Compression-Only CPR is better!

CPR: Compression-Only Wins the Long Race

Bystanders, forget about the breaths — pump that chest!

While rescue breathing might be important in certain situations, emergency medical service (EMS) dispatchers have a difficult time quickly establishing whether it's appropriate for individual victims. Compression-only cardiopulmonary resuscitation (CPR) obviates the need for this determination, but there have been no definitive long-term data supporting a shift to compression-only CPR.

Researchers combined data from two randomized trials comparing standard CPR with compression-only CPR and measured outcomes up to 5 years after the event. The aggregate group included 2500 patients. Overall survival was 11% at one year, 10.6% at 3 years, and 9.4% at 5 years. Compression-only CPR was associated with a lower risk for death (adjusted hazard ratio, 0.91).

Comment: While the rates of survival after CPR remain dismal, those who are fortunate to remain alive can look forward to a durable benefit. This study supports the 2010 Advanced Cardiac Life Support Guidelines and should encourage EMS dispatchers to instruct lay bystanders to initiate compression-only CPR in adult victims of cardiac arrest.

— J. Stephen Bohan, MD, MS, FACP, FACEP

Published in Journal Watch Emergency Medicine February 15, 2013

CITATION(S):

Dumas F et al. Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation.Circulation 2013 Jan 29; 127:435. (http://dx.doi.org/10.1161/CIRCULATIONAHA.112.124115)

Look what Savannah did!

Savannah's mayor applied for and won a grant from the Cities of Service. The grant provides 1,000 American Heart Association Bystander CPR kits to Savannah. Savannah will, in turn train 1,000 Savannah residents and give them the kit they trained with in exchange for their promise to train at least five more Savannah residents with that kit.

In pulling together the wording of the instructions to the trainees, it occurred to me that "Bystander CPR" doesn't capture the essence of reality: the vast majority of people you will see die from a Sudden Cardiac Arrest - and each of us has more than a ten percent chance of seeing at least one person do so in our lifetime - will be a family member, a friend, an acquaintance, or a co-worker.

For a family, having everybody learn CPR is a SCA Mutual Aid Program!

Bob

Make different kind of list for the new year!

It's going to be a list of names. Here's how you build it and what you're going to do about it:

1. Start with your name. If you have not refreshed your CPR skills in the past 12-18 months, put a star before your name.
2. Now start adding the names of your family members, friends, acquaintances, etc. If they have been trained or refreshed within the past 12-18 months, you can skip the star before their name on the list.
3. Spend a moment realizing that your CPR training doesn't make you any safer - it makes the people around you safer. Similarly, their training makes you safer.
4. Now look at the list, asking yourself if any of the people with stars are people you spend any appreciable time with - alone. It might be your spouse. It might be someone you go fishing with, or play golf or tennis with.

Question: What's the difference between #1.neither you nor your spouse having been trained in CPR and you and your spouse not having been trained in CPR and #2. both of you playing Russian Roulette, but with the revolver pointed at each other's head?

Answer: Not a heck of a lot.

The bottom line is "2013 would be a really good time to get all your family, friends, and acquaintances trained in CPR." Taking care of that this month would be even better!

Bob

San Francisco, CA (updated) - What doesn't kill you is supposed to make you stronger, an adage that many a long-distance runner has clung to, but intriguing findings from a new study presented last week suggest the mortality benefits of running are best accumulated in shorter distances, specifically at less than 20 miles per week [1]. 

In fact, at longer distances, the researchers observed a U-shape relationship between all-cause mortality and running, with longer weekly distances trending back in the wrong direction, toward less mortality benefit.

"We were thinking that at some dose of running, things would level off, that we'd see that runners would have a reduction in mortality at certain distances and then it would kind of level off," Dr Carl Lavie (Ochsner Health System, New Orleans, LA), one of the study investigators, told heartwire. "The fact that it reached its plateau at such a low level is surprising, as is the fact that it didn't level off but actually went the other way. 

We never had a point where runners did worse than nonrunners, but really, if you put it in almost a joking way, it showed that if you ran enough you got yourself back to the level of a couch potato. You lost the survival advantage."

31% is not too shabby

The 2013 statistical update from the USA CDC showed significant 2000-2009 improvement in age-adjusted death rate from CVD.

Wow!

A long way to go, but 30.9% is real progress. Recent achievements in door to thrombolytic time interval for strokes bodes well for next year's statistical update.

Now, if we can only make faster progress on Bystander involvement in out-of-hospital sudden cardiac arrests.

Bob

MICR still paying off

Cardiac Arrest Survival Rates Triple For Ariz. FD

STAFF EXPLORER NEWSPAPER
THE EXPLORER (TUCSON, ARIZONA)
CREATED: DECEMBER 11, 2012

Survival rates have more than tripled for cardiac arrest patients in the Northwest Fire District (NWFD) as a result of a new treatment protocol and a close partnership with the University of Arizona Medical Center.

(see article at http://www.firehouse.com/news/10840863/cardiac-arrest-survival-rates-triple-for-ariz-fd)

Essentially, the overall survival rate has gone from 4.9% to 14.6% for all arrests and from 11.1% to 37.5% for witnessed arrests.

This builds on the MICR work Bobrow et al. published in JAMA in March 2008. 

http://jama.jamanetwork.com/article.aspx?articleid=181606

The enabler was a focus on the issues, minimization of interruptions, and postponing or eliminating intubation. The JAMA article announced a similar percentage gain: "Among the 886 patients in the 2 metropolitan cities, survival-to-hospital discharge increased from 1.8% (4/218) before MICR training to 5.4% (36/668) after MICR training (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1-8.9). In the subgroup of 174 patients with witnessed cardiac arrest and ventricular fibrillation, survival increased from 4.7% (2/43) before MICR training to 17.6% (23/131) after MICR training (OR, 8.6; 95% CI, 1.8-42.0)." That's more than a three-fold improvement in just shy of three years. 

The more than three-fold improvement just reported was reached within 8 months of the implementation of MICR principles.

Has your EMS implemented MICR?

Another piece of the compelling case...

see:

http://circ.ahajournals.org/content/126/24/2844.full.pdf+html

The results of a Japanese study was published in today's issue of circulation.

The study showed that there is a significant advantage to the victim of an out-of-hospital sudden cardiac arrest when the rescuers use compression-only CPR.

Be safe.