More people can survive a cardiac
arrest when emergency medical workers use a new resuscitation
method that starts with a round of 200 chest compressions
before a defibrillator shock, U.S. researchers said on Tuesday.
Rescue teams in Arizona who used the new approach on people
who had a cardiac arrest outside the hospital tripled the
survival rate of the standard approach.
"Cardiac arrest is incredibly common and survival is poor,"
said Dr. Bentley Bobrow, medical director for emergency
services for the state of Arizona and a researcher at the Mayo
Clinic in Scottsdale.
The new resuscitation method, which is not intended for
bystanders, increases blood flow to the heart and brain when
the heart stops pumping blood.
"Even if you could improve survival by a few percentage
points, you will save thousands of people across the country,"
said Bobrow, whose study appears in the Journal of the American
Medical Association.
For bystanders, the most important thing is to give chest
compressions while waiting for an ambulance, many experts say.
Cardiac arrest occurs when the heart stops circulating
blood. Most often, people with cardiac arrest have a type of
heart rhythm known as ventricular fibrillation, in which the
heart quivers but does not pump blood.
If no shock is delivered in the first four minutes of this
deadly rhythm, the heart stops altogether and it becomes much
harder to get it restarted. During this phase, old-fashioned
chest compressions can help push blood back into the heart,
making it more likely to restart.
As most emergency teams do not arrive on the scene in that
critical first four minutes, the new resuscitation approach
calls for a round of 200 chest compressions given in the first
two minutes to improve the odds that the heart will restart.
"Traditionally, we've told them to defibrillate right away.
When they do that, the patient dies frequently," Bobrow said in
a telephone interview.
In 2004, only 3 percent of people in Arizona who had a
cardiac arrest outside of a hospital survived.
Bobrow wanted to improve those odds. He and colleagues
studied the use of minimally interrupted cardiac resuscitation,
a highly choreographed method of CPR for emergency medical
workers that is also called cardiocerebral resuscitation.
After the first 200 compressions, the victim gets a shock,
then another worker jumps in and gives another set of 200 chest
compressions. At that point, they may give a shot of
epinephrine to stimulate the heart, and then insert a tube into
the trachea to ventilate the lungs.
The approach is focused on continuously pumping blood to
the heart and brain. Bobrow's team trained emergency workers in
two city fire departments in the state, then compared the
survival data before and after in 886 patients with cardiac
arrest. The data were collected between 2005 and 2007.
The rate of people who lived long enough to be discharged
from the hospital rose from 1.8 percent before the training to
5.4 percent using the new protocol.
The benefit was greatest for those who had ventricular
fibrillation with a shockable rhythm. Survival in those
patients rose from 4.7 percent to 17.6 percent.
Dr. Mary Ann Peberdy of Virginia Commonwealth University in
Richmond said the findings suggest the need for a
back-to-basics approach to cardiopulmonary resuscitation.
"We are learning more and more that we can't get sloppy on
how we do CPR," Peberdy said in a commentary in JAMA.(reuters)
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