only worked for a transfer service for a short time span, before one of the paramedics was like "look kid, if you want to get into medical school, 0.01 more GPA is worth more than this place."

But from what I saw, we would dump the patients off and that would be that - I don't know what happened to any of them.
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If you have a decent work relationship with the hospitals you serve all you have to do is ask a clerk, nurse, or even doc (on the rare occasion they aren't extremely busy) to pull the patients records to see dispo. At least that's how it is here. I do my best to follow up on all the patients I can, this way I can see how well I am doing at my field diagnosis and subsequent treatment.
 
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