Restarting a heart

Shaunta Grimes

Wednesday, Nov. 17, 1999 | 10:14 a.m.

Where would you rather have your first heart attack, Sam's Town or University Medical Center?

It may seem like an obvious choice, but at least one local cardiologist says people may be better off in a casino rather than a hospital if their heart suddenly stops pumping blood to the brain.

Dr. Keith Boman, private cardiologist and medical director for the Boyd Gaming Corp.'s Automated External Defibrillator program, said last week that local hospitals could be using the technology that would make restarting a cardiac arrest victim's heart much faster.

The automated defibrillators, or AEDs, use electrodes to detect a fluttering heartbeat that is not pumping blood, determines whether a shock would bring about a normal heartbeat, then administers that shock. The AED machines are fully automated and can be used by lay people with four hours training. Because anyone can use an AED, Boman thinks they would be useful in hospitals with trained nurses, perhaps shaving precious minutes off of the time it takes a doctor to get a lifesaving shock to a patient experiencing cardiac arrest.

Local hospital officials say AEDs are not on the horizon for them because they are not necessary in a hospital setting where highly trained professionals are available to diagnose a fluttering heartbeat and administer a shock if necessary as quickly if not quicker than the AED.

Who hasn't heard someone who isn't a doctor but plays one on TV yell "clear!" just before slamming paddles on to the chest of a patient, sending a shock to the heart and bringing the patient back from the brink of death?

That action is even more important than CPR in keeping a patient alive, Boman said. A person's odds of surviving a massive heart attack decreases drastically with each minute treatment is delayed.

But it can take a doctor in a hospital four or five minutes to get to a patient who is experiencing cardiac arrest, Bowman said, which is why he advocates putting the automated defibrillators in hospitals.

He's not alone. Hospitals nationwide caught flack from Mary Ann Peberdy of the Medical College of Virginia last week during an American Heart Association meeting in Atlanta.

"Hospitals have been very slow to adopt this technology," she told the group, "so survival in hospitals has stagnated for three decades and hasn't kept up with the improvement in pre-hospital survival."

The technology has made a marked difference outside hospitals.

Four years ago Boyd Gaming was the first group of hotels in the world to put AEDs into use, and all security officers are trained on the machines. The survival rate for its guests who suffer cardiac arrest has risen from 10 percent or 12 percent to 50 percent in the past four years, Boman said.

And the technology is easy to use.

A study reported in the Oct. 19 edition of the Journal of the American Heart Association pitted AED use by 15 sixth-grade children against 22 paramedics. The children were able to use the AED on dummies in 69 to 111 seconds. The paramedics' time ranged from 50 to 87 seconds -- a surprisingly small difference, the journal reported.

It is virtually impossible to make a mistake using an AED, Boman added, because if the patient doesn't require a shock, the machine won't give one.

AEDs use the same diagnostic technology that is used in internal defibrillators that are surgically implanted in the hearts of people who are at risk for a second cardiac arrest, Boman said. "This technology is a miracle."

But it's a miracle that hospitals say they do not need. No hospitals in the Las Vegas Valley use AEDs, Bowman said, and those reached last week confirmed that they do not plan to.

"We have doctors and nurses on staff who provide safer and faster service using a regular defibrillator," Helen Vos, assistant vice president of patient care services at Mountain View Hospital, said last week. At Sunrise Hospital and Medical Center, the average response time to a cardiac arrest is one minute, although the first person on the scene may not be a doctor, Vince Leist, administrative director cardiovascular pulmonary services, said. The response could not be any quicker, he said. Officials at UMC and Mountain View Hospital also said response time at area hospitals is as fast as it possibly could be.

It is not necessary for a doctor to be present when defibrillation and other cardiac life support techniques begin on a patient experiencing cardiac arrest, Leist said, because the procedures are standardized, allowing anyone trained in advanced cardiac life support to treat the patient.

"There would be no added value in time savings with the AED in a hospital full of trained personnel," Leist said.

Defibrillation is only one way for people trained in advanced cardiac life support to restart a fluttering heart, Leist said. Other techniques include opening a patient's airway with a tube in the throat and using resusitation drugs. Even if hospitals had AEDs in every patient room, there is no way they would take the place of regular defibrillators, he said.

UMC is not considering adopting AED technology for the same reason -- officials do not believe it is necessary in a hospital setting. Davette Shea, director of emergency trauma and transport for the hospital, said AEDs are not necessarily a technological advancement over regular defibrilators, they are just different. "It's apples and oranges," she said.