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C.D.C. Reviewing Cases of Heart Problem in Youngsters After Getting Vaccinated and AHA Reassures that Benefits Overwhelm the Risks of Vaccination

Reporter: Amandeep Kaur, B.Sc. , M.Sc.

The latest article in New York times reported by Apoorva Mandavilli outlines the statement of officials that C.D.C. agency is investigating few cases of young adults and teenagers who might have developed myocarditis after getting vaccinated. It is not confirmed by the agency that whether this condition is caused by vaccine or not.

According to the vaccine safety group of the Centers for Disease Control and Prevention, the reports of heart problems experienced by youngsters is relatively very small in number. The group stated that these cases could be unlinked to vaccination. The condition of inflammation of heart muscle which can occur due to certain infections is known as myocarditis.

Moreover, the agency still has to determine any evidence related to vaccines causing the heart issues. The C.D.C. has posted on its website the updated guidance for doctors and clinicians, urging them to be alert to uncommon symptoms related to heart cases among teenagers who are vaccine recipients.

In New York, Dr. Celine Gounder, an infectious disease specialist at Bellevue Hospital Center stated that “It may simply be a coincidence that some people are developing myocarditis after vaccination. It’s more likely for something like that to happen by chance, because so many people are getting vaccinated right now.”

The article reported that the cases appeared mainly in young adults after about four days of their second shot of mRNA vaccines, made by Moderna and Pfizer-BioNTech. Such cases are more prevalent in males as compared to females.

The vaccine safety group stated “Most cases appear to be mild, and follow-up of cases is ongoing.” It is strongly recommended by C.D.C. that American young adults from the age of 12 and above should get vaccinated against COVID-19.

Dr. Yvonne Maldonado, chair of the American Academy of Pediatrics’s Committee on Infectious Diseases stated “We look forward to seeing more data about these cases, so we can better understand if they are related to the vaccine or if they are coincidental. Meanwhile, it’s important for pediatricians and other clinicians to report any health concerns that arise after vaccination.”

Experts affirmed that the potentially uncommon side effects of myocarditis get insignificant compared to the potential risks of SARS-CoV-2 infection, including the continuous syndrome known as “long Covid.” It is reported in the article that acute Covid can lead to myocarditis.

According to the data collected by A.A.P, about 16 thousand children were hospitalized and more than 3.9 million children were infected by coronavirus till the second week of May. In the United States, about 300 children died of SARS-CoV-2 infection, which makes it among the top 10 death causes in children since the start of pandemic.

Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston stated that “And that’s in the context of all the mitigation measures taken.”

According to researchers, about 10 to 20 of every 1 lakh people each year develop myocarditis in the general population, facing symptoms from fatigue and chest pain to arrhythmias and cardiac arrest, whereas some have mild symptoms which remain undiagnosed.

Currently, the number of reports of myocarditis after vaccination is less than that reported normally in young adults, confirmed by C.D.C. The article reported that the members of vaccine safety group felt to communicate the information about upcoming cases of myocarditis to the providers.

The C.D.C. has not yet specified the ages of the patients involved in reporting. Since December 2020, the Pfizer-BioNTech vaccine was authorized for young people of age 16 and above. The Food and Drug Administration extended the authorization to children of age 12 to 15 years, by the starting of this month.

On 14th May, the clinicians have been alerted by C.D.C. regarding the probable link between myocarditis and vaccination. Within three days, the team started reviewing data on myocarditis, reports filed with the Vaccine Adverse Event Reporting System and others from the Department of Defense.

A report on seven cases has been submitted to the journal Pediatrics for review and State health departments in Washington, Oregon and California have notified emergency providers and cardiologists about the potential problem.

In an interview, Dr. Liam Yore, past president of the Washington State chapter of the American College of Emergency Physicians detailed a case of teenager with myocarditis after vaccination. The patient was provided treatment for mild inflammation of the inner lining of the heart and was discharged afterwards. Later, the young adult returned for care due to decrease in the heart’s output. Dr. Yore reported that still he had come across worse cases in youngsters with Covid, including in a 9-year-old child who arrived at the hospital after a cardiac arrest last winter.

He stated that “The relative risk is a lot in favor of getting the vaccine, especially considering how coronavirus vaccine have been administered.”

In the United States, more than 161 million people have received their first shot of vaccine in which about 4.5 million people were between the age 12 to 18 years.

Benefits Overwhelm Risks of COVID Vaccination, AHA Reassures

The latest statement of American Heart Association (AHA)/ American Stroke Association (ASA) on May 23rd states that the benefits of COVID-19 vaccination enormously outweigh the rare risk for myocarditis cases, which followed the C.D.C. report that the agency is tracking the Vaccine Adverse Events Reporting System (VAERS) and the Vaccine Safety Datalink (VSD) for myocarditis cases linked with mRNA vaccines against coronavirus.

The myocarditis cases in young adults are more often observed after the second dose of vaccine rather than the first one, and have more cases of males than females. The CDC’s COVID-19 Vaccine Safety Technical Work Group (VaST) observed such heart complications after 4 days of vaccination.

CDC reported that “Within CDC safety monitoring systems, rates of myocarditis reports in the window following COVID-19 vaccination have not differed from expected baseline rates.”

The CDC team stated that “The evidence continues to indicate that the COVID-19 vaccines are nearly 100% effective at preventing death and hospitalization due to COVID-19 infection, and Strongly urged all young adults and children 12 years and above to get vaccinated as soon as possible.”

Even though the analysis of myocarditis reports related to coronavirus vaccine is in progress, the AHA/ASA stated that “myocarditis is typically the result of an actual viral infection, and it is yet to be determined if these cases have any correlation to receiving a COVID-19 vaccine.”

Richard Besser, MD, president and CEO of the Robert Wood Johnson Foundation (RWJF) and former acting director of the CDC stated on ABC’s Good Morning America “We’ve lost hundreds of children and there have been thousands who have been hospitalized, thousands who developed an inflammatory syndrome, and one of the pieces of that can be myocarditis.” He added “still, from my perspective, the risk of COVID is so much greater than any theoretical risk from the vaccine.”

After COVID-19 vaccination the symptoms that occur include tiredness, muscle pain, headaches, chills, nausea and fever. The AHA/ASA stated that “typically appear within 24 to 48 hours and usually pass within 36-48 hours after receiving the vaccine.”

All healthcare providers are suggested to be aware of the rare adverse symptoms such as myocarditis, low platelets, blood clots, and severe inflammation. The agency stated that “Healthcare professionals should strongly consider inquiring about the timing of any recent COVID vaccination among patients presenting with these conditions, as needed, in order to provide appropriate treatment quickly.”

President Mitchell S.V. Elkind, M.D., M.S., FAHA, FAAN, Immediate Past President Robert A. Harrington, M.D., FAHA, President-Elect Donald M. Lloyd-Jones, M.D., Sc.M., FAHA, Chief Science and Medical Officer Mariell Jessup, M.D., FAHA, and Chief Medical Officer for Prevention Eduardo Sanchez, M.D, M.P.H., FAAFP are science leaders of AHA/ASA and reflected their views in the following statements:

We strongly urge all adults and children ages 12 and older in the U.S. to receive a COVID vaccine as soon as they can receive it, as recently approved by the U.S. Food and Drug Administration and the CDC. The evidence continues to indicate that the COVID-19 vaccines are nearly 100% effective at preventing death and hospitalization due to COVID-19 infection. According to the CDC as of May 22, 2021, over 283 million doses of COVID-19 vaccines have been administered in the U.S. since December 14, 2020, and more than 129 million Americans are fully vaccinated (i.e., they have received either two doses of the Pfizer-BioNTech or Moderna COVID-19 vaccine, or the single-dose Johnson & Johnson/Janssen COVID-19 vaccine).

We remain confident that the benefits of vaccination far exceed the very small, rare risks. The risks of vaccination are also far smaller than the risks of COVID-19 infection itself, including its potentially fatal consequences and the potential long-term health effects that are still revealing themselves, including myocarditis. The recommendation for vaccination specifically includes people with cardiovascular risk factors such as high blood pressure, obesity and type 2 diabetes, those with heart disease, and heart attack and stroke survivors, because they are at much greater risk of an adverse outcome from the COVID-19 virus than they are from the vaccine.

We commend the CDC’s continual monitoring for adverse events related to the COVID-19 vaccines through VAERS and VSD, and the consistent meetings of ACIP’s VaST Work Group, demonstrating transparent and robust attention to any and all health events possibly related to a COVID-19 vaccine. The few cases of myocarditis that have been reported after COVID-19 vaccination are being investigated. However, myocarditis is usually the result of a viral infection, and it is yet to be determined if these cases have any correlation to receiving a COVID-19 vaccine, especially since the COVID-19 vaccines authorized in the U.S. do not contain any live virus.

We also encourage everyone to keep in touch with their primary care professionals and seek care immediately if they have any of these symptoms in the weeks after receiving the COVID-19 vaccine: chest pain including sudden, sharp, stabbing pains; difficulty breathing/shortness of breath; abnormal heartbeat; severe headache; blurry vision; fainting or loss of consciousness; weakness or sensory changes; confusion or trouble speaking; seizures; unexplained abdominal pain; or new leg pain or swelling.

We will stay up to date with the CDC’s recommendations regarding all potential complications related to COVID-19 vaccines, including myocarditis, pericarditis, central venous sinus thrombosis (CVST) and other blood clotting events, thrombosis thrombocytopenia syndrome (TTS), and vaccine-induced immune thrombosis thrombocytopenia (VITT).

The American Heart Associationrecommends all health care professionals be aware of these very rare adverse events that may be related to a COVID-19 vaccine, including myocarditis, blood clots, low platelets, or symptoms of severe inflammation. Health care professionals should strongly consider inquiring about the timing of any recent COVID vaccination among patients presenting with these conditions, as needed, in order to provide appropriate treatment quickly. As detailed in last month’s AHA/ASA statement, all suspected CVST or blood clots associated with the COVID-19 vaccine should be treated initially using non-heparin anticoagulants. Heparin products should not be administered in any dose if TTS/VITT is suspected, until appropriate testing can be done to exclude heparin-induced antibodies. In addition, health care professionals are required to report suspected vaccine-related adverse events to the Vaccine Adverse Event Reporting System, in accordance with federal regulations.

Individuals should refer to their local and state health departments for specific information about when and where they can get vaccinated. We implore everyone ages 12 and older to get vaccinated so we can return to being together, in person – enjoying life with little to no risk of severe COVID-19 infection, hospitalization or death.

We also support the CDC recommendations last week that loosen restrictions on mask wearing and social distancing for people who are fully vaccinated. For those who are unable to be vaccinated, we reiterate the importance of handwashing, social distancing and wearing masks, particularly for people at high risk of infection and/or severe COVID-19. These simple precautions remain crucial to protecting people who are not vaccinated from the virus that causes COVID-19.

Source:

Other related articles were published in this Open Access Online Scientific Journal, including the following:

Thriving Vaccines and Research: Weizmann Institute Coronavirus Research Development

Reporter: Amandeep Kaur, B.Sc., M.Sc.

https://pharmaceuticalintelligence.com/2021/05/04/thriving-vaccines-and-research-weizmann-coronavirus-research-development/

Identification of Novel genes in human that fight COVID-19 infection

Reporter: Amandeep Kaur, B.Sc., M.Sc.

https://pharmaceuticalintelligence.com/2021/04/19/identification-of-novel-genes-in-human-that-fight-covid-19-infection/

Fighting Chaos with Care, community trust, engagement must be cornerstones of pandemic response

Reporter: Amandeep Kaur, B.Sc., M.Sc. 

https://pharmaceuticalintelligence.com/2021/04/13/fighting-chaos-with-care/

T cells recognize recent SARS-CoV-2 variants

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2021/03/30/t-cells-recognize-recent-sars-cov-2-variants/

Need for Global Response to SARS-CoV-2 Viral Variants

Reporter: Aviva Lev-Ari, PhD, RN

https://pharmaceuticalintelligence.com/2021/02/12/need-for-global-response-to-sars-cov-2-viral-variants/

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Effectiveness of Anti-arrhythmic Drugs: Amiodarone and Lidocaine, for treating sudden cardiac arrest, increasing likelihood of Patients Surviving Emergency Transport to Hospital

Curator: Aviva Lev-Ari, PhD, RN

 

Original Study

http://www.nejm.org/doi/full/10.1056/NEJMoa1514204

Editorial

Out-of-Hospital Cardiac Arrest — Are Drugs Ever the Answer? Jose A. Joglar, M.D., and Richard L. Page, M.D.

http://www.nejm.org/doi/pdf/10.1056/NEJMe1602790

Monday, April 4, 2016

Antiarrhythmic drugs found beneficial when used by EMS treating cardiac arrest

Researchers have confirmed that certain heart rhythm medications, when given by paramedics to patients with out-of-hospital cardiac arrest who had failed electrical shock treatment, improved likelihood of patients surviving transport to the hospital. The study was published online in the New England Journal of Medicine and helps answer a longstanding scientific question about the effectiveness of two widely-used antiarrhythmic drugs, amiodarone and lidocaine, for treating sudden cardiac arrest.

“This trial shows that amiodarone and lidocaine offer hope for bringing patients back to life and into the hospital after cardiac arrest.”

Peter Kudenchuk, M.D., Principal Study Author

The study followed the patients from hospital admission to hospital discharge. Although neither drug significantly improved the overall rate of survival to hospital discharge, amiodarone showed a favorable trend in that direction. Survival to discharge is the point at which a patient is discharged from the hospital.

“This trial shows that amiodarone and lidocaine offer hope for bringing patients back to life and into the hospital after cardiac arrest,” said principal study author Peter Kudenchuk, M.D., a cardiac electrophysiologist at the University of Washington Medical Center in Seattle. “While the overall increase in survival to hospital discharge of about 3 percent with amiodarone was not statistically significant, it came very close. Importantly, there was a significant improvement in survival to hospital discharge with either drug when the cardiac arrest was bystander-witnessed.” A bystander-witnessed cardiac arrest is one that is witnessed by another person.

Sudden cardiac arrest is a condition in which the heart suddenly or unexpectedly stops beating, cutting off blood flow to the brain and other vital organs. More than 300,000 people are treated for out-of-hospital cardiac arrest each year, with the vast majority occurring at home, according to the American Heart Association. Studies show that nationally only about 10 percent of people who suffer cardiac arrest outside the hospital survive. Effective treatments, such as CPR and defibrillation, can greatly increase a victim’s chance of survival. This study adds the possibility of additional benefit from the use of the heart rhythm medications.

EMS (emergency medical services) providers commonly use antiarrhythmic drugs for out-of-hospital cardiac arrest that is not responsive to defibrillation shocks to the heart for restoring its normal rhythm. However, doctors remain unclear whether these drugs have proven survival benefit or if any benefit might be undone by possible drug side effects. As a result, use of these treatments by paramedics varies.

The three-year study began in 2012, and randomized 3,026 patients with out-of-hospital cardiac arrest caused by ventricular fibrillation and ventricular tachycardia, life-threatening rhythms of the heart’s lower pumping chambers that are often resistant to electrical shock.

Researchers assigned the patients to treatment with amiodarone, lidocaine, or neither drug (a saline placebo) by rapid injection, along with all other standard resuscitation treatments. The study was conducted by the Resuscitation Outcomes Consortium (link is external), which includes clinical sites in the United States and Canada.

“Survival among the approximately 1,900 patients in the study whose cardiac arrest was witnessed by a bystander was improved significantly, from about 23 percent to 28 percent, by either drug,” Dr. Kudenchuk said.  Better than half of study participants fit this bystander-witnessed category, a group that was identified before the study began as potentially more likely to respond to such treatment. “This suggests treating patients as soon as possible after their collapse might be a critical determinant of whether drugs like amiodarone or lidocaine will have a significant clinical effect,” he added.

“I’m encouraged by the fact that though seemingly small, the 3-5 percent increase in survival reported in this trial means 1,800 additional lives could potentially be saved each year from cardiac arrest,” Dr. Kudenchuk said. “We can and should strive to improve our treatments for this all-to-common event. We believe this study is a significant step in that direction.”

Adverse effects from the drugs were infrequent, and scientists are continuing to analyze findings from the trial to gain additional insight into its results.

Funding for this study was provided by NHLBI in partnership with the U.S. Army Medical Research & Material Command, the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the American Heart Association. The study was presented at the American College of Cardiology 2016 Scientific Sessions in Chicago.

EMS agencies and receiving hospitals that participated in this trial are located in: Birmingham, Alabama; Vancouver, British Columbia; Dallas-Fort Worth; Seattle-King County; Milwaukee; Ottawa-OPALS Group, Ontario; Toronto; Portland, Oregon; San Diego; and Pittsburgh.

Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online athttp://www.nhlbi.nih.gov.

SOURCE

http://www.nih.gov/news-events/news-releases/antiarrhythmic-drugs-found-beneficial-when-used-ems-treating-cardiac-arrest

Other related articles published in this Open Access Online Scientific Journal include the following: 

Antiarrhythmic drugs

https://pharmaceuticalintelligence.com/?s=Antiarrhythmic+drugs

A-Fib

https://pharmaceuticalintelligence.com/?s=a-fib

Electrophysiology N = 80

https://pharmaceuticalintelligence.com/?s=Electrophysiology

 

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Reporter: Aviva Lev-Ari, PhD, RN

 

Very significant research results are reported below.

I witnessed the Rapid Response Team at MGH, on my night shift in August 2007 on a Cardiac Step-down Floor, performing CPR on a 71 year old female, a Cardiac patient. She was unsalvageable, her Attending Physician arrived to her bedside from home, two dozen professionals gathers in minuted from the Code Blue overhead announcement. The code cart was pushed to her room by myself and another Nurse. As the Physician who managed the Code left the patient room very disappointed, saying, “I have yet to see one successful resuscitation.”

In January 2009, as Supervisor of Kindred Long Term Care Acute Hospital at Waltham Hospital, 5th Floor, I performed CPR for a 69 year old male, a non Cardiac patient in Cardiac Arrest, Dr. Natov contacted the Code Blue, ACLS guidelines were followed and Patient survived.

I am very encouraged to learn the Survival Improvement by CPR achieved after “In-hospital Cardiac Arrest” as I am reporting, below.

In-hospital Cardiac Arrest: No Longer ‘Unsalvageable’

By Jill Gormley
Feb 27, 2013
 - Chest pain

In-hospital cardiac arrest accounts for approximately160,000 deaths in the U.S. every year—similar to deaths from lung cancer—and yet it receives little attention and limited research funding. Those studying this silent epidemic say that decreasing the morbidity and mortality associated with in-hospital cardiac arrest is attainable and should be a focus of every provider’s quality improvement efforts.

One of those researchers, Paul S. Chan, MD, of Saint Luke’s Health System in Kansas City, Mo., feels that paying more attention to preventing and responding appropriately to in-hospital cardiac arrest can make a huge impact. He cites the great leaps made in improving care for heart failure and MI over the past few decades, contending that similar strides can be made in improving survival after in-hospital cardiac arrest.

The American Heart Association has made in-hospital cardiac arrest a focus for quality improvement with its Get With the Guidelines-Resuscitation (GWTG-R) registry, which collects information about resuscitation cases from participating hospitals and offers feedback on resuscitative practices and outcomes. The registry also uses the information collected to develop evidence-based guidelines and best practices. Currently, more than 1,550 hospitals participate in the registry, and studies of outcomes using registry data indicate that attention to the problem is producing results.

Survival Is Improving

ACS-NSQIP = American College of SurgeonsNational Surgical Quality Improvement Program; CPR = cardiopulmonary resuscitation
Source: JAMA Surg 2013;148[1]:14-21

Studying adults who experienced in-hospital cardiac arrest and using acute resuscitation survival (rate of return of spontaneous circulation for at least 20 minutes) and survival to discharge as endpoints, Chan and colleagues found encouraging trends among hospitals participating in GWTG-R (N Engl J Med 2012;367:1912-1920). Survival to discharge improved from 13.7 percent in 2000 to 22.3 percent in 2009. Acute resuscitation survival improved from 42.7 percent to 54.1 percent over the same period, and post-resuscitation survival increased from 32 percent to 42.9 percent.

There are similar trends in the pediatric arena. Between 2 and 6 percent of children admitted to intensive care units experience in-hospital cardiac arrest every year. Survival rates are poor and survivors often are left with neurological impairment. But a study of urban teaching hospitals with pediatric residency or fellowship programs participating in GWTG-R showed improvement among this vulnerable population as well (Circ Cardiovasc Qual Outcomes 2013; 6:42-49). Survival to discharge increased from 14.3 percent in 2000 to 43.4 percent in 2009 and post-resuscitation survival increased from 42.9 percent to 81.2 percent over the same time period. The researchers found no significant change in the percentage of survivors who experienced neurological impairment.

Saket Girotra, MD, an interventional cardiologist at the University of Iowa Hospital and co-author with Chan of the adult and pediatric studies, suggests there are a number of factors supporting increased survival of in-hospital cardiac arrest. Prompt recognition of patient distress, quality of chest compressions, timely defibrillation when necessary, proper administration of optimal medication, the engagement of hospital leadership in organizing better resuscitation team coordination and improved aftercare stand out among them. “All these are likely contributors, but we don’t yet have data to tell us what is driving these improvements. That is the next step for research,” he says.

There is some evidence that length of resuscitation efforts has an impact on survival (Lancet 2012;380:1473-1481). Again working with the GWTG-R registry, researchers analyzed the duration of resuscitation attempts in non-survivors at more than 400 hospitals to determine the mean length of resuscitation attempts before termination of rescue efforts. Overall, the mean length was 12 minutes for survivors and 20 minutes for non-survivors. But the researchers noted substantial variation between hospitals, with the hospitals in the quartile

with the longest duration of resuscitation attempts (mean of 25 minutes) engaging in resuscitative efforts 50 percent longer than hospitals in the quartile with the shortest duration of resuscitation (mean of 16 minutes). They found that patients who had cardiac arrests within hospitals with longer mean resuscitation attempt times were more likely to survive than those whose arrests occurred in hospitals with shorter mean resuscitation times.

Another recent study by a different team of researchers looked at cardiopulmonary resuscitation in surgical patients, and identified a potentially potent weapon against in-hospital arrest and mortality—prevention. This study found that complications, especially pneumonia and sepsis, preceded the large majority of cardiac arrests in surgical patients (JAMA Surg 2013;148[1]:14-21). Survival among these patients was poor—overall mortality at 30 days was 71.6 percent—but the authors concluded that many of these deaths could have been avoided through prevention of complications and expedient diagnosis and treatment of complications when they occurred.

Misperceptions Impede Progress

The opinion that the in-hospital cardiac arrest patient is unsalvageable persists, according to Chan. “There is a perception of futility that these patients are very, very sick, that they are unlikely to survive and that if they do survive, they will be neurologically devastated. Twenty years ago, that may have been true in many cases, but our research is showing it’s not true anymore,” he says.

In-hospital cardiac arrest is now less likely to be a result of MI or to be related to cardiovascular disease than it was in 2000, according to the analyses of GWTG-R data. Patients suffering in-hospital cardiac arrest are younger than they were in 2000 and more likely to have septicemia or other infections, to have been on mechanical ventilation and to have received intravenous vasopressors.

“Also, and very significantly, is that most patients who survive to discharge leave the hospital with no or minor neurological disability,” says Girotra. The study on survival outcomes showed that in 2000 half the patients who survived to discharge left the hospital with severe or clinically significant neurological disability, but by 2009, that percentage had dropped to 38.8 percent.

The study on duration of resuscitation attempts also examined neurologic status among patients who survived to discharge, and showed that those who survived long resuscitation attempts fared no worse neurologically than those whose resuscitations were shorter.

Researchers are currently exploring costs associated with survival of in-hospital cardiac arrest, aftercare, readmission and other variables, compared with the costs of surviving heart failure. “We are trying to paint an accurate picture of these patients to determine the amount of resources it takes to care for them after survival, and whether the outlook for these patients is really as pessimistic as is sometimes thought,” Chan says.

More granular data are necessary to identify the drivers of increased survival of in-hospital cardiac arrest and Chan says there is a need for funding to study cardiac arrest as a disease process. “If we can pinpoint exactly what the high-performing hospitals are doing well, we can establish good guidelines and best practices,” Girotra says. “Then, perhaps, we will see the sort of improvement that we have seen in MI survival extend to these patients, at all hospitals.”

http://www.cardiovascularbusiness.com/topics/prevention/hospital-cardiac-arrest-no-longer-‘unsalvageable’?page=0%2C1

 

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