The study needs to be done.

The NIH has launched two multicenter clinical trials that will evaluate treatments for sudden cardiac arrest that occurs out of the hospital.

The CCC trial will compare survival with hospital discharge rates for two CPR approaches — continuous chest compressions combined with pause-free rescue breathing vs. standard CPR — delivered by paramedics and firefighters to those experiencing cardiac arrest. Trained emergency personnel will give all participants in the CCC trial three cycles of CPR followed by heart rhythm analysis and, if needed, defibrillation.

There have been two trials in Scandanavia that showed 30%-40% improvements in outcome with compression-only CPR. There was a study in Japan that showed that, for a specific class of heart disease, compression-only CPR was not as good as 30 & 2 CPR.

What will really be interesting is to see whether the promotion of compression-only CPR will persuade more people to take action at the scene of a cardiac arrest. If compression-only CPR increases the number of bystanders who take action, it the CCC trial will conclude that continuous-compression CPR is a really good thing.

A related, recent study showed that cardiac arrest victims who were intubated - the traditional gold standard for control of the airway - fared far worst than victims who were not intubated. Apparently, it's all about minimizing interruptions during chest compressions, at least in the first 5-10 minutes.

It's easy to read the paper without realizing what needs to be fixed.

Tragically, a 64 y/o gentleman died in San Antonio yesterday. The cause of death has not been announced, but it's likely that it was either a sudden cardiac arrest, a ruptured aortic anurism, or asphyxia via drowning, with the most likely being a sudden cardiac arrest.

It is apparent from the article that there are a number of problems with the way public pools are staffed and managed that make it unlikely that someone could survive in the situation this gentleman encountered. Even more sadly, most of these factors are to some degree controllable by the management of the pool.

THE SHORT FORM:
My mission is not to criticize anyone. My Mission is to point out that the odds of surviving were not good for several structural reasons and to rally public support for changing the environment.

THE DETAILS:
KSAT.com published the news, and their story included the following.

• "Annett told KSAT that she and her husband were swimming on Friday when she noticed him at the bottom of the pool.
• "She called for help and three lifeguards pulled him out and administered CPR, but Earl did not survive."
• There was no mention of an AED's having been used.

OK. Let's stop there and think about what we just read.

• A quick check on the internet reveals that there are two pools at the Blossom Center in San Antonio: a 25 meter long pool, 7-13 feet deep and a 50 meter long pool, 3-12 feet deep.
• These pools are in adjacent buildings.
• The 'three lifeguard' reference suggests that two were assigned in the building that houses the larger pool, and one was assigned in the building that houses the smaller pool.
• The story states that it was the three lifeguards that pulled the victim from the pool.
• The story also clearly states that it was the wife who spotted the victim on the bottom and called for help.

The victim's chances of surviving the incident depends upon the cause of death and the timing of the steps taken subsequent to the victim's sinking to the bottom.

Let's first estimate how much time elapsed between the time of the incident and the time that CPR was initiated. I've included my estimate of the "shortest" (the minimum time possible) and "more likely" (the more likely value for that timing). These "more likely" values are by no means maximums. I am a swimmer and a paramedic and have had to respond in emergency situations.

1. Discovery: the time between the event and the time the body was noticed on the bottom;
2. LG's know: the time between the the body's being noticed and the cries for help were heard and understood by the lifeguards.
3. Response to victim: the time between the cries for help were understood by the lifeguards and the time enough lifeguards were on the bottom at the victim's side to begin getting the victim out of the water.
4. Extrication: the time between the start of the extrication and the time the victim was on his back out of the pool on a hard flat surface.
5. To begin CPR: the time between the victim's being on his back on a hard, flat surface and the time CPR compressions were begun.

Item	Shortest	More Likely	Comments
1.Discovery	2 sec	180 sec	Which pool, how crowded
2. LG's know	3 sec	15 sec	Try yelling something to a LG in an enclosed pool.
3. Response to victim	15 sec	50 sec	Try it before you scoff. If you can swim 50 meters in 50 seconds, the local swimming coach wants to meet you. When you are in rescue mode you can run to a closer point, but on the average - if you are the only LG at a 25 meter pool or one of two LG's at a 50 meter pool, it's going to take you the better part of a minute to get into the water and get alongside the victim on the bottom, sometimes more, sometime's less.
4. Extrication	90 sec	120 sec	If you haven't had to do this, please try it before you complain about my estimates.
5. To begin CPR	1 sec	15 sec	Lifeguards are taught certificated CPR. That's necessary to make sure that management can be reasonably assured that the LG's actually attended class and passed.
Totals	1:51	6:20	If it took 6:20 to begin CPR, his odds of surviving with major brain functions intact had rapidly dwindled to about 1 in 20 by the time CPR began. (10% per minute)

OPPORTUNITIES:

1. There need to be enough life guards on duty so that they have a high likelihood of being the first to notice the problem. One easy way of sizing up the life guard staffing, quality, and management is to walk up to a lifeguard, positioning yourself, if possible, to make sure he or she cannot see the pool, and ask how many people are in the pool. If the LG can't tell you instantly - and without looking at the pool - there is a problem. If there is only one on duty, there is a problem.
2. There have to be enough life guards on duty to get any given swimmer from the bottom to the surrounding deck. After I saw the article this morning, I headed over to a local community pool, saw the lifeguard - a strong, fit person - intently watching the pool. I then took a look at the swimmers and made the assessment that about a quarter of the swimmers were people that the strong, fit LG on duty could not have single-handedly gotten out of the pool. (Yes, the LG answered without hesitation that there were nine people in the pool.)
3. The LG has to have access to other help and an AED. If he or she are in a "one LG, one swimmer" situation, the LG needs a way of activating the emergency network (calling 911) and of getting an AED and a helper to his or her side quickly.
4. There has to be an AED at the facility for the helper, when notified, can bring.
5. The LG's have to drill. How many LG's regularly have had to get 200 pounds of limp victim off the bottom and onto the deck in a position ready for chest compressions?

None of these changes will happen without public pressure. Bob

Know CPR, have AED handy - it works.

RICHMOND – A 57-year-old grandfather watching his granddaughter play in a high school basketball game collapsed in the stands Tuesday night, and authorities are crediting the skillful, quick use of an AED in reviving him.

Richmond-Burton High School athletic trainer Julianne Stewart administered a shock to the Poplar Grove man with an automated external defibrillator – one of four the school has on premises. He had suffered a heart attack and collapsed face forward about 7:15 p.m., just before half time, school and emergency officials said.

“Julianne Stewart had the wherewithal to get the AED and ... she delivered a shock to revive the gentleman,” Richmond Township Fire Protection District Chief Rick Gallas said. “By the time we got there, he was breathing and starting to talk.”

A Richmond emergency crew took the man, whose name was not released, to Centegra Hospital – McHenry.

Gallas also credited Dave Ernst, a father who was in the stands for his daughter’s basketball game, for performing CPR on the man before Stewart came over with the defibrillator.

“Dave determined that [the man] was not breathing; he was turning purple, and did CPR on him,” he said.

Richmond-Burton Principal Tom DuBois said the incident was a bit frightening, but that everyone involved responded appropriately and everyone was happy about the positive outcome.

“His son and daughter-in-law just stopped by to thank us,” DuBois said Wednesday morning. “They were on their way to the hospital to go see him. … He appears to be doing OK.”

Gallas said the quick response should greatly benefit the man’s recovery.

“It just goes to show the value of CPR and the use of an AED in the field,” said Gallas, who added that the fire department will present both Ernst and Stewart with a life safety award.

Ernst and Stewart were unavailable to comment Wednesday.

Yeah - what he said.

The Athletic Heart: Sudden Cardiac Death in Athletes
By Ramin Manshadi, MD, FACC, FSCAI, FAHA, FACP
Jan 11, 2012 - 10:32:17 PM

(HealthNewsDigest.com) - Sudden Cardiac Death (SCD) is a non-traumatic, nonviolent, unexpected death due to cardiac causes within one hour of the onset of symptoms. Though there is no official registry, research suggests between 200-300 high school athletes die of SCD each year.

What Happens During Sudden Cardiac Death?

Simply, these athletes die of arrhythmias.

A correctly functioning heart has electrical activity going from the top of the heart to the bottom, making the heart squeeze and pump correctly. An arrhythmia is when the entire electrical portion of the heart is firing all at once. The muscle cannot function. The pumping fails. You pass out since you’re not getting enough oxygen to the brain, and in time you die. The most obvious sign of an arrhythmia is blacking out due to lack of blood pressure.

CPR doesn’t really revive you. That can happen, but CPR really just keeps your heart pumping blood through your body by pressing down on the chest. This keeps you alive until paramedics or someone arrives to perform more intensive intervention (like with a defibrillator) to restore heart function. In fact, you should be aware that CPR isn’t even always successful. It really needs to be performed perfectly to keep a patient alive. That’s why staying practiced and updated on its ever-improving protocols is so vital. If you ever have the opportunity to learn or review your CPR skills – take it.

Fortunately, young athletes are generally very healthy. As soon as they’re down, if you shock them with a defibrillator, their heart rhythm can restore. They come back very fast and are just like they were before. It’s pretty astonishing.

Prevention as Solution

If we have a policy in place in which a competent physician evaluates all athletes before they start rigorous exercise activity, we can prevent many young athletes from abruptly collapsing and dying.

Others have already begun doing this. In Northeastern Italy, a simple EKG test has been added to the examination of all athletes. An EKG is a simple exam costing only around $30. With this simple testing, they were able to cut down the risk of sudden cardiac death in their athletes by 85 percent!

We need to adopt using such a test in the United States as well. While there are more expensive tests one can do (like an echocardiogram), an EKG should be able to detect over 95 percent of those with the underlying conditions that could lead to sudden cardiac death.

Athletes should be aware of the possible warning signs of SCD, which include:

Chest pain
Palpations
Dizziness
Feelings of passing out
Shortness of breath outside of the norm one would expect with exercise

If experiencing these symptoms, a cardiologist knowledgeable about SCD in athletes should evaluate the person.

The Solution on the Field

While prevention is key, something can also be done if an arrhythmia causes an athlete to collapse.

A terrific device called a defibrillator sends a therapeutic dose of electrical current into a person’s body to normalize heart function in various life-threatening situations. It’s what you’ve seen on TV and in movies, where paramedics place paddles on the patient’s chest in a hospital or, and the heart is “shocked” back into beating correctly.

In real life, if someone collapses and you get to him or her within five minutes and shock him or her out of arrhythmia, they will likely survive. But if it takes longer than five minutes to shock them in this manner, the likelihood of survival is almost zero. That’s why these devices need to be at athletic fields everywhere. The time it takes for someone to phone for help, for paramedics to arrive and get to the student, break out the equipment and use it – will most likely exceed those precious five minutes.

Portable Automatic Defibrillators

Fortunately, there are also portable “automatic” defibrillators. Even a person with little training can use one. You simply attach the leads to the chest, press the button, and it performs its own diagnosis and shock. So if someone collapses, you grab it and use it right away before paramedics even get there. If a portable automatic defibrillator is applied within the first minute, the survival rate is 90 percent. But if no such defibrillator is present, then survival drops to five percent, even with CPR. These defibrillators cost about $2000 each, but if one of these can save someone’s life, they’re worth many times that. It is imperative that high schools and colleges possess these life-saving tools.

Most recently, The Sacramento Kings basketball organization realized the importance of schools having portable “automatic” defibrillators, and has been working to create a PSA (public service announcement) to raise awareness of sudden cardiac death in athletes. In fact, once the owners, Gavin and Joe Maloof, originally became aware of this project, they immediately got personally involved. Geoff Petrie, the General Manager, similarly offered to support the cause without hesitation. In addition, their media team has shown a genuine caring attitude in their assistance with this PSA community.

Athletics Offers Terrific Benefits

Athletics has benefits far beyond the exercise and fitness. It has the positive effect of socialization, competitiveness and teamwork, Plus the sense of achieving a goal. Every student-athlete should be involved in some sport. Not necessarily to become a pro and earn money, but to develop these values that will help in their future and daily work lives.

Being competitive, while also being a gentleman or gentlewoman as an athlete, is an example of what can help you to be successful in life.

It is important to relate this because while there are risks in everything, there are distinct benefits as well. It wouldn’t be beneficial for parent or student to shy away from participating in athletics because of anything that has been presented here.

It is important to relay health information like what has been described above, even if it makes some people uncomfortable. Perhaps that discomfort will motivate others to champion their own quest to enhance protections for our young athletes.

Knowledge is Powerful

Bottom line, athletes must simply be informed about their own body and how it functions, not just for their own sake, but for the sake of their team too. If you see a teammate experiencing a medical “event”, everyone else might stand around not knowing what happened (possibly thinking the fallen individual only had the wind knocked out of him). But you, with the knowledge presented here, may jump into action. Start CPR while yelling for someone to call 911, or summon the proper equipment to resuscitate someone. Perhaps an athlete’s life will be saved – simply because someone took the time to read this article.

Dr. Ramin Manshadi is a Board-Certified physician with the American Board of Interventional Cardiology, American Board of Cardiology, American Board of Internal Medicine and is Board-Eligible with the American Board of Nuclear Cardiology. He is an Associate Clinical Professor in the Department of Cardiology at UC Davis Medical Center. Dr. Manshadi was named a “2011 Top Cardiologist” by U.S. News & World Report. He is the author of The Wisdom of Heart Health: Attaining a Healthy and Robust Heart in Today’s Modern World. For more information, please visit, www.DrManshadi.com.

IT WORKS

By Kevin Haas RRSTAR.COM Posted Jan 11, 2012 @ 04:56 PM

RICHMOND — Authorities say the quick use of CPR and a defibrillator saved the life of a 57-year-old Poplar Grove man who collapsed Tuesday in the stands of a high school basketball game.

The man, whose name was not released, suffered a heart attack just before half time of the Richmond-Burton vs. North Boone girls basketball game and collapsed into the bleachers around 7:15 p.m., Richmond Township Fire Protection District Chief Rick Gallas said.

Several people immediately came to the man’s aid, said Belvidere Police Department Deputy Chief Dave Ernest, who was in the stands to watch his daughter, Malli, a junior on the team.

Ernest performed CPR until Richmond-Burton High School athletic trainer Julianne Stewart used an automated external defibrillator to deliver a dose of electrical energy to the man’s heart, Gallas said.

“It was amazing. He just came to,” Ernest said. “Everybody was there coaching, helping and doing anything they can.”

The man was transported to Centegra Hospital in McHenry, where he is recovering.

The chances of successful recovery increase the faster the response.

“When we teach CPR and we teach AED, we say that quick action is what makes the difference in saving a person’s life,” Gallas said. “This person’s life was definitely saved by quick action.”

An AHA Call To Arms

TUESDAY, Jan. 10 (HealthDay News) -- People who suffer sudden cardiac arrest are more likely to survive if 911 and EMS dispatchers help bystanders assess victims and begin CPR immediately, says a new scientific statement from the American Heart Association.

One of its main goals is to increase how often bystanders perform CPR (cardiopulmonary resuscitation).

"I think it's a call to arms," statement lead author E. Brooke Lerner, an associate professor of emergency medicine at the Medical College of Wisconsin, Milwaukee, said in an AHA news release. "It isn't as common as you think, that you call 911 and they tell you what to do."

The statement includes four recommendations:

Dispatchers should assess whether someone has had a cardiac arrest and if so, tell callers how to administer CPR immediately.

Dispatchers should confidently give hands-only CPR instructions for adults who have had a cardiac arrest not caused by asphyxia (as in drowning).

Communities should measure performance of dispatchers and local EMS agencies, including how long it takes until CPR is begun.

Performance measurements should be part of a quality assurance program involving the entire emergency response system including EMS and hospitals.

The statement, released Jan. 9, was published simultaneously in the journal Circulation.

Sudden cardiac arrest occurs when a problem arises with electrical impulses in the heart, causing it to stop beating normally. The survival rate for people who suffer sudden cardiac arrest outside of a hospital is only 11 percent.

Each year in the United States, more than 380,000 people are assessed by EMS for sudden cardiac arrest.

Rapid assessment and early CPR are among the links in the "Chain of Survival" that can improve a person's chances of surviving sudden cardiac arrest. Other links include rapid defibrillation, effective advanced life support and integrated post-cardiac arrest care.

People who don't have CPR training are often afraid to help. But even if a person is suffering from something other than cardiac arrest, "the chances that you're going to hurt somebody are very, very small," Lerner said. "And if you do nothing, they're not getting the help that's going to save their life."

More information

The U.S. National Heart, Lung, and Blood Institute has more about sudden cardiac arrest.

Copyright © 2011 HealthDay. All rights reserved.

Consider HCM Screening, AED at games?

Teenage footballer dies after scoring goal

A 13-year-old schoolboy died after scoring a goal during a football match in Staffordshire.

Liam Wood collapsed on the pitch just after he had scored a fifth goal for AFC Saints.

The match was on playing fields off Cotswold Avenue in Knutton, near Newcastle-under-Lyme, on Sunday morning.

Liam was resuscitated by people at the game and was then put in an ambulance. He died later in hospital.

Geoff Green, the manager of the opposition team, Stafford Falcons, said: "Liam scored a goal and he was running back up the pitch celebrating, when he just collapsed, fell to the floor.

"After a short period of time, he wasn't coming round - it looked as though he'd stopped breathing - so we started giving him mouth to mouth and CPR, at which time the ambulance was called as well."

Mr Green said that the ambulance arrived quickly.

"It upset everybody... it was just a shame that there was nothing we could do at the time, more than what we could have done. It all happened so quick."