For those of us who got comfortably used to seeing changes in resuscitation science every five years, the past few years have seemed fast-paced. But the rate of change is accelerating. It's time to fasten your seat belt.
Thanks to the pioneering work of the past few years, we are now beginning to accumulate solid data on what works and what doesn't.
Here's what I suspect lies ahead:
First, the age of five-year updates is behind us. I think we'll see changes in resuscitation science guidelines far more frequently than every five years.
Second, a dirty little secret has surfaced: most people don't do CPR well enough. I think we will see an increasing focus on the quality of the resuscitation effort: fewer and shorter interruptions in chest compressions, compressions more compliant with the two inches or more guideline, and shorter pauses between the cessation of chest compressions and the delivery of the shock.
Additionally, the evidence is growing compellingly in favor of more broadly pursuing therapeutic hypothermia, not only for cardiac arrest victims, but others. The trick here is to get the hospitals who receive cardiac arrest patients from ambulances to get the equipment and establish the protocols that will permit them to continue therapeutic hypothermia, once a chilled patient arrives in their ED. (You really shouldn't be initiating TH in the ambulance unless the hospital to which you are transporting the resuscitated victim can continue it.)
I, for one, will be spending considerable energy pushing for these changes over the next few years. i hope that my pre-hospital companions across the land will press for the same changes in their geographic areas. There is no reasonable excuse to lose the number of people to cardiac arrest as we do, particularly in light of the fact that there is a 10:1 difference in success rates in different geographies.
We have never been so close to being able to make a difference. Please help make it happen.
Bob
When you see a cardiac arrest, your brain fights you - "No, this isn't really happening" - and the circumstances fight you - "Dang! in CPR class the manikin didn't weigh very much and wasn't sitting in a deep chair. This blog deals with practical details and presents reports of "saves." Let me have your questions and comments - they will steer the course of this blog. This blog is brought to you by the volunteers at www.slicc.org
Tuesday, August 9, 2011
Therapeutic Hypothermia. AKA "Ice 'em down"
Tim Larsen was sprawled out on the men's restroom floor, purple and lifeless, but his job supervisor had been trained for such an emergency.
Tim Evans, another employee at Crane/Pacific Valves, 3201 Walnut Ave. in Signal Hill, immediately applied cardiopulmonary resuscitation, compressing Larsen's chest cavity until the paramedics arrived.
Every moment was critical April 18, and Evans continued to perform CPR while the paramedics set up defibrillator paddles.
"He's a heck of a good guy," Larsen said of Evans. "I just can't thank him enough."
Once a heartbeat was detected, Larsen was rushed to Long Beach Memorial Medical Center, where doctors worked to stabilize him, intensifying their efforts to prevent brain damage by using a high- tech process known as Arctic Sun.
The technique requires putting a patient's body into a hypothermic state with cooling pads that are connected to a machine that regulates their temperature.
The hypothermia process is relatively new at Memorial, where it's been used on about 20 patients during the past 18 months, according to Dr. Nima Ramezan, director of Neuro-Science and Stroke.
Evans' work on Larsen had given the doctors hope that the hypothermia treatment would succeed.
Dr. Omid Vahdat, who treated Larsen, said that when using the Arctic Sun equipment, a heart patient's body remains in a hypothermic state for at least 48 hours while doctors check on the well-being of the brain.
"The brain is the most sensitive organ," Vahdat said.
Vahdat said that using hypothermia is similar to the effort to keep an injured ankle from swelling.
Without slightly cooling the body, the brain could be damaged. But the cooling reduces the potential inflammation.
"This is the same concept," Vahdat said. "And it helps the healing process."
The Arctic Sun cooling pads are attached to the patient's legs, chest and arms.
A team of doctors - the cardiologist, neurologist, intensive care unit and primary physicians - work with the nurses in monitoring the patient's temperature, which drops only a few degrees.
"The temperature is not that cold," Vahdat said.
The cardiologist said he's pleased by the results of the cases he's handled.
"We've had exceptional success using this methodology," he said.
Larsen - nicknamed "Lucky 19" Arctic Sun patient - benefited from the hypothermia process, displaying his wellness afterward by answering his doctor's questions and demonstrating memory skills, Vahdat recalled.
Two studies show that using induced hypothermia has contributed to improved neurological outcomes, Ramezan said.
Patients benefiting from induced hypothermia include those who are comatose within six hours after a cardiac arrest; those able to maintain a blood pressure after CPR; or those in coma at the time of cooling, according to a report by the Perelman School of Medicine, University of Pennsylvania.
Patients who might be at risk from the hypothermia treatment may include those with major head trauma; those who have had major surgery within 14 days, since hypothermia may increase the risk of infection and bleeding; and those with a systemic infection because hypothermia inhibits immune function, the report says.
Larsen, however, met the criteria for the hypothermia process, doctors said.
In general, patients are cooled using the induced hypothermia protocol for 24 hours to a goal temperature of 89 to 93degrees, just slightly lower than 97.8 degrees, which is the lowof the regular human body temperature range. The target time to reach the temperature goal is six to eight hours.
The doctors worked to keep Larsen's body from shivering by giving him a sedative, Vahdat said. Shivering is considered very uncomfortable, and it generates heat, impairing the patient's ability to achieve the target cool temperature.
The doctors also monitor Arctic Sun-treated patients for arrhythmia associated with hypothermia. They also provide skin care, checking for burns every six hours.
To warm back up to a normal body temperature takes patients about eight hours.
Ramezan, the director of Neuro-Science and Stroke, declined to give the exact percentage of success rate at Memorial, saying that the numbers are too small to give a clear indication.
One patient, Dave San Jose, has high praise for the medical method, and he marked the one-year anniversary of his victory over death Thursday. San Jose is a well-known North Long Beach resident whose heart attack and return from the brink of death were well- publicized.
"I can't prove it, but I know the Arctic Sun is responsible for me being alive," said San Jose, 70.
San Jose said there's a need for more Arctic Sun machines, adding that two were in use at Memorial when he arrived there last year, and one had to be borrowed from another hospital.
"That machine is the only reason I'm talking now," he emphasized.
Vahdat said he is impressed by the success of the process.
"These are people who truly cheated death," he said.
Copyright © 2011 LexisNexis, a division of Reed Elsevier Inc. All rights reserved.
Monday, August 1, 2011
Kayla Burt died in 2002
Kayla Burt, a former University of Washington basketball star, died in 2002 of a sudden cardiac arrest and recently was hired as an outreach coordinator for The Hope Heart Institute, a nonprofit research and education organization in Bellevue.
Her recovery from death-by-SCA has been attributed to her teammates having performed CPR on her until the medics arrived.
In 2002, this was a rare happening. Today it is more common. Yet several hundred thousand people die every year in the U.S.A., just because it isn't common enough. If you haven't been trained in Bystander CPR in the past year, just go do it. You have a one-in-seven chance of seeing at least one sudden cardiac arrest in your lifetime, and when you do, it will most likely be a family member or friend.
Of all the lines you don't want to hear at a funeral, the worst is "I meant to take a CPR course, but hadn't gotten around to it."
Probability-wise, not being trained is about the same as playing Russian Roulette, but with the pistol pointed at a family member or friend.
Her recovery from death-by-SCA has been attributed to her teammates having performed CPR on her until the medics arrived.
In 2002, this was a rare happening. Today it is more common. Yet several hundred thousand people die every year in the U.S.A., just because it isn't common enough. If you haven't been trained in Bystander CPR in the past year, just go do it. You have a one-in-seven chance of seeing at least one sudden cardiac arrest in your lifetime, and when you do, it will most likely be a family member or friend.
Of all the lines you don't want to hear at a funeral, the worst is "I meant to take a CPR course, but hadn't gotten around to it."
Probability-wise, not being trained is about the same as playing Russian Roulette, but with the pistol pointed at a family member or friend.
Thursday, July 28, 2011
Yeah, it works.
16-Year-Old Brings Little Brother Back To Life
by Kim Gebbia
PUTNAM COUNTY, Tenn. - A Putnam County three-year-old nearly drowned in his backyard pool. When his grandmother didn't know what to do, his teenage brother stepped in to save his life.
16-year-old Jeffrey Hall said he never thought he would remember what to do in an emergency and never thought that emergency would involve his little brother in his own backyard.
On Tuesday, Skyler disappeared from sight in their backyard pool when his grandmother, Karen Hall made a phone call inside the house. She walked outside and saw his life jacket on the cement and feared the worst.
"My eyes went directly and I saw his body laying at the bottom of the pool and I dived in," she said.
She pulled the three-year-old from the water, and admitted she didn't know what to do next.
"Just to have that baby in my arms, lifeless. To me he was gone and I didn't know what to do I felt helpless," said Hall.
But Skyler's brother, 16-year-old Jeffrey Hall, didn't feel helpless.
"I was very nervous and scared when I saw his body lifeless like that but I had to stay calm and think that I could save his life I could," said Hall.
He remembered the CPR lessons he learned at Cookeville High School, the lessons he thought he'd never have to use.
"I did five reps of the pushing and two breaths and he started coughing up and then I heard a sigh and it was the biggest smile on my face just happened," said Hall.
"When I saw him at Cookeville Hospital, when they had that baby I grabbed him and said Jeffrey thank you so much thank you so much for saving my baby," Hall said.
Skyler is almost recovered and eager to go home. Jeffrey said this toddler is a living lesson to all adults and teens that CPR saves lives; he just never thought it would be him saving his little brother's.
"If I wasn't there we would be going to funeral he would be gone," said Hall.
Jeffrey said he is organizing a CPR class for everyone on his street since so many of his neighbors in Cookeville have pools.
A detective from the Putnam County Sheriff's Department said Skyler is proof that those two hour classes are well worth the time in Cookeville High Schools.
by Kim Gebbia
PUTNAM COUNTY, Tenn. - A Putnam County three-year-old nearly drowned in his backyard pool. When his grandmother didn't know what to do, his teenage brother stepped in to save his life.
16-year-old Jeffrey Hall said he never thought he would remember what to do in an emergency and never thought that emergency would involve his little brother in his own backyard.
On Tuesday, Skyler disappeared from sight in their backyard pool when his grandmother, Karen Hall made a phone call inside the house. She walked outside and saw his life jacket on the cement and feared the worst.
"My eyes went directly and I saw his body laying at the bottom of the pool and I dived in," she said.
She pulled the three-year-old from the water, and admitted she didn't know what to do next.
"Just to have that baby in my arms, lifeless. To me he was gone and I didn't know what to do I felt helpless," said Hall.
But Skyler's brother, 16-year-old Jeffrey Hall, didn't feel helpless.
"I was very nervous and scared when I saw his body lifeless like that but I had to stay calm and think that I could save his life I could," said Hall.
He remembered the CPR lessons he learned at Cookeville High School, the lessons he thought he'd never have to use.
"I did five reps of the pushing and two breaths and he started coughing up and then I heard a sigh and it was the biggest smile on my face just happened," said Hall.
"When I saw him at Cookeville Hospital, when they had that baby I grabbed him and said Jeffrey thank you so much thank you so much for saving my baby," Hall said.
Skyler is almost recovered and eager to go home. Jeffrey said this toddler is a living lesson to all adults and teens that CPR saves lives; he just never thought it would be him saving his little brother's.
"If I wasn't there we would be going to funeral he would be gone," said Hall.
Jeffrey said he is organizing a CPR class for everyone on his street since so many of his neighbors in Cookeville have pools.
A detective from the Putnam County Sheriff's Department said Skyler is proof that those two hour classes are well worth the time in Cookeville High Schools.
Imagine what the little girl's mom was experiencing. You don't ever want to be in that spot. Get Trained!
San Jose: Teacher recounts resuscitating girl who nearly drowned in pool
By Mark Gomez mgomez@mercurynews.com
Posted: 07/28/2011 11:30:34 AM PDT
Updated: 07/28/2011 01:16:26 PM PDT
It's been a few years since Lynbrook High School teacher Jeff Bale has undergone CPR training. Wednesday night, the 29-year-old social studies teacher relied on that training to resuscitate a 6-year-old girl who moments earlier had been pulled out of the deepest part of a swimming pool.
"I was certainly nervous," Bale said. "When it's a real person, it's different than a test dummy."
Bale is one of a group of people who sprang into action Thursday night after a 40-year-old father and his 6-year-old daughter were found at the bottom of the 8-¿1/2-foot pool at the Regency Park townhome complex, off Miller Avenue near Vallco Shopping Mall.
The man and girl were pulled out of the pool by a family friend whose identity has not yet been released by the San Jose Fire Department. Fire officials have credited the family friend with saving the lives of the dad and daughter, who were both out of the hospital by early Thursday afternoon.
As of this morning, the father has been released from the hospital and the little girl was doing well but still hospitalized for observation, according to San Jose Fire Capt. Mary Gutierrez.
Gutierrez said the man who pulled out the father and daughter is declining all requests for interviews.
"He's humble and is not comfortable talking to the press," Gutierrez said. "He's happy that his friends are out of the hospital and are safe and sound."
The father and daughter are also declining interview requests.
Sometime around 9 p.m. Wednesday night, Linda Bale was home in her kitchen, which overlooks the swimming pool area, when she heard a cry for help. Her first thought was that kids were playing around. But then Bale saw the a woman -- the girl's mother -- screaming for help. Bale called out for her son Jeff.
As Linda Bale dialed 911, her son jumped over a metal fence surrounding the pool area and ran to the girl, who was lying on the concrete, unconscious and not breathing. He also saw the family friend trying to pull out the girl's father from the deepest part of the pool.
"It was pretty clear she wasn't breathing," Jeff Bale said. "Her mom was already trying to do some impromptu CPR. She kept yelling, 'I don't know how to do CPR.' "
Bale resuscitated the girl after about a dozen compressions. She coughed up some water and started making noises, Bale said. Then the girl started crying.
San Jose firefighters say the girl was sitting atop her father's shoulders as he stood in the shallow end of the pool at about 8:55 p.m. The mother and other friends and neighbors in the complex sat some 25 feet away in a hot tub, facing away from the pool.
Then the mother and friends heard an eerie quiet in the pool. The mother and a family friend got out of the hot tub and ran over to the pool to discover two bodies the bottom of the pool, according to fire department officials.
The friend immediately jumped into the water and pulled both the unconscious girl and her father from the pool. Other people in the area had revived the man by giving him CPR, firefighters said.
"The man was in shock," Jeff Bale said. "We got towels and tried to get him warm. He had a very glassy look."
Jeff Bale deflected credit for his role in saving the girl, saying the family friend who dove into the water deserves the credit, as well as the first-responders who arrived to help.
"This was a community effort," said Bale, adding that the incident has "encouraged me to get a refresher course," in CPR training.
Staff writer Mike Rosenberg contributed to this report. Contact Mark Gomez at 408-920-5869.
By Mark Gomez mgomez@mercurynews.com
Posted: 07/28/2011 11:30:34 AM PDT
Updated: 07/28/2011 01:16:26 PM PDT
It's been a few years since Lynbrook High School teacher Jeff Bale has undergone CPR training. Wednesday night, the 29-year-old social studies teacher relied on that training to resuscitate a 6-year-old girl who moments earlier had been pulled out of the deepest part of a swimming pool.
"I was certainly nervous," Bale said. "When it's a real person, it's different than a test dummy."
Bale is one of a group of people who sprang into action Thursday night after a 40-year-old father and his 6-year-old daughter were found at the bottom of the 8-¿1/2-foot pool at the Regency Park townhome complex, off Miller Avenue near Vallco Shopping Mall.
The man and girl were pulled out of the pool by a family friend whose identity has not yet been released by the San Jose Fire Department. Fire officials have credited the family friend with saving the lives of the dad and daughter, who were both out of the hospital by early Thursday afternoon.
As of this morning, the father has been released from the hospital and the little girl was doing well but still hospitalized for observation, according to San Jose Fire Capt. Mary Gutierrez.
Gutierrez said the man who pulled out the father and daughter is declining all requests for interviews.
"He's humble and is not comfortable talking to the press," Gutierrez said. "He's happy that his friends are out of the hospital and are safe and sound."
The father and daughter are also declining interview requests.
Sometime around 9 p.m. Wednesday night, Linda Bale was home in her kitchen, which overlooks the swimming pool area, when she heard a cry for help. Her first thought was that kids were playing around. But then Bale saw the a woman -- the girl's mother -- screaming for help. Bale called out for her son Jeff.
As Linda Bale dialed 911, her son jumped over a metal fence surrounding the pool area and ran to the girl, who was lying on the concrete, unconscious and not breathing. He also saw the family friend trying to pull out the girl's father from the deepest part of the pool.
"It was pretty clear she wasn't breathing," Jeff Bale said. "Her mom was already trying to do some impromptu CPR. She kept yelling, 'I don't know how to do CPR.' "
Bale resuscitated the girl after about a dozen compressions. She coughed up some water and started making noises, Bale said. Then the girl started crying.
San Jose firefighters say the girl was sitting atop her father's shoulders as he stood in the shallow end of the pool at about 8:55 p.m. The mother and other friends and neighbors in the complex sat some 25 feet away in a hot tub, facing away from the pool.
Then the mother and friends heard an eerie quiet in the pool. The mother and a family friend got out of the hot tub and ran over to the pool to discover two bodies the bottom of the pool, according to fire department officials.
The friend immediately jumped into the water and pulled both the unconscious girl and her father from the pool. Other people in the area had revived the man by giving him CPR, firefighters said.
"The man was in shock," Jeff Bale said. "We got towels and tried to get him warm. He had a very glassy look."
Jeff Bale deflected credit for his role in saving the girl, saying the family friend who dove into the water deserves the credit, as well as the first-responders who arrived to help.
"This was a community effort," said Bale, adding that the incident has "encouraged me to get a refresher course," in CPR training.
Staff writer Mike Rosenberg contributed to this report. Contact Mark Gomez at 408-920-5869.
Tuesday, July 26, 2011
If you had been the bystander, would that child still be alive? It doesn't take long to learn what to do.
Quick action of babysitter may have saved child in pool
A toddler who nearly drowned in a backyard pool this afternoon on Raspberry Patch Drive in Greece is recovering tonight at Strong Memorial Hospital.
According to Greece Police, the quick action of an adult babysitter who performed CPR may have saved the child’s life.
Around noon, police and first responders from North Greece Fire Department and Greece Volunteer Ambulance were called to 185 Raspberry Patch Drive for a report of a child found non-responsive in a pool, according to police.
A 2-year-old child had apparently exited the residence and entered the above-ground pool via an attached deck.
While emergency crews were enroute, a babysitter at the home removed the child from the pool and performed CPR, which revived the child.
Police did not release the names of the child or babysitter.
According to police, at last check with the hospital, the child “was reported to be doing well.”
A toddler who nearly drowned in a backyard pool this afternoon on Raspberry Patch Drive in Greece is recovering tonight at Strong Memorial Hospital.
According to Greece Police, the quick action of an adult babysitter who performed CPR may have saved the child’s life.
Around noon, police and first responders from North Greece Fire Department and Greece Volunteer Ambulance were called to 185 Raspberry Patch Drive for a report of a child found non-responsive in a pool, according to police.
A 2-year-old child had apparently exited the residence and entered the above-ground pool via an attached deck.
While emergency crews were enroute, a babysitter at the home removed the child from the pool and performed CPR, which revived the child.
Police did not release the names of the child or babysitter.
According to police, at last check with the hospital, the child “was reported to be doing well.”
Monday, July 25, 2011
Teen buried in sand dies and is brought back.
SANTA CLARA, Calif. -- A California teenager was hospitalized after a sand tunnel she was digging collapsed on her.
Anjelica Marroquin was digging the tunnel at Doran Beach with her brother and nephew when it collapsed, burying the 17-year-old from her head to her knees.
The girl was trapped for nearly two minutes before family members managed to free her.
"They pulled her out, she was blue, her heartbeat was really, really light," beachgoer Anissa Barajas told San Francisco's KTVU-TV.
A bystander revived her using CPR and Marroquin was taken to a local hospital, where she was recently released. She is expected to fully recover.
"I'm so grateful I got my daughter back," said her mother, Shannon Jefferies.
Read more: http://www.wyff4.com/news/28655568/detail.html#ixzz1TALmWC79
Anjelica Marroquin was digging the tunnel at Doran Beach with her brother and nephew when it collapsed, burying the 17-year-old from her head to her knees.
The girl was trapped for nearly two minutes before family members managed to free her.
"They pulled her out, she was blue, her heartbeat was really, really light," beachgoer Anissa Barajas told San Francisco's KTVU-TV.
A bystander revived her using CPR and Marroquin was taken to a local hospital, where she was recently released. She is expected to fully recover.
"I'm so grateful I got my daughter back," said her mother, Shannon Jefferies.
Read more: http://www.wyff4.com/news/28655568/detail.html#ixzz1TALmWC79
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