ANDRÉ PICARD
PUBLIC HEALTH REPORTER— From Tuesday's Globe and Mail
Published Monday, Jun. 20, 2011 4:00PM EDT
Last updated Monday, Jun. 20, 2011 4:43PM EDT
The research, published in Tuesday’s edition of the medical journal Circulation, indicates that minimizing the brief period it takes to move from cardiopulmonary resuscitation to administering an electric shock with a defibrillator is a key predictor for survival.
“If your preshock pause is over 20 seconds, the chances of surviving to reach a hospital, be treated and be discharged are 53 per cent less than if the pause is less than 10 seconds,” said Sheldon Cheskes, medical director of the Sunnybrook Osler Centre for Prehospital Care in Brampton, Ont., and lead author of the study. “Those seconds matter.”
He said he hopes the findings will encourage paramedics to move more quickly. In particular, he said, using defibrillators in manual mode halves the delay. Dr. Cheskes said that manufacturers of lifesaving equipment also need to update software to ensure that the time required to analyze a patient’s heart rhythm and charge the defibrillator before delivering a shock is minimal.
The new study is based on data from 815 people who suffered out-of-hospital cardiac arrest between 2005 and 2007 across Canada and the United States. Their average age was 64, and 80 per cent were men.
All of the people included in the research suffered either ventricular fibrillation (abnormal heart rhythm) or pulseless ventricular tachycardia (no effective cardiac output), conditions that can be reversed with an electric shock. They were treated promptly – paramedics arrived, on average, in less than six minutes – and received CPR and defibrillation. The patients received at least one shock but required, on average, five jolts to restart their heart.
Dr. Cheskes and his colleagues in the research group known as the Resuscitation Outcomes Consortium found the time that passed between stopping CPR and defibrillation ranged from 0 to 107 seconds. The median time required for the transition was 22 seconds.
The researchers found that when the pause was less than 20 seconds, 32.6 per cent of patients survived; between 20 and 39 seconds, the survival rate was 31.9 per cent. But when the pause exceeded 40 seconds, the survival rate fell to 20.3 per cent.
“If you minimize interruptions, you maximize survival,” Dr. Cheskes said. He stressed, however, that the study focused on just one element in a chain of events that needs to occur when a person suffers cardiac arrest.
“We looked at the work of paramedics but don’t forget that without bystander CPR – people doing CPR before the paramedics arrive – very few people survive,” Dr. Cheskes said. “Any delay in blood flow to the brain is detrimental for survival.”
In 2010, new CPR guidelines were published that urge people to push hard and fast – at least 100 compressions a minute. While assisting with breathing (mouth-to-mouth in common parlance) is still important, it is considered secondary because it discouraged many people from intervening.
In addition to chest compressions, people are urged to call 911 and ask for another bystander to locate a public access defibrillator. PADs are automated and will not “shock” a patient unless there is no heart rhythm.
In the new study, in 52 per cent of cases, a bystander performed CPR before paramedics arrived, but a PAD was used in fewer than 1 per cent of cases.
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
Monday, June 20, 2011
Time matters - it's really important
Contact: Tagni McRae
tagni.mcrae@heart.org
214-706-1396
American Heart Association
Shorter pause in CPR before defibrillator use improves cardiac arrest survival
A shorter pause in CPR just before a defibrillator delivered an electric shock to a cardiac arrest victim's heart significantly increased survival, according to a study in Circulation: Journal of the American Heart Association.
Researchers found the odds of surviving until hospital discharge were significantly lower for patients whose rescuers paused CPR for 20 seconds or more before delivering a shock (the pre-shock pause), and for patients whose rescuers paused CPR before and after defibrillation (the peri-shock pause) for 40 seconds or more, compared to patients with a pre-shock pause of less than 10 seconds and a peri-shock pause of less than 20 seconds.
"We found that if the interval between ending CPR and delivering a shock was over 20 seconds, the chance of a patient surviving was 53 percent less than if that interval was less than 10 seconds," said Sheldon Cheskes, M.D., principal investigator of the study and assistant professor of emergency medicine at the University of Toronto. "Interestingly there was no significant association between the time from delivering a shock to restarting CPR, known as the post-shock pause, and survival to discharge. This led us to believe that a primary driver for survival was related to the pre-shock pause interval."
The team also found that patients with peri-shock pauses of more than 40 seconds had a 45 percent decrease in survival when compared to those who had peri-shock pauses of less than 20 seconds.
Based on previous studies, American Heart Association resuscitation guidelines advise minimizing interruptions to chest compressions to 10 seconds or less. However, previous studies didn't measure how such pauses in CPR affected survival to hospital discharge.
According to this study, emergency medical services (EMS) in the United States treat nearly 300,000 cardiac arrest cases a year that occur outside the hospital. Less than 8 percent survive.
Cheskes and colleagues used data gathered by the Resuscitation Outcomes Consortium (ROC), a group of 11 U. S. and Canadian Emergency Medical Services that carry out research studies related to cardiac arrest resuscitation and life-threatening traumatic injury.
Between Dec. 1, 2005, and June 30, 2007, 815 patients suffered a cardiac arrest and were included in the study. They were treated by EMS paramedics in Toronto and Ottawa, Ontario; Vancouver, B.C.; Seattle/King County, Wash. and Pittsburgh, Pa. The patients were treated with either an automated external defibrillator (AED) or a manual defibrillator.
Other findings from the study:
The length of the post-shock pause showed no significant survival difference between the two groups.
AEDs were used to treat 40 percent of the cardiac arrests; 20 percent received shocks from a manual defibrillator.
Patients treated with AEDs had pre-shock pause times nearly double those treated in the manual mode, a median of 18 seconds versus 10 seconds. This likely resulted from the time required for an AED to analyze the patient's rhythm as well as the time required to charge it prior to delivering a shock.
The study findings could prompt EMS providers and defibrillator manufacturers to adopt changes likely to increase the number of successful cardiac arrest resuscitations, researchers said. These include:
Paramedics should minimize all CPR interruptions; preferably defibrillate patients in manual mode to limit the pre-shock pause to an "optimal time" of five seconds.
Manufacturers should modify defibrillator software to quicken the assessment of a patient's heart rhythm, and allow devices to deliver more timely shocks while in AED mode. "If these changes occur, I think you have at least the potential to see a greater number of patients surviving cardiac arrest," Cheskes said.
Although the study was not a randomized controlled trial, researchers said their findings confirm those of other smaller observational studies and that it would be very difficult to perform a randomized controlled trial given the evidence to date. Furthermore, higher rates of bystander witnessed cardiac arrest and bystander-provided CPR occurred in the study group which may have resulted in a selection bias. Although the study controlled for a large number of resuscitation variables, the potential for other components of CPR such as compression rate and depth may have also confounded the findings.
###
Study co-authors and funding sources are listed on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
NR11 – 1088 (Circ/Cheskes)
Additional resources:
Information about CPR, including guidelines and training, is located at www.heart.org/cpr.
Information about cardiac arrest can be found at www.heart.org/cardiacarrest.
Downloadable stock footage, animation and our image gallery are located at www.heart.org/news under Multimedia.
tagni.mcrae@heart.org
214-706-1396
American Heart Association
Shorter pause in CPR before defibrillator use improves cardiac arrest survival
A shorter pause in CPR just before a defibrillator delivered an electric shock to a cardiac arrest victim's heart significantly increased survival, according to a study in Circulation: Journal of the American Heart Association.
Researchers found the odds of surviving until hospital discharge were significantly lower for patients whose rescuers paused CPR for 20 seconds or more before delivering a shock (the pre-shock pause), and for patients whose rescuers paused CPR before and after defibrillation (the peri-shock pause) for 40 seconds or more, compared to patients with a pre-shock pause of less than 10 seconds and a peri-shock pause of less than 20 seconds.
"We found that if the interval between ending CPR and delivering a shock was over 20 seconds, the chance of a patient surviving was 53 percent less than if that interval was less than 10 seconds," said Sheldon Cheskes, M.D., principal investigator of the study and assistant professor of emergency medicine at the University of Toronto. "Interestingly there was no significant association between the time from delivering a shock to restarting CPR, known as the post-shock pause, and survival to discharge. This led us to believe that a primary driver for survival was related to the pre-shock pause interval."
The team also found that patients with peri-shock pauses of more than 40 seconds had a 45 percent decrease in survival when compared to those who had peri-shock pauses of less than 20 seconds.
Based on previous studies, American Heart Association resuscitation guidelines advise minimizing interruptions to chest compressions to 10 seconds or less. However, previous studies didn't measure how such pauses in CPR affected survival to hospital discharge.
According to this study, emergency medical services (EMS) in the United States treat nearly 300,000 cardiac arrest cases a year that occur outside the hospital. Less than 8 percent survive.
Cheskes and colleagues used data gathered by the Resuscitation Outcomes Consortium (ROC), a group of 11 U. S. and Canadian Emergency Medical Services that carry out research studies related to cardiac arrest resuscitation and life-threatening traumatic injury.
Between Dec. 1, 2005, and June 30, 2007, 815 patients suffered a cardiac arrest and were included in the study. They were treated by EMS paramedics in Toronto and Ottawa, Ontario; Vancouver, B.C.; Seattle/King County, Wash. and Pittsburgh, Pa. The patients were treated with either an automated external defibrillator (AED) or a manual defibrillator.
Other findings from the study:
The length of the post-shock pause showed no significant survival difference between the two groups.
AEDs were used to treat 40 percent of the cardiac arrests; 20 percent received shocks from a manual defibrillator.
Patients treated with AEDs had pre-shock pause times nearly double those treated in the manual mode, a median of 18 seconds versus 10 seconds. This likely resulted from the time required for an AED to analyze the patient's rhythm as well as the time required to charge it prior to delivering a shock.
The study findings could prompt EMS providers and defibrillator manufacturers to adopt changes likely to increase the number of successful cardiac arrest resuscitations, researchers said. These include:
Paramedics should minimize all CPR interruptions; preferably defibrillate patients in manual mode to limit the pre-shock pause to an "optimal time" of five seconds.
Manufacturers should modify defibrillator software to quicken the assessment of a patient's heart rhythm, and allow devices to deliver more timely shocks while in AED mode. "If these changes occur, I think you have at least the potential to see a greater number of patients surviving cardiac arrest," Cheskes said.
Although the study was not a randomized controlled trial, researchers said their findings confirm those of other smaller observational studies and that it would be very difficult to perform a randomized controlled trial given the evidence to date. Furthermore, higher rates of bystander witnessed cardiac arrest and bystander-provided CPR occurred in the study group which may have resulted in a selection bias. Although the study controlled for a large number of resuscitation variables, the potential for other components of CPR such as compression rate and depth may have also confounded the findings.
###
Study co-authors and funding sources are listed on the manuscript.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.
NR11 – 1088 (Circ/Cheskes)
Additional resources:
Information about CPR, including guidelines and training, is located at www.heart.org/cpr.
Information about cardiac arrest can be found at www.heart.org/cardiacarrest.
Downloadable stock footage, animation and our image gallery are located at www.heart.org/news under Multimedia.
Sunday, June 19, 2011
Where the hell was the AED?
TONY Guerra had just smashed through the windows of his burning house and delivered his wife to safety when he made the most awful realisation. His young daughter Brittany was still trapped inside.
The 43-year-old builder burst back into the blazing house in a brave but doomed bid to save his 10-year-old daughter, who had an intellectual disability. She died in the fire, and while Mr Guerra made it back out to the front garden he suffered a fatal heart attack there.
Brittany's mother, Kylie Guerra, 38, survived the blaze in Melbourne Road, Sorrento, early yesterday and was taken to Frankston Hospital suffering shock and smoke inhalation. Last night she was reunited with the couple's other, younger daughter, who had been staying with her grandmother
Read more: http://www.theage.com.au/victoria/father-dies-in-doomed-rescue-bid-20110619-1ga7l.html#ixzz1PlNn0mUO
The 43-year-old builder burst back into the blazing house in a brave but doomed bid to save his 10-year-old daughter, who had an intellectual disability. She died in the fire, and while Mr Guerra made it back out to the front garden he suffered a fatal heart attack there.
Brittany's mother, Kylie Guerra, 38, survived the blaze in Melbourne Road, Sorrento, early yesterday and was taken to Frankston Hospital suffering shock and smoke inhalation. Last night she was reunited with the couple's other, younger daughter, who had been staying with her grandmother
Read more: http://www.theage.com.au/victoria/father-dies-in-doomed-rescue-bid-20110619-1ga7l.html#ixzz1PlNn0mUO
Another save...
[NB: what really doesn't help is language such as "who found her suffering from a sudden heart stoppage on the Redmond Powerline Trail." What this really means is that two people found a dead person and did a few simple steps that permitted that dead person to become a 'formerly dead person'. It's that serious. It's not a matter of life or death - it's a matter of life or death or something worse. It's not a person who has suffered a heart stoppage, it's a dead person who is going to stay dead if you do nothing, a dead person who has a one-in-twenty chance of getting out of the hospital with major brain functions intact if you call 911, or a dead person who has a far better chance of getting out of the hospital with major brain functions intact if you call 911 and immediately begin chest compressions.
Bob]
____________________________
Two passersby performed CPR on Karen McClure when she experienced a heart stoppage on the Redmond Powerline Trail.
By Fernando Sioson | 12:29pm
Karen McClure knows it's likely she would not be alive today if it weren't for Nishant Kumar and Ruchir Astavans, two long-time friends and Microsoft employees who found her suffering from a sudden heart stoppage on the Redmond Powerline Trail the evening of May 19.
"If they (Kumar and Astavans) hadn't been there, I think I would have died," McClure said Saturday at a reunion for the 51-year-old Redmond resident and her two rescuers.
While running on the trail, McClure experienced sudden cardiac arrest, an incident where the heart completely stops beating. The two strangers who found McClure had never taken a single CPR class in their lives.
After a desperate 911 call, Redmond dispatchers talked Kumar and Astavans through a “hands-only” version of CPR until the Redmond Fire Department and paramedics could find the trio.
"It was luck and instinct," Kumar told McClure on Saturday. "We had seen you fall and thought you were just injured. We came closer and realized your skin and lips were blue and you weren't breathing."
According to Redmond paramedic and firefighter Skip Boylan, the survival rate for people who experience heart failure in a secluded area is 4 percent across all of King County. Bystander CPR is typically the critical element that enables patients to survive the incident, officials said.
When medics arrived on the scene, they continued resuscitation efforts for approximately 45 minutes until McClure regained a pulse and blood pressure.
"She was essentially dead for more than 45 minutes," Boylan said. "Then we finally brought her back."
On Saturday, warm greetings and thank-yous were accompanied by gifts from the Redmond Fire Department to McClure, Kumar and Astavans, including CPR home training kits and a jogger ID tag for McClure.
McClure had no identification on her at the time of the incident, so she was checked in to Evergreen Hospital as a Jane Doe until her family managed to locate her.
Also present at Saturday's reunion were Karen McClure's husband and son, who went out looking for her after she failed to return from her run.
"Dad was worried when mom didn't come back," her son Eric McClure said. "We started to call hospitals in the area looking for her, and finally someone at Evergreen told us there was exactly one person admitted in the last 24 hours who matched mom's description."
At Evergreen, McClure was put on ice to lower her body temperature, decreasing the demand on her heart. She was fitted with a pacemaker just hours after the incident.
McClure had no previous history of heart problems and exercised regularly. She frequently walked and jogged on the Powerline Trail.
Redmond Fire Chief Bob Oliver and other fire department personnel who were at the reunion agreed McClure’s rescue was an excellent success for the King County Medic One program, which dedicates police and fire department resources to teaching people CPR through classes, at home and during emergencies.
"Those two gentlemen (Kumar and Astavans) were very scared," Boylan said. "It's great to see King County citizens taking that kind of initiative."
PLEASE HELP WITH THIS ONE!
Teach students how to save lives
Published 12:01 a.m., Sunday, June 19, 2011
Students learn many skills in high school. Some they will carry with them for the rest of their lives, while others quickly fade away.
The American Heart Association has recommended, based on the latest research, that all high school students learn CPR. With the most recent version of the CPR guidelines this can easily be accomplished in a half-hour health class or phys-ed class at virtually no cost. The benefit to students, their families and their communities is tremendous.
When a patient has a sudden cardiac arrest and a bystander steps up and provides the simple steps of CPR, it doubles and sometimes triples the chance of survival. When no one starts CPR, the chances of the best EMTs and paramedics resuscitating the patient are slim to none.
A law has been proposed to require CPR training in the high schools of our state, yet legislators have not yet voted on this live-saving law. Please urge your senator and assemblyman to vote yes to the CPR-in-high-school bill before the end of this session.
BOB ELLING
Colonie (NY) Paramedic
AHA Board Member
Published 12:01 a.m., Sunday, June 19, 2011
Students learn many skills in high school. Some they will carry with them for the rest of their lives, while others quickly fade away.
The American Heart Association has recommended, based on the latest research, that all high school students learn CPR. With the most recent version of the CPR guidelines this can easily be accomplished in a half-hour health class or phys-ed class at virtually no cost. The benefit to students, their families and their communities is tremendous.
When a patient has a sudden cardiac arrest and a bystander steps up and provides the simple steps of CPR, it doubles and sometimes triples the chance of survival. When no one starts CPR, the chances of the best EMTs and paramedics resuscitating the patient are slim to none.
A law has been proposed to require CPR training in the high schools of our state, yet legislators have not yet voted on this live-saving law. Please urge your senator and assemblyman to vote yes to the CPR-in-high-school bill before the end of this session.
BOB ELLING
Colonie (NY) Paramedic
AHA Board Member
Saturday, June 18, 2011
Bystander saves boy, 4, from near-drowning
[Look for the pop quiz question below the article.]
Mom wants to say thanks, warn others
Written by
Sarah Eddington
Brandy West says she hopes she can one day thank the person who saved her 4-year-old son after he nearly drowned in an apartment pool this week.
West's son Jamarian was at the bottom of an 8-foot pool for what doctors believe could have been 10 minutes before anyone discovered him.
West said her 24-year-old sister was babysitting Jamarian on Tuesday and took him with her to an apartment complex pool. West, who was working, said she heard later that there were several other adults in the pool, but no one noticed Jamarian had gone under until someone tripped over him in the deep end.
West said a bystander pulled Jamarian out and administered CPR. He was then taken to St. Francis Medical Center where he was placed on a ventilator.
Aristoteles Pena-Miches, a pediatric neurologist at St. Francis Medical Center, said Jamarian was treated aggressively and transferred to the ICU.
"We were concerned because a near drowning can cause not only damage to the brain but can damage the lungs," he said. "To my surprise, once the lungs were stable, they took the tubes out and he was able to get up and start playing with the flashlights right away. We were very happy."
Doctors discharged Jamarian from the hospital Friday afternoon with no permanent lung or brain damage.
But Pena-Miches said it was a close call, and the family was lucky that someone at the pool knew CPR.
"We encourage everyone to learn CPR because you never know when you're going to need it," he said. "Anybody with a pool or babysitting children should have instructions for life support."
Pena-Miches said summer is when the most drowning accidents occur, and people should take necessary precautions when taking children around water.
LaVonne LeBlanc, director of administration at the Northeast Louisiana Chapter of the Red Cross, said CPR and first aid are crucial skills for summertime.
"In the summer, there are a lot more outdoor activities, so CPR and first aid are so important," she said. "Things like heat illnesses and allergic reactions are so much greater in the summertime. All those things are covered in our first aid class."
The Red Cross offers CPR certification and first aid classes year round. It also offers swimming lessons earlier in the year.
"You're never too young to start swimming lessons," LeBlanc said. "By starting them young, you eliminate some of that fear of water."
Meade O'Boyle, a pediatrician at St. Francis Medical Center, said accidents happen rapidly.
"It is so essential if you have a kid, you have to know exactly where that child is at all times," she said.
West said her son should have been more carefully monitored, and she is thankful he survived.
"I'm still searching for the man who gave my son CPR," she said. "I want to squeeze him and hug him and let him know how grateful we are."
____________________
POP QUIZ QUESTION:
Suppose you were the person who found the child. Suppose that you have been administering CPR for five minutes, the ambulance wasn't there yet, and another bystander brought you an adult AED. Would you use an adult AED on a four year old?
Mom wants to say thanks, warn others
Written by
Sarah Eddington
Brandy West says she hopes she can one day thank the person who saved her 4-year-old son after he nearly drowned in an apartment pool this week.
West's son Jamarian was at the bottom of an 8-foot pool for what doctors believe could have been 10 minutes before anyone discovered him.
West said her 24-year-old sister was babysitting Jamarian on Tuesday and took him with her to an apartment complex pool. West, who was working, said she heard later that there were several other adults in the pool, but no one noticed Jamarian had gone under until someone tripped over him in the deep end.
West said a bystander pulled Jamarian out and administered CPR. He was then taken to St. Francis Medical Center where he was placed on a ventilator.
Aristoteles Pena-Miches, a pediatric neurologist at St. Francis Medical Center, said Jamarian was treated aggressively and transferred to the ICU.
"We were concerned because a near drowning can cause not only damage to the brain but can damage the lungs," he said. "To my surprise, once the lungs were stable, they took the tubes out and he was able to get up and start playing with the flashlights right away. We were very happy."
Doctors discharged Jamarian from the hospital Friday afternoon with no permanent lung or brain damage.
But Pena-Miches said it was a close call, and the family was lucky that someone at the pool knew CPR.
"We encourage everyone to learn CPR because you never know when you're going to need it," he said. "Anybody with a pool or babysitting children should have instructions for life support."
Pena-Miches said summer is when the most drowning accidents occur, and people should take necessary precautions when taking children around water.
LaVonne LeBlanc, director of administration at the Northeast Louisiana Chapter of the Red Cross, said CPR and first aid are crucial skills for summertime.
"In the summer, there are a lot more outdoor activities, so CPR and first aid are so important," she said. "Things like heat illnesses and allergic reactions are so much greater in the summertime. All those things are covered in our first aid class."
The Red Cross offers CPR certification and first aid classes year round. It also offers swimming lessons earlier in the year.
"You're never too young to start swimming lessons," LeBlanc said. "By starting them young, you eliminate some of that fear of water."
Meade O'Boyle, a pediatrician at St. Francis Medical Center, said accidents happen rapidly.
"It is so essential if you have a kid, you have to know exactly where that child is at all times," she said.
West said her son should have been more carefully monitored, and she is thankful he survived.
"I'm still searching for the man who gave my son CPR," she said. "I want to squeeze him and hug him and let him know how grateful we are."
____________________
POP QUIZ QUESTION:
Suppose you were the person who found the child. Suppose that you have been administering CPR for five minutes, the ambulance wasn't there yet, and another bystander brought you an adult AED. Would you use an adult AED on a four year old?
WHERE WAS THE &#^$ AED?
[NB: Channel 3000 has an over-reaching "do not redistribute" policy. It's likely not enforceable, but I don't want to have to waste the time arguing with them. The URL for the story appears below.]
Death at swimming practice
Death at swimming practice
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