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More Lives Saved from Cardiac Arrest with New CPR
“Cardiocerebral Resuscitation will have a
world-wide impact.”
April 14, 2006 - Survival rates following the most
common form of cardiac arrest – a common killer of senior citizens -
increased three-fold when emergency medical personnel used a new form of
CPR developed at The University of Arizona Sarver Heart Center. The new
approach, called Cardiocerebral Resuscitation, is dramatically different
from guideline-directed CPR procedures.
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Because of its importance, the editors of the
American Journal of Medicine chose to release the report in advance of
the journal’s April print issue.
“Cardiocerebral Resuscitation eliminates certain
previously recommended procedures and reprioritizes the order of actions
the emergency medical services deliver,” said Michael J. Kellum, MD,
leading author of the study report.
Under the new approach, first responders skipped
the first steps of the standard protocol: intubating (inserting a tube
into the windpipe) for ventilation and delivering a shock using a
defibrillator. While still attaching the victim to a defibrillator, they
did not wait for the device to analyze the patient’s heart rhythm, but
started fast, forceful chest compressions.
“Intubating the patient and waiting for the
defibrillator to do its analysis takes time – time a cardiac arrest
victim doesn’t have,” said Gordon A. Ewy, MD, director of the Sarver
Heart Center and co-author of the study. “I am convinced that
Cardiocerebral Resuscitation will have a world-wide impact.”
“In laboratory experiments, we found that the most
important factor of survival is to keep the blood moving through the
body by continuous chest compressions,” said Dr. Ewy, who pioneered the
CPR Research Group at the Sarver Heart Center. "Stopping chest
compressions for ventilations was far more harmful than helpful.
Excessive ventilations during chest compression turned out to be
harmful, too.”
First responders applying the new protocol were
able to resuscitate the majority (58 percent) of out-of-hospital
witnessed cardiac arrest victims, provided they had a “shockable”
initial heart rhythm. “Shockable” describes a condition in which the
heart quivers rather than beats but can be shocked back into normal beat
with a defibrillator. In contrast, the survival rate was only 20 percent
in the 3 years before, when the standard CPR protocol was used.
The current study, which involved 125 patients,
reports the experiences after the revised protocol was implemented in
two Wisconsin counties in a collaboration between the CPR Research Group
at the University of Arizona’s Sarver Heart Center and the Mercy Health
System in Wisconsin.
“We think one of the reasons that CPR as directed
by international guidelines has not worked well is because it is
designed for two entirely different conditions: cardiac arrest and
respiratory arrest,” said Dr. Ewy. “What is good for one may not be good
for the other. Cardiocerebral Resuscitation is designed for cardiac
arrest. Sudden unexpected collapse in an adult is almost always due to
cardiac arrest. The new approach is not recommended for respiratory
arrest, a much less common situation following, for example, drowning or
drug overdose.”
As a cause of death, out-of-hospital cardiac arrest
is second only to all cancer deaths combined, taking the lives of
490,000 Americans every year. Unlike the impression created by TV shows
such as “E.R.”, the chance of surviving an out-of-hospital cardiac
arrest is usually much less than 10 percent. In spite of periodic
updates of standardized international guidelines, survival rates have
remained more or less unchanged over the last couple of decades.
Survival rates are better only if an automated external defibrillator (AED)
is available and is used soon after the cardiac arrest.
Reference:
Michael J. Kellum, MD, Kevin W. Kennedy, MS, and Gordon A. Ewy, MD.
Cardiocerebral Resuscitation Improves Survival of Patients with
Out-of-Hospital Cardiac Arrest. The American Journal of Medicine (2006)
119, 335-340.
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