Drop the inferiority complex - you can do it

Advanced Rescuer- versus Citizen-Witnessed Cardiac Arrest: Is There a Difference in Outcome?

[Note: for those with busy schedules, the short answer is 'No']

Posted online on September 13, 2010. (doi:10.3109/10903127.2010.514089)

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Amy H. Kaji, MD, PhD, Arslan M. Hanif, MD, James T. Niemann, MD

From the Department of Emergency Medicine, Harbor–UCLA Medical Center, Torrance, California (JTN, AHK, AMH); the Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, California (JTN, AHK); and the David Geffen School of Medicine at UCLA, Los Angeles, California (JTN, AHK). Revision received June 7, 2010; accepted for publication June 11, 2010.

Presented in part at the 2010 National Association of EMS Physicians annual meeting, Phoenix, Arizona, January 2010.

None of the authors have any conflicts of interests with other people or organizations that could inappropriately influence this work. There were no study sponsors.

Address correspondence and reprint requests to: James T. Niemann, MD, Department of Emergency Medicine, Harbor–UCLA Medical Center, 1000 West Carson Street, Box 21, Torrance, CA 90509. e-mail: jniemann@emedharbor.edu

Abstract

Background. Substantial financial and human resources are invested in training and maintaining advanced life support (ALS) skills of paramedics who are deployed to the field in response to out-of-hospital cardiac arrest. It would be expected that patients who experience cardiac arrest in the presence of a trained health care practitioner, such as a paramedic, have better outcomes.Objective. To compare the rates of return of spontaneous circulation (ROSC), survival to hospital admission (SHA), and survival to hospital discharge (SHD) between paramedic-witnessed out-of-hospital cardiac arrest vs. citizen-witnessed out-of-hospital cardiac arrest. Methods. In this retrospective cohort study, the records of all out-of-hospital nontraumatic cardiac arrest patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The age, gender, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether it was a witnessed arrest and, if witnessed, whether it was a paramedic-witnessed arrest, site of the arrest, and the rate of SHD were noted. A univariate odds ratio was computed to describe the association between paramedic-witnessed out-of-hospital cardiac arrest vs.citizen-witnessed out-of-hospital cardiac arrest and SHD. A multivariable logistic regression analysis was also performed, controlling for age, gender, arrest rhythm, bystander CPR, and site of arrest. Results. Of the total cohort of 1,294 out-of-hospital cardiac arrests, 750 (52.6%) were either paramedic-witnessed (154/750 = 20.5%) or citizen-witnessed (596/750 = 79.5%). Among the witnessed cardiac arrests, overall the SHD was 53 of 750 (7.1%). On univariate analysis, the ROSC, SHA, or SHD rates were not statistically significantly different between paramedic- and citizen-witnessed arrests. Even after multivariable adjustment, the ROSC, SHA, and SHD rates were not significantly different between paramedic- and citizen-witnessed arrests. Conclusions. Among our study population of out-of-hospital cardiac arrest victims, paramedic-witnessed arrests did not appear to have improved survival rates when compared with citizen-witnessed arrests. Key words:cardiac arrest; cardiopulmonary resuscitation; advanced life support; basic life support

Once in a while, CPR is enough...but don't count on it!

Central Catholic's Hayward Demison 'just happy to be alive' -- 9/12 1:51 a.m.

Hayward Demison had just made the biggest play of his life, running 45 yards for the go-ahead touchdown for Central Catholic's football team Friday night.

Moments later, though, Demison lay unconscious on the sideline, no longer breathing, his heart stopped, as medical personnel worked to save his life.

“It was the scariest thing I've ever been a part of,” Central Catholic football coach Steve Pyne said.

Demison, a 6-foot-1, 195-pound high school junior, was diagnosed with athletic asthma two years ago. So after his touchdown run, when his heart raced and he struggled to catch his breath, he sent for his inhaler. After using it, though, his heart only accelerated. Nauseated and dizzy, he lost his balance and leaned on assistant coach Woody Green.

“He was gasping for air like it was his last breath,” Green said.

He was having a heart attack.

“I just fell on the ground,” Demison said. “I don't remember anything else except waking up a few minutes later, and people are standing over me, and I'm in shock. I'm trying to get up, and everybody's saying, 'Stay there. Calm down.' I looked to my left and saw everybody, and they were crying.”

Demison's heart had stopped for about two minutes. But thanks to the quick action of cardiac nurse Lisa Lyver, who came down from the stands at West Linn High School and performed CPR, he was resting comfortably at Legacy Emanuel Medical Center on Saturday.

“I’m just happy to be alive,” Demison said. “The person that gave me CPR saved my life. I'm very thankful. I'm truly blessed. It was a close call.”

Tests have revealed that Demison's left coronary artery wasn't supplying his heart with enough blood during exertion, according to his father, Hayward Demison II. Although the younger Demison didn't sustain heart damage from the heart attack, he will have surgery in about two weeks for the existing condition and should be able to make a full recovery within six months, allowing him to return to the football field in his senior year.

“Hopefully I'll be back, after everything is taken care of,” he said.

Tragedy was narrowly averted.

Lyver said that by the time paramedics would have arrived at West Linn High School -- where Central Catholic beat Canby 28-24 on Friday night thanks to Demison's fourth-quarter score -- it probably would have been too late to save Demison. And Lyver said that Demison was fortunate that the 60 or so chest compressions she performed were enough to restore his pulse.

“In training, they tell you that you need a defibrillator for people to come back, because they just don't come back with CPR,” Lyver said. “So he is absolutely one of the luckiest ones.”

Demison had dizzy spells and shortness of breath two years ago as a freshman at Gresham High School. He went to the doctor and was told he had athletic asthma. He got a much different diagnosis this weekend.

“The doctor explained that this is a defect he's had for years,” his father said. “He's like one out of 100,000 kids that this happens to so late in his life. I'm just disappointed because it was a ticking time bomb. Thank God there was someone there to give him CPR and they were able to get him to the hospital, because what if he had been out jogging and collapsed with nobody around?”

Demison collapsing on the sideline with about seven minutes left in the fourth quarter didn't draw much attention at first, even among his teammates, many of whom knew about Demison's treatment for asthma.

But it caught the eye of Pyne's wife, Erica, who was sitting with Lyver, a neighbor whose husband, Troy, is Central Catholic's team statistician.

“I thought, 'You know, maybe I should just head down there,’ " Lyver said. “By the time I got to the track, I saw that they were lifting his legs up and I thought, 'Well, this is kind of right up my alley. This might be something I might be able to help with.’ "

She asked the team's orthopedist, Dr. Jack O'Shea, if the medical staff needed help, and he agreed. They told her of Demison's history of asthma.

“I'm looking at him and I'm thinking, 'It sure doesn't look like an asthma attack,' " Lyver said. “And I looked at his eyes and there was absolutely no reaction. He wasn't breathing.”

Demison also didn't have a pulse. Lyver has worked for 16 years at Meridian Park Hospital in Tualatin, but never has been in charge of resuscitating a patient. This time, though, she took the lead, performing chest compressions. After about 60 compressions, and two rescue breaths from O'Shea, Demison's heart started beating again.

The game continued, and few were aware of the drama that had unfolded. Lyver said that nearby teammates even tried to help Demison to his feet before she made it clear that he was going to the hospital. Demison was groggy at first but regained his bearings enough to give a thumbs-up to the crowd as he was taken to the ambulance.

Hayward Demison II, a delivery driver, was in Port Angeles, Wash., on Friday night when he received a call from Green at about 9:30. By then, his son was stable, but the emotion in Green's voice told the story.

“He was telling me that he saw Hayward with his eyes rolling back in his head,” Hayward Demison II said. “He thought that he was gone. He was really scared. It really scared him.”

Said Green: “He was in my arms and I thought he was gone. We were saying, 'C'mon 21, c'mon Hayward, fight.' "

Demison's stepmother, Linda, who wasn't at the game, also received a call from Green and left to join him at the hospital. Central Catholic's coaches and players prayed for Demison on the field after the game, and most of the team -- Pyne counted 47 players -- visited him in the hospital Friday night.

Hayward Demison II made it to the hospital early Saturday morning, with a copy of the sports page that mentioned Demison's winning touchdown. He woke him up and showed it to him.

“He was like, 'Dad, I didn't get to see ‘Friday Night Lights’ last night,' " Hayward Demison II said, referring to a local television highlights show. “He was told by a lot of people he was on there.”

Perhaps he will make it on the local football highlights show next season.

“Football is his passion,” Steve Pyne said of Demison, who transferred to Central Catholic, a private school in Southeast Portland, from Gresham this year. “He has a lot of talent, and he's an extremely hard-working young man. He's a kid that can play at the next level, in my opinion.”

Thanks to Lyver, he should get a chance to find out.

“We really want to thank her,” Hayward Demison II said. “Thank God she was there.”

Said Lyver: “It was where I was supposed to be. Seventeen-year-olds aren't supposed to die, especially on the football field.”

Using chest compressions first just as successful as immediate defibrillation after cardiac arrest

Public release date: 9-Sep-2010

Contact: Shantell M. Kirkendoll
smkirk@umich.edu
734-764-2220
University of Michigan Health System

But in cases of long waits for EMS, University of Michigan Health System study shows chest compressions first approach may be better

ANN ARBOR, Mich. – Chest compressions before defibrillation in patients with sudden cardiac arrest is equally successful as immediate treatment with an electrical defibrillator, according to a new study by the University of Michigan Health System.

Few people who suffer cardiac arrest outside of a hospital survive. U-M physicians, along with a team of international experts, examined two promising rescue strategies: chest compressions first vs. defibrillation first.

Their results, published online Thursday in BMC Journal, show that both timing strategies are effective, yet chest compressions before defibrillation may be best in events where emergency response times are longer than five minutes.

"Current evidence does not support the notion that chest compressions first prior to defibrillation improves the outcome of patients in out-of-hospital cardiac arrest; instead it appears that both treatments are equivalent," says lead study author Pascal Meier, M.D., an interventional cardiologist at the U-M Cardiovascular Center.

One-year survival rates were higher among those who had chest compressions first. Data also suggests chest compressions may benefit cardiac arrests with a prolonged response time.

The study pooled data from four randomized trials that included a total of 1,503 patients. Researchers compared patient survival rates after emergency medical service providers performed at least 90 seconds of chest compressions before electrical defibrillation.

"The compressions-first approach appears to be as good as the defibrillation-first approach, especially if there are delays to EMS arriving on-scene," says senior author Comilla Sasson, M.D., an emergency medicine physician researcher at the University of Colorado. "This has major policy implications."

Sasson continues: "Our study shows that chest compressions matter so even more emphasis should be placed on doing high-quality chest compressions both by laypeople providing bystander CPR and EMS providers."

Sasson worked on the study while at the U-M where she created a body of work focused on out-of-hospital cardiac arrest and resuscitation, including demographic and racial differences in cardiac arrest survival.

EMS providers assess approximately 300,000 people with cardiac arrest in the United States each year. Only about 8 percent of people who have sudden cardiac arrest outside of a hospital survive. There's an urgent need to find ways to save lives of those whose heart has suddenly stopped beating.

When administered as soon as possible, chest compressions in conjunction with cardiopulmonary resuscitation, and, in some cases, rapid treatment with a defibrillator — a device that sends an electric shock to the heart to try to restore its normal rhythm — can be lifesaving.

When delivered by EMS professionals, CPR is a combination of rescue breathing and chest compressions to keep oxygen-rich blood circulating until an effective heartbeat is restored.

Bystanders are encouraged to immediately begin CPR using only chest compressions until professional help arrives, according to the American Heart Association.

In the coming weeks, the AHA is expected to launch its 2010 guidelines for CPR and emergency cardiovascular care.

"Based on our study, current guidelines emphasizing early defibrillation still are important," Meier says.

"However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines."

###

Authors: Pascal Meier, M.D., U-M Health System, Paul Baker, Ph.D., SA Ambulance Service, Eastwood, South Australia, Australia; Daniel Jost, M.D., Service Medical D'Urgence, Paris, France; Ian Jacobs, Ph.D., Crawley Australia, Bettina Henzi, Department of Clinical Research, University of Bern Medical School, Bern Switzerland; Guido Knapp, Ph.D., Department of Statistics, TU Dortmund University, Germany; and Comilla Sasson, M.D., M.S., formerly of the U-M Health System.

Reference: "Chest compressions before defibrillation for out of hospital cardiac arrest: A meta-analysis of randomized controlled clinical trials," BMC Journal.

Funding: The study was supported by a research grant of the Swiss National Science Foundation

Resource:
University of Michigan Cardiovascular Center
www.umcvc.org

American Heart Association Resuscitation Guideline updates www.heartcheckmark.biz/presenter.jhtml?identifier=3035517

Here's an action-provoking thought:

THE POLITE VERSION:

The statistics regarding sudden cardiac arrests and CPR are shocking:

• The odds that you will see one or more sudden cardiac arrests in your lifetime are about one-in-seven;
• When you see a cardiac arrest, the odds are about 85% that the victim will be a family member, a friend, or an aquaintance.

These statistics are even more shocking when you consider the implications of both at the same time: there is a non-trivial probability that you will have to either perform CPR on a family member or friend someday.

Please get trained if your current training is more than two years old - CPR has changed.

________

...and if that hasn't convinced you that you need to get current CPR training, read the blunt version below.

THE BLUNT VERSION:

What's the difference between playing Russian Roulette and not knowing CPR?

Very little, actually:

• If you play Russian Roulette, the odds that you will die or be terribly neurologically damaged are about one in six with every spin of the cylinder of a revolver. If you lose, you die or spend the rest of your life in a care facility. In this case, you are acting irresponsibly, you might suffer tragically, and it's not going to be a walk in the park for those you leave behind.
• If you don't know CPR, it's just like Russian Roulette, but the revolver is pointed at the head of a family member or friend or acquaintance. In this case, a family member or friend dies or spends the rest of their life in a care facility. In this case, you are acting irresponsibly, and your family or friends or acquaintances might suffer tragically.

Please get trained if your current training is more than two years old - CPR has changed.

Studies offer insight into potential CPR standard changes

THE SHORT FORM:

1. There is no advantage in performing full CPR vs compression-only CPR in many sudden cardiac arrest situations.
2. There is a significant benefit to using an AED before the EMS arrives.

THE DETAILS:We need to strengthen the pre-arrival link in the chain of survival if we are to reduce the number of these deaths

By Art Hsieh
EMS1 Editorial Advisor

As the countdown continues toward the fall release of the American Heart Association Guidelines for emergency cardiac care, studies continue to provide insight into potential changes. Two such articles came across my Google Reader that I'd like to share.

The first is titled "CPR with Chest Compression Alone or with Rescue Breathing" and was conducted in both the United States (King and Thurston Counties, Wash.) and the United Kingdom (London).

The researchers wanted to find out if there were any differences in outcome in cardiac arrest based on whether bystanders were instructed to provide mouth to mouth rescue breathing, or if they were instructed to perform only chest compressions.

The results indicate that there were no differences in overall survival to discharge. There were "favorable trends" for performing compression-only CPR for patients who suffered sudden death from a cardiac cause, and there appeared to be an improvement in neurological outcome as well.

The second article looked at the prevalence of public access defibrillation (PAD) and its impact on survival. "Survival After Application of Automatic External Defibrillators Before Arrival of the Emergency Medical System" is based on research being performed with the Resuscitation Outcomes Consortium (ROC), a multicenter, multiregional study group spread across the United States.

In this study, researchers looked at the impact of PAD in patients experiencing out of hospital cardiac arrests (OHCA). They found significant differences in survival to hospital discharge in those patients who had bystander CPR performed but did not receive pre-EMS defibrillation in public areas (9 percent), compared to those who did have an AED applied and a shock delivered (38 percent).

These studies continue to reinforce the notion that EMS must continue to participate in community-based activities that promote an immediate and appropriate bystander response to sudden cardiac arrest.

SCA continues to be our number one killer in the United States. We need to strengthen the pre-arrival link in the chain of survival if we are to reduce the number of these deaths.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P is the Chief Executive Officer and Education Director of the San Francisco Paramedic Association. In the profession since 1982, Art has worked as a line medic and chief officer in both third service and fire-based EMS. He has directed both primary and EMS continuing education programs. A Past President of the National Association of EMS Educators, and a scholarship recipient of the American Society of Association Executives, Art is a published textbook author and has presented at conferences nationwide.

Spruce Creek High football player collapses during practice

[The phenomenon involved in the story below is called Commotio Cordis.

(from wiki) From 1996 to spring 2007, the U.S.A. national Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. (Position Statement on Commotio Cordis". US Lacrosse. Retrieved 2008-10-16.) Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years, and fewer than 1 in 5 survived the incident.

When you look at a cardiogram, you see an ongoing cycle of a trigger signal (a P wave) a complex cycle (the QRS complex) in which the large pumps in the heart do the heavy lifting job of pumping the blood to the lungs (the right ventricle pump) and to the rest of the body (the left ventricle pump. The next major feature you see is the recharging of the heart (the T wave) to get ready for the next trigger signal. If a sudden, physical impact to the chest in the area of the heart occurs at a specific portion of the recharging operation, a person can go into sudden cardiac arrest.

The Sudden Cardiac Arrest Foundation is competing in the Pepsi Refresh Everything project this month for a $50,000 grant. You can support them with your vote by going to www.slicc.org/Pepsi/ ]

A football player collapsed during practice at Spruce Creek High School this evening and was taken to a hospital in critical condition, emergency workers said.

The boy was identified by teammates as defensive lineman Jordan Peterson, a senior. He was hit in the chest by another defensive lineman during a drill and fell to the ground in cardiac arrest, according to Port Orange Battalion Cmdr. Bryan Smith.

"Anybody who's hit in the chest can experience cardiac arrest if you're hit at the specific time when your heart beats," Smith said.

Volusia County rescue workers received a 911 call about 5:55 p.m. about an injury at the Port Orange school. The caller said an athletic trainer was performing cardiopulmonary resuscitation on the player, Smith said. With the trainer's help, a coach used an automated external defibrillator donated by Port Orange Fire Rescue to restart the boy's heart, witnesses and officials said.

"That saved that kid's life," Smith said. "No doubt."

Teammate Chauncey Langevin, a running back, said coaches initially thought Jordan just got the wind knocked out of him. But when he didn't get up, one of the coaches began performing CPR and an ambulance arrived. The other Hawks players were told to go inside and hadn't been given any further information, Chauncey said.

Jordan Peterson was doing tackling drills with teammates.

Defensive lineman Shayne Laidler said the two players rolled over after the tackle, and nothing initially seemed out of the ordinary. Then Jordan walked about 10 feet away, went down on one knee and appeared to be catching his breath, Shayne said. One of the coaches asked if he was OK, and Jordan waved him off, then rolled over onto his back, Shayne said.

A few seconds later, a coach walked over and asked if Jordan was all right and got no response.

"He [Jordan] got nailed in the chest and he fell to the ground and wasn't getting back up and one of our coaches had to perform CPR on him," said teammate Patrick Maneti. "They got a pulse and a heart signal on him and when they took him to the hospital he was in cardiac arrest."

Jordan was taken to Halifax Health Medical Center of Port Orange, where he was stabilized, and immediately transferred to Halifax Health Medical Center of Daytona Beach, which handles more serious traumas.

He was in critical condition the entire time, said Mark O'Keefe of EVAC ambulance. A nursing supervisor tonight said Jordan was not listed as a patient, although that could mean he was admitted under another name or his information is being kept private. A spokeswoman for the Volusia County school district, Nancy Wait, said she could not comment on his condition.

The incident happened the same day as a football player collapsed and died during practice at Wekiva High School near Apopka.

Sudden Cardiac Arrest – Is There Hope?

On June 25, 2009, Michael Jackson, well-known as the King of Pop, died of cardiac arrest.

Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. and the majority of CVD deaths are attributable to Sudden Cardiac Arrest (SCA) which claims more than 250,000 lives each year. One person dies of SCA-related events every two minutes. This is equivalent to more 650 deaths each day. Each year, more people die from SCA than from breast cancer, lung cancer, stroke, or AIDS combined. 95% of SCA cases are fatal and two-thirds of SCA events occur in people without any previous indications of heart disease.

According to the American Heart Association (AHA), SCA occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. The blood supply to the rest of the body ceases and without the blood supply, the oxygen supply is also cut off, resulting in tissue damage and death. Because of its suddenness, cardiac arrest is also called sudden death or sudden cardiac arrest (SCA) or sudden cardiac death.

Cardiac arrest is not a heart attack. It is a widespread misconception that SCA is synonymous to a heart attack. In order to educate the public, the AHA and the Sudden Cardiac Arrest Coalition (SCAC) are quick to point out the difference. A heart attack or myocardial infarction occurs when the arterial supply or coronary arteries are compromised or blocked, thus cutting off the blood supply to the heart. And if allowed to continue will eventually lead to infarction or injury to the heart muscles. “The term “massive heart attack” is often wrongly used in the media to describe sudden death.” The SCAC has a beautiful analogy to explain to the general public: “If you think of your heart as a house – SCA would be a problem with the electricity; a heart attack would be a problem with the plumbing.”

Cardiac arrest is not heart failure. In cardiac arrest the electrical failure of the heart is sudden and unexpected, whereas heart failure is progressive but slow, thus allowing time for heart failure patients to eventually be considered as possible heart transplant candidates.

Some people are more at risk for SCA than others.

(1) SCA deaths are more common among women aged 35 to 44 years old compared to men of the same age. Women have also a less chance of recovering from SCA than men.

(2) African Americans have a much higher risk to suffer from SCA-related events than whites and other ethnic groups. They also have less than a 1% chance of surviving, much lower compared to the 5% survival chance in the general population.

(3) Some underlying conditions especially heart problems make people more susceptible to SCA than others. Yet, even healthy individuals without any health problems may suffer from SCA.

There many things that can cause the heart to stop abruptly. Most of the cardiac arrests that lead to sudden death occur when the electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both. This irregular heart rhythm (arrhythmia) causes the heart to suddenly stop beating. Some cardiac arrests are due to extreme slowing (bradycardia) of the heart.

So what causes the electrical system of the heart to fail?

(1) Cardiovascular disease. According to the AHA, in 90% of adult victims of sudden cardiac death, two or more major coronary arteries are narrowed by fatty buildups. Scarring from a prior heart attack is found in two-thirds of victims.

(2) Electric shock/electrocution. A strong electric shock, e.g. electrocution and lighting strikes can cause the heart to stop. Conversely, it also takes an electric shock to restart the heart.

(3) Respiratory arrest. When people cannot breathe during to choking, suffocation, drowning, or injury, SCA can also occur.

(4) Strenuous physical activity. There are cases of athletes suddenly collapsing during training or competitions. This may be caused by underlying heart abnormalities. Adrenaline released during intense physical activity acts as a triggering mechanism for arrhythmia and sudden death.

(5) Medications. Certain drugs, prescription or illegal, can interfere with heart rhythms. When taken in excessive amounts, certain medications can completely stop the heart. Some of these drugs are: performance-enhancing drugs used in sports, prescription drugs for heart problems, pain, and sleeping disorders especially insomnia, and illegal or “recreation” drugs.

(6) Trauma. A strong sudden blow to the heart during sports competition for example, can cause a condition called Commotio cordis that can trigger ventricular fibrillation and lead to SCA. An injury that damages the heart can also lead to cardiac arrest.

(7) Unknown causes. Unfortunately, a lot of cases of SCA are put down to unknown causes, often in young, healthy people with no apparent heart disease or other risk factors.

How can death from SCA be prevented? Not easy, in fact, 95% of SCA cases are fatal. To have a chance of surviving, victims of SCA must receive life-saving defibrillation within the first 4 to 6 minutes of an attack, when brain and organ damage start to occur.

Following are ways to restart the heart during SCA:

(1) Defibrillators. These are the so-called paddles applied to the chest to deliver an electric shock to make the heart beat again. Defibrillators are only available in emergency services and hospitals and can only be operated by medical professionals.

(2) Automatic External Defibrillators (AEDs) are battery-operated portable defibrillators. Current AEDs are designed to be operable by almost anybody, even without formal medical training. AEDs are now widely available in public places where crowds tend to gather.

(3) Implantable Cardioverter Defibrillators (ICDs) are implanted in patients who have a high risk for cardiac arrest from recurrent, sustained ventricular tachycardia or fibrillation. An ICD automatically reacts to irregular rhythms of the heart and applies an electrical jolt to restore normal heart rhythms. According to the SCAC, ICDs are 98% effective at protecting those at risk for SCA, but only 35 percent of patients who require this device have one. According to a New York Times article “in the last two years the number of patients receiving defibrillators has actually declined, as more doctors and patients decide the risks and uncertainties the devices pose may outweigh their potential benefits.” More recently, the European Society of Cardiology (ESC) issued a statement on driving restrictions for patients implanted with ICDs.

(4) Cardiopulmonary resuscitation (CPR) works by attempting to maintain the blood flow to the heart and the brain until more effective defibrillation can be performed. About 80% of SCA cases happen at home, just like in the case of Michael Jackson. Therefore, CPR needs to be performed by bystanders, family members, and people, even without medical training. Unfortunately, only a third of out-of-hospital SCA victims receive bystander CPR and many die before the arrival of emergency services. Immediate effective bystander CPR can double or even triple a victim’s dismal survival chances. A 2008 survey by the AHA revealed that 80% of respondents said they were willing and able to do something to help if they witnessed a medical emergency. However, only a few (12%-20%) are confident that they would know when it is appropriate to perform CPR or use an AED.

So, what could have caused Michael Jackson’s cardiac arrest? Some of the possible causes based on Jackson’s personal and medical history (Source: heartwire) include:

(1) Overdose of prescription medications. Expectedly this is the most popular theory but without a toxicology report, this remains speculative. It seems that Jackson was on prescription painkillers and two that may possibly be implicated in his death are Demerol (meperidine) and Oxycontin (oxycodone). Dr Douglas Zipes of Indiana University Medical School, Indianapolis tells heartwire: “It’s really where I would go, but it’s all very speculative at this point. We know that depending on the type of painkillers, they can depress respiration. The initial stories are that he gradually slowed his respiratory rate and stopped breathing. That can create hypoxia, which can produce ventricular fibrillation.” The use of Diprivan for his insomnia has also been implicated. Without an official toxicology report, all these however, remain as speculations.

(2) Complications from lupus. It is not a well-known fact, but Jackson seemed to have been suffering from lupus, an inflammatory disease that can also affect the heart and lead to a heart block.

(3) Other heart diseases. A heart attack has also been speculated but the singer did not have a history of heart disease and no other heart conditions were detected during the most recent routine physical exam.

(4) Stress. It cannot be denied that Jackson was under too much stress. He was having major financial problems and he was busy preparing for an international concert tour about to start in two weeks.

It is without doubt that SCA is a major and deadly health concern. Advocacy groups including the American Heart Association and the Sudden Cardiac Arrest Coalition are actively involved in bringing this issue to the forefront. There are even those who advocate the routine placement of AEDs in the homes of patients who are at high risk.

Yet SCA mortality remains high even in the setting of bystander CPR and AEDs. WE have a long way to go!

Post Published: 07 September 2010
Author: admin
Found in section: Hot News