Category Archives: Advanced CPR

Compression Only CPR By Kate Bolduan – WTVD-11 May 24 2007

wtvd

(05/24/07 — RALEIGH) – Two breaths and 15 compressions. That’s what most are taught when learning CPR, but that could change. Some Wake County paramedics now say skip the rescue breathing, and the success rate proves it’s working.

Seventy-four year old Ben Blalock and Wake County paramedic Larry Barham haven’t been friends long, but they have a very special bond after a fateful meeting in July.
Blalock said he and his wife had stopped at Bo jangle’s for breakfast. At the same time, Barham, who was returning from vacation, also stopped for breakfast.

Blalock collapsed inside the restaurant. He was suffering from a heart attack and went into cardiac arrest.

Barham jumped into action and immediately started CPR. “It was effective,” he said. “He’d start moving his extremities, he’d start opening his eyes.”

But what paramedics say saved Blalock was the type of CPR Barham used. It’s slightly different from traditional CPR.

It’s called compression-only CPR which means you place your hands in the center of the chest and begin compressions uninterrupted until help arrives. Paramedics say it’s simple, easy and saves lives.

Wake County EMS says its resuscitation success rate has almost doubled since it introduced the compression-only technique. They point out that for an inexperienced person, there’s much less to worry about under such stressful circumstances.

Fortunately for Blalock, the technique worked, giving him a new lease on life and a new friend.

Wake County’s not alone in using compression-only CPR. Durham, Orange and Cumberland also recommend it for the general public.

The American Heart Association still officially recommends breathing and compression, but it won’t argue with the success rate of the new approach.

To Treat the Dead; The new science of resuscitation is changing the way doctors think about heart attacks–and death itself.” Newsweek (May 7, 2007): 56

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Byline: Jerry Adler

Consider someone who has just died of a heart attack. His organs are intact, he hasn’t lost blood. All that’s happened is his heart has stopped beating–the definition of “clinical death”–and his brain has shut down to conserve oxygen. But what has actually died?

As recently as 1993, when Dr. Sherwin Nuland wrote the best seller “How We Die,” the conventional answer was that it was his cells that had died. The patient couldn’t be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn’t receive cardiopulmonary resuscitation within that time, and if his heart can’t be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. “After one hour,” he says, “we couldn’t see evidence the cells had died. We thought we’d done something wrong.” In fact, cells cut off from their blood supply died only hours later.

But if the cells are still alive, why can’t doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed . It was that “astounding” discovery, Becker says, that led him to his post as the director of Penn’s Center for Resuscitation Science, a newly created research institute operating on one of medicine’s newest frontiers: treating the dead.

Biologists are still grappling with the implications of this new view of cell death–not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by “reperfusion,” the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body’s primary defense against cancer. “It looks to us,” says Becker, “as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die.”

With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he’s lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? “We give them oxygen,” Becker says. “We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it’s taking up more oxygen.” Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.

Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a “cardioplegic” blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.

Becker also endorses hypothermia–lowering body temperature from 37 to 33 degrees Celsius–which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. “In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, ‘I don’t think we’re going to get this guy back,’ and then you just stop,” Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.

What’s Made the Biggest Diffrence in Patient Care in the last 3 years?

Over the past three years what procedure or medication has made the most difference in the way we practice care in the prehospital setting?

CPAP

Advances in caring for the patient who is in Congestive Heart Failure.

Prior to the availability of portable continuous positive airway pressure (CPAP) devices, patients were treated for acute respiratory distress with intubation, medications and extended intensive care stays. The addition of portable CPAP systems has cut the need for advanced airway care by as much as 50%. Reduced hospital stay and limited exposure to possible hospital acquired infections.

A recent study (Hubble, et.al) showed that the number needed to treat to prevent possible death was 6. For every 6 patients treated with CPAP the community avoids one bad outcome (death or disability).

According to the American Heart Association, people 40 and older have a 1 in 5 chance of developing CHF in their lifetime. Nearly 5 million people in the United States—mostly older adults—already have CHF, and the number of people with CHF keeps rising. About 550,000 people develop CHF each year.

Changes in protocols to include the early use of CPAP have led to better patient outcomes and reduced hospital costs. A win-win for both the patient and the community.

Wake EMS Uses New Tools During Cardiac Arrest

 

Continuing in it’s aggressive management of victims of cardiac arrest,the Wake County EMS System is using new tools to aid in resuscitation.

Vidacare's EZ-IO®

 

Vidacare’s EZ-IO® provides rapid vascular access during cardiac arrest or severe trauma.
Wake EMS was an early adopter of adult intraosseous routes for medication and fluid delivery. Using the battery powered handle the needle can be placed in a matter of seconds. No more searching for IV access in critical times.

With a coordinated team of firefighter first responders and County paramedics, Wake’s revival rates is one of the best in the Nation.

In addition to rapid vascular access, the Wake EMS System uses a device on the end of the endotracheal tube that maintains pressure in the cadio-pulmonary vascular bed aiding in cardiac blood flow.

The ResQPOD Circulatory Enhancer® from Advanced Circulatory Systems,INC.

ResQPOD Circulatory Enhancer®

is used in conjunction with uninterrupted CPR and continuous capnography.

 

[from the ACSI’s website] … Sudden cardiac arrest, traumatic injury, heat stroke and the common faint, for example, all result in states of low blood flow or perfusion. In each case, a lack of adequate blood flow back to the heart contributes to the low blood pressure. States of low blood flow impair the body’s circulatory function, which delivers oxygen to the body’s vital organs and removes toxic cellular waste.
ACSI’s circulatory enhancer technology uses inspiratory impedance to increase blood flow to the body’s vital organs. It is unique in that it enhances the body’s biophysical performance without depending upon pharmaceutical or other outside agents. This patented inspiratory impedance technology uses the relationship of the heart, lungs and thorax to increase venous blood return to the heart…