Cardiac Save Guidelines??

[Medic26]

I have the chance this year to serve our banquet and awards committee, in the past our company has viewed a cardiac save as any patient delivered to the ER staff with pulses that lives 24 hours. This in my opinion is in much need of change......my personal view is a patient that is ultimately discharged with some quality of life. My problem is that I cannot find any data or policy in writing that supports this theory. I belive that the AHA has a guideline similar to this and I have been unable to locate anything after extensive searching.

Any help would be great!!

[whit72]

You cant find any info, because the minuscule percentage of survival to discharge without sever disability is about 0%. Give or take 0%

Unless your response times are under 3 minutes, your public is trained in CPR and AED and not to afraid to assist a person cause they might get sued, and oh yeah you have a horseshoe shoved up your ass.

[Just Plain Ruff]

sorry to say this, but did you do a search here? I distinctly remember a thread or a group of threads in the past year or so that addressed this exact topic?

I remember a topic like that but I can't seem to remember what the name of the topic was.

[VentMedic]

One I remember was the thread:

What constitutes a save

http://www.emtcity.com/phpBB2/viewtopic.ph...onstitutes+save

[crazycanuck]

Ventmedic linked up a thread with extensive discussion on what others consider "a save".

I believe Medic26 is looking for some data and academic discussion of the definitions and guidelines if I read the request correctly.

Personal definitions of survival are based on semantics and were discussed in the earlier thread. Survival outcomes and definitions will vary by study design. They will usually be as you mentioned based on time-line from intervention to time of death. Do you count it as a save if the patient has ROSC but no neuro function? Do you count it as a save if the patient goes on to discharge with previous level of function? This is the great debate, but here's what the literature says....

Here's some of what I could dig up and I hope it is of assistance to you 26.

1) http://circ.ahajournals.org/cgi/content/full/114/25/2760

Increasing Use of Cardiopulmonary Resuscitation During Out-of-Hospital Ventricular Fibrillation Arrest

**see the section outcomes for their definitions and descriptions of "survival" posted here as well

"Outcomes

The primary outcome was survival status at hospital discharge. We also assessed discharge destination (home versus nursing or rehabilitation facility) and neurological status at discharge based on hospital record review using Cerebral Performance Category. A Cerebral Performance Category score of 1 or 2 was classified as favorable neurological status.15,18 Using the electronic AED record, we assessed the timing of CPR between the first (stack of) shock(s) and the second (stack of) shock(s) to help determine whether the protocol changes influenced the timing and quantity of CPR. Specifically, we assessed the time interval between the first shock and the start of CPR (hands-off interval 1), the total time spent performing CPR between the first and second shock, the interval between the completion of CPR and the second (stack of) shock(s) (hands-off interval 2), and the total time between the first (stack of) shock(s) and the second (stack of) shock(s) (hands-off interval 1+CPR interval+hands-off interval 2).19 This review used both the real-time electronic ECG and the audio recording information to assess CPR timing. Prior study has indicated good interviewer reliability with regard to the timing of CPR with this approach.11"

2) http://eurheartj.oxfordjournals.org/cgi/co...full/27/23/2840

Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score

3) http://content.nejm.org/cgi/content/full/3...2473fbbdcdbfd38

Long-Term Outcomes of Out-of-Hospital Cardiac Arrest after Successful Early Defibrillation

**see the results section and it gives definitions for survival and outcomes

4) http://content.onlinejacc.org/cgi/content/abstract/7/4/752

Factors influencing survival after out-of-hospital cardiac arrest

*check out the references at the bottom of that link as well for more articles**

[Dustdevil]

Not to be a party pooper, but this doesn't really sound like something award-worthy. It's the luck of the draw. You happen to catch the run. You happen to be in close proximity. You interpret a simple single-lead EKG and happen to follow the right protocol which happens to work because the patient happen to have the right combination of conditions going for him. Any other medic in the organisation could have and would have done the same thing given the same circumstances. Not exactly an "above and beyond" kind of deal.

Awards mean a lot more to people if they have to actually earn them by doing more than just showing up to work everyday. If I am giving awards to my personnel, they are going to be for educational achievements, progressive ideas and actions, portraying a positive public image, and any actions that are truly above and beyond the norm. Heroics will be rewarded only if stupidity is not involved. But just doing what everybody else does or would have done doesn't really qualify for praise. If none of your people are really doing any of the above, then standing up and telling them that at an awards ceremony where no awards are given would certainly drive home the point.

Of course, if this is a volly organisation, then you have to blow a certain amount of smoke up people's arses to make them feel appreciated and stick around, I guess. In that case, it might be appropriate to add in "saves" and attendance for recognition. After all, professionals get rewarded for just showing up by getting paid, so some kind of reward is also in line for volunteers showing up. But those would certainly be lower on the priority list below the other achievements though.

[Sdowler]

I have to agree that it is all about timing to save a patient. If awards are being given then maybe no deficits is a tough requirement. We are limited in the amount that we contribute to the patient's neurological condition.

[Chief1C]

Patient leaves hospital, has a quality of life equal or similar to that of what they had before the incident. I.e. no life support machines, inability to communicate, etc.

[Medic26]

Not to be a party pooper, but this doesn't really sound like something award-worthy. It's the luck of the draw. You happen to catch the run. You happen to be in close proximity. You interpret a simple single-lead EKG and happen to follow the right protocol which happens to work because the patient happen to have the right combination of conditions going for him. Any other medic in the organisation could have and would have done the same thing given the same circumstances. Not exactly an "above and beyond" kind of deal.

Sure and we'll just keep awarding these damn things for patients who eventually die before they have anything but a day or two on a vent. :roll:

My boss is very black and white, if he changes something he wants to be able to back it up with research, documentation, etc. Thats what I am looking for here! I understand the whole, we would have all done the same thing bit, I am just trying to help improve a poor process we have here.

[Medic26]

I believe Medic26 is looking for some data and academic discussion of the definitions and guidelines if I read the request correctly.

Bingo and thank you.