Releases Saturday 9 June 2001
No 7299 Volume 322
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(1) SHORTER AMBULANCE RESPONSE TIMES
WOULD CUT HEART ATTACK DEATHS
(2) RISK
OF DEATH GREATER IN DIABETICS
REGARDLESS
OF SEX, AGE OR AFFLUENCE
(3) MOST
DOCTORS DO NOT POSITION
RESUSCITATION
PADDLES CORRECTLY
(1) SHORTER AMBULANCE
RESPONSE TIMES
WOULD CUT HEART ATTACK DEATHS
(Effect of reducing ambulance response
times on deaths
from out of hospital cardiac arrest:
cohort study)
http://bmj.com/cgi/content/full/322/7299/1385
Reducing ambulance response times to 5
minutes could
almost double the survival rate for cardiac
arrests not
witnessed by ambulance crews, finds a
study in this
week's BMJ.
All out of hospital cardiopulmonary arrests
due to cardiac
disease attended by the Scottish Ambulance
Service
during May 1991 to March 1998 were analysed
to
determine the association between ambulance
response
times and survival from cardiac arrest
in the community.
Two predictive models were then developed
to assess the
potential impact on survival of reducing
response times.
The team found that ambulance response
times are
independently associated with defibrillation
(administering
an electric shock to restore a normal
heartbeat) and
survival. Currently, ambulances in the
United Kingdom are
required to respond to 90% of emergency
calls within 14
minutes. Our models suggest that increasing
this target to 8
minutes would increase survival from 6%
to 8%, explain
the authors, while responding to 90% of
calls within 5
minutes would increase survival to 10-11%.
Reducing response times would inevitably
require
additional resources, add the authors.
However, previous
studies suggest that the additional cost
would be less if the
reduced times were achieved by equipping
other first line
responders (such as fire fighters and
the police) with
defibrillators.
Contact:
Stuart Cobbe, Walton Professor of Medical
Cardiology,
University of Glasgow, Glasgow Royal Infirmary,
Scotland.
Email: stuart.cobbe{at}clinmed.gla.ac.uk
(2) RISK OF DEATH
GREATER IN DIABETICS
REGARDLESS OF SEX, AGE OR AFFLUENCE
(Excess mortality in a population
with diabetes and the
impact of material deprivation:
longitudinal, population
based study)
http://bmj.com/cgi/content/full/322/7299/1389
(Editorial: Diabetes black spots
and death by postcode)
http://bmj.com/cgi/content/full/322/7299/1375
A study in this week's BMJ finds that people
with diabetes
are at a higher risk of death - irrespective
of age, sex or
affluence - compared to those without
diabetes. This
excess mortality exists even in the poorest
areas of the
United Kingdom, where death rates are
already above the
national average, and presents a depressing
snapshot of
the prospects for diabetic people in the
UK today.
Roper and colleagues identified people
with known
diabetes living in the South Tees region
of the UK on 1
January 1994. Over a six year period,
deaths in this group
were compared with the mortality of the
population of
England and Wales and the local population
without
diabetes. A measure of material deprivation
was also
calculated for each participant.
The team found excess mortality in people
with diabetes in
both sexes and across all ages - extending
even to those
aged 80 and over, but most pronounced
in young people.
In both men and women diagnosed with diabetes
by the
age of 40, life expectancy was reduced
by eight years
compared to people without diabetes. Women
diagnosed
after the age of 50 lost more years than
men. Even the
most affluent people with diabetes still
had a higher
mortality than the local population without
diabetes, say
the authors, and this excess increased
with worsening
material deprivation.
Given that the main cause of death in our
group with
diabetes was ischaemic heart disease,
say the authors,
aggressive approaches to the management
of
cardiovascular risk factors could reduce
the risk of
premature death in people with diabetes.
Obesity is now recognised as a cardiovascular
risk factor
in its own right, and this may well explain
a large part of
the excess cardiovascular mortality associated
with social
deprivation, writes Professor Gareth Williams
in an
accompanying editorial.
He describes the rising prevalence of diabetes,
particularly
amongst young people, and the "dire consequences"
of
this increasing burden both in the UK
and the developing
world. "We can only hope that the national
service
framework and its counterparts in other
countries can rise
to these difficult challenges and that,
against expectation,
public health measures will be able to
turn the rising tide of
obesity," he concludes.
Contacts:
[Paper]: Nick Roper, NHS Research Training
Fellow,
Diabetes Care Centre, Middlesbrough General
Hospital,
Middlesbrough, UK
Email: n.a.roper{at}ncl.ac.uk
[Editorial]: Gareth Williams, Professor
of Medicine,
Department of Medicine, University Hospital
Aintree,
Liverpool, UK
Email: garethw{at}liv.ac.uk
(3) MOST DOCTORS
DO NOT POSITION
RESUSCITATION PADDLES CORRECTLY
(Do doctors position defibrillation
paddles correctly?
Observational study)
http://bmj.com/cgi/content/full/322/7299/1393
Most doctors do not position defibrillation
paddles in
accordance with European Resuscitation
Council
guidelines when attempting to resuscitate
patients in
cardiac arrest, finds a study in this
week's BMJ.
Deakin and colleagues recruited 101 doctors
of all grades
and specialities at Southampton General
Hospital, who
were unprepared and unaware of the nature
of the study.
They were shown an anatomically accurate
male
resuscitation manikin and were asked to
perform
defibrillation (administering an electric
shock to restore a
normal heartbeat) by placing two defibrillation
pads
(sternal and apical) on the chest wall,
on to which were
placed the corresponding paddles. The
position of the
centre of the pads was recorded using
a grid placed over
the chest wall.
Overall, 65% of sternal paddles were placed
within 5cm
of the position recommended in the guidelines.
However,
only 22% of apical paddles were placed
correctly. Paddle
positioning did not differ between doctors'
grades or
specialities or between those who had
received
defibrillation training within the past
three years and those
who had not.
Given that each minute of delay in restoring
normal heart
rhythm increases mortality by 7-10%, teaching
of
advanced life support must place greater
emphasis on
paddle position if successful defibrillation
is to be
optimised, conclude the authors.
Contact:
Charles Deakin, Consultant Anaesthetist,
Southampton
General Hospital NHS Trust, Southampton,
UK
Email: cddeakin{at}hotmail.com
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(http://www.eurekalert.org)
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