Friday, February 25, 2000
Restarting hearts is UC study goal
Gathering spots will get defibrillators
BY EARNEST WINSTON
The Cincinnati Enquirer
Angelo Ripellino was winning at the $5 slots when his heart abruptly gave out and he blacked out and collapsed.
He might have died there on the floor of the Grand Victoria Casino but for one thing: A casino worker, alerted to the commotion, grabbed a portable defibrillating machine and shocked his still heart into beating again.
Mr. Ripellino is proof that victims of cardiac arrest don't have to die in places where large groups of people gather, University of Cincinnati Medical Center officials say.
The university is part of a new national study to test expanded use of life-saving defibrillators in public facilities, where more than 50,000 Amer icans die of sudden cardiac arrest each year.
By October, defibrillators could be in trial use at two dozen Greater Cincinnati hotels, shopping malls, apartment buildings and sports and entertainment arenas. Music Hall and the Hyatt Regency Hotel, downtown, are the first to express interest.
The university plans to train everyday workers — rather than professional medical people — to operate the units. Defibrillators have become so easy to use that almost anyone can learn to save a life in cer tain cardiac crises, medical experts say.
“We want to know if placing these devices in the community where trained volunteers could access them will prevent additional deaths, and whether such a program is feasible,” says Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute, which is helping finance the tests.
The growing use of portable defibrillators is one of medicine's most promising ways of improving emergency first aid for people whose hearts suddenly stop beating. Electrodes attached to a victim's chest can deliver an electrical shock strong enough to jump-start a failing heart.
The units aren't for all heart ailments, however. Defibrillators won't help people whose hearts fail because the blood supply is blocked.
Defibrillators already are used by trained professionals in many Tristate police and fire departments. Delta is among airlines training flight attendants to operate the units in flight.
Grand Victoria and Argosy casinos on the Ohio River; Cinergy Field and Firstar Center, downtown; and area businesses, including Procter & Gamble Co. and General Electric Co., have the units. But use of the machines is spotty in most public places, where more than one-fourth of all sudden cardiac arrests occur.
About two dozen medical centers in the United States and Canada are participating in the $25 million study, which is being funded by the National Heart, Lung and Blood Institute and the American Heart Association.
UC will monitor use of the machines here for 18 months to learn if they help save lives and are worth the $3,000 that each unit costs.
Sudden cardiac arrest kills about 1,500 people in Greater Cincinnati each year. More than 95 percent of the 1,000 Americans who suffer from cardiac arrest each day die before reaching the hospital. In many cases, death occurs because life-saving defibrillators arrive on the scene too late, if at all, the Heart Association says.
Defibrillation is most successful if used within three minutes of a cardiac arrest. Every minute lowers the chances of survival up to 10 percent; and after 10 minutes, defibrillation usually fails.
In Cincinnati, emergency medical officials reach cardiac arrest patients about 8.5 minutes from the time 911 officials get the call. About 7 percent of victims are saved, says Dr. Michael Sayre, assistant professor of emergency medicine at UC's College of Medicine.
“The only way we're going to get to patients quicker is if we pre-position the defibrillators near to where we think cases might happen,” he says.
Sudden cardiac arrest can happen to anyone, but men in their 60s are most prone to be victims. Many victims have no history of heart disease, or the underlying ailment has not affected their lives.
When Mr. Ripellino's heart gave out, he and his wife of 54 years were enjoying a successful day at Grand Victoria Casino in Rising Sun, Ind.
When he came to, he felt “like a horse kicked me,” referring to the aftereffects of defibrillation shocks. “They told me I was dead for five minutes,” says Mr. Ripellino, 76.
Since December 1997, when Grand Victoria Casino put a defibrillator on its riverboat and another on land, workers have used the devices on seven patients. Only one has died.
“The intent was to provide a safe and healthy environment for our guests,” says Rick Probst, the casino's security director.
The Ripellinos have traveled from their Columbus, Ohio, home to the casino three more times since his cardiac arrest last May.
“I wasn't going to let it beat me,” Mr. Ripellino says. “I've been given something that most people aren't privileged to.”
Anyone with questions or comments about the Public Access Defibrillation Study can call 558-1191.
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