Issue: Does a out patient radiology center have a obligation to attempt resuscitation of a patient how suffers a cardiac arrest in their facility? 73 year old female, presented to out patient radiology center for a US GUIDED CORE BREAST BIOPSY -LEFT. US could not "find the mass" so the patient was discharged with instructions to follow-up. While getting dressed, the patient collapsed. Patients' family member reports no action was taken by staff other than to call EMS. When aske, the family member said no actions were taken. The EMS records seem to corroborate this.
Time line:
Dispatch: 2024-05-I0 14:05:22
Arrival: 2024-05-I0 14:12:47
According to the EMS record no resuscitation, CPR, medication use etc. was used at all before their arrival. EMS was able to restore circulation. The patient was Diagnosed with significant HIE and after a neurological evaluation revealed clinical brain death life support was withdrawn and the patient expired.
Files:
Q: Did facility have basic CPR equipment?
A: At this time we do not know. IN response to our records requests the records did not even note the event.
Q: Did the outpatient imaging center perform other exams, such as contrast enhanced mammography, or post contrast CT or MRI?
A: —
Do you believe there might have been medical error?
staff should be trained to have ACLS or BLS certification and should make an attempt to take a pulse, get vitals and do basic CPR until help arrives. At the very least they should assess for a heartbeat document, and get the defibrillator device ready to check the rhythm. These are no-brainer actions and the machine literally makes the decision for you. Otherwise, why even bother getting the certification or have a defibrillator onsite?
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
seven minutes is a lifetime in CPR. if they had just restored some circulation with chest compressions only and I'm not even talking about breaths or airway bagging it's possible they might have had a better neurological outcome. Depend depending on the cause of the code there may even have been medications to inject on site.
What makes you a good expert for this case?
I am a radiologist at a major academic center, and I have trained in ACLS and BLS and maintain those certifications throughout my career. I have been called by the technologies to respond to unstable patients at the CT scanner and other radiological equipment. I have seen complications for procedures, injections, scans in inpatient and outpatient settings.
How often do you encounter cases similar to this one in your practice?
once every couple months, there will be a complication and an imaging center. A cardiac arrest is quite rare. It might only happen once every few years.
Do you believe there might have been medical error?
If the center is accredited by The Joint Commission, ACR, or IAC, those bodies generally require: - A written emergency response plan - Basic Life Support (BLS)-trained staff on site - A crash cart or AED accessible - Clear protocols for activating EMS (911)
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
In any cardiac arrest, time to defibrillation (Tdefib) is the single most important variable associated with survival, as mortality increases up to 10% for each additional minute of delay in defibrillation. Great strides in improving the "chain of survival" have been achieved for both in-hospital and out-of-hospital cardiac arrest, from early access to emergency services to early CPR to early defibrillation.
What makes you a good expert for this case?
I have 20 years experience in both hospital and outpatient imaging services. However, I have not been involved in resuscitation of a patient.
How often do you encounter cases similar to this one in your practice?
Never. I currently do offsite teleradiology.
Do you believe there might have been medical error?
If intravenous contrast material is administered at the same imaging center there is an even higher obligation to have capabilities for at least BLS/AED or even ACLS/Crash cart trained personnel versus an imaging center where contrast material is not used which would have the same obligation of any outpatient clinic which would be simply calling 911 and initiation of BLS/AED (if available).
Do you believe there might have been causation (i.e. the medical error resulted in an injury)?
Delayed resuscitation is most likely cause of hypoxic injury.
What makes you a good expert for this case?
I am a Chair of Radiology which includes overseeing an outpatient imaging center.
How often do you encounter cases similar to this one in your practice?
Medical emergencies in Radiology are rare, but they need to be handled like any other medical emergency.
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Comments are accepted only from Diagnostic Radiology - includes all subspecialties experts.