There is no good place to suffer cardiac arrest. But if you do, a hospital is obviously one location where quick treatment is likely to increase the chances of recovery. As described in two papers in The New England Journal of Medicine, certain casinos in Nevada and Mississippi, and some airlines, also make recovery a better bet.
The type of cardiac arrest concerned is that caused by ventricular fibrillation, in which contraction of heart-muscle fibres becomes uncoordinated. The key to treatment is the use of defibrillating equipment, and swiftly: with each minute that passes, the possibility of recovery falls rapidly.
T. D. Valenzuela et al. (N. Engl. J. Med. 343, 1206–1209; 2000) report the results of a programme in which defibrillators were installed in casinos and security staff were trained to use them. The overall success rate, judged by a patient's eventual discharge from hospital, was 53%. The national average is just 5%.
The other study (R. L. Page et al. 343, 1210–1216; 2000) involved American Airlines. Like some other aircraft operators, American Airlines has introduced defibrillators on its planes and trained flight attendants to use them. Here the rate of survival was 40%, which compares well even with the rates achieved by quick-response emergency services in other circumstances. The authors calculate that if all commercial aircraft carried the equipment, 93 people would survive who would otherwise have died each year.
The authors also point to a study showing that age need not be a barrier to the effective use of defibrillators. Twelve-year-old children took only 27 seconds longer to carry out defibrillation than medical personnel, albeit in simulations.
But perhaps a safer approach is to avoid flying or gambling altogether. Cardiac arrest is more common in these situations than in most other public places — although, in the case of casinos, it is not clear whether the main factor is winning, losing or just being there.
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