Changing EMS dispatcher CPR instructions to 400 compressions before mouth-to-mouth improved bystander CPR rates

From our buddies down under...

Abstract
Background
To examine the impact of changing dispatcher CPR instructions (400 compressions: 2 breaths, followed by 100:2 ratio) on rates of bystander CPR and survival in adults with presumed cardiac out-of-hospital arrest (OHCA) in Melbourne, Australia.

Methods
The Victorian Ambulance Cardiac Arrest Registry (VACAR) was searched for OHCA where Emergency Medical Services (EMS) attempted CPR between August 2006 and August 2009. OHCA included were: 1) patients aged ≥18 years old; 2) presumed cardiac etiology; and 3) not witnessed by EMS.

Results
For the pre- and post- study periods, 1021 and 2101 OHCAs met inclusion criteria, respectively. Rates of bystander CPR increased overall (45% to 55%, p<0.001) and by initial rhythm (shockable 55% to 70%, p<0.001 and non-shockable 40% to 46%, p=0.01). In VF/VT OHCA, there were improvements in the number of patients arriving at hospital with a return of spontaneous circulation (ROSC) (48% to 56%, p=0.02) and in survival to hospital discharge (21% to 29%, p=0.002), with improved outcomes restricted to patients receiving bystander CPR. After adjusting for factors associated with survival, the period of time following the change in CPR instructions was a significant predictor of survival to hospital discharge in VF/VT patients (OR 1.57, 95%CI: 1.15 to 2.20, p=0.005).

Conclusion
Following changes to dispatcher CPR instructions, significant increases were seen in rates of bystander CPR and improvements were seen in survival in VF/VT patients who received bystander CPR, after adjusting for factors associated with survival.

It had to happen sometime...

Heart lecture interrupted by heart attack
By Daniel Hartill, Sun Journal
Posted June 29, 2011, at 9:29 a.m.
Last modified June 29, 2011, at 6:21 p.m.
Russ Dillingham | Sun Journal

LEWISTON, Maine — Dr. William Phillips figured he was being kidded when a lecture on coronary heart disease was interrupted by a man complaining of chest pain.

A moment later, the cardiologist and nearby nurses saved the man’s life.

“I can’t tell you how I was hoping that guy was going to open his eyes, because, I thought, nothing could be worse if he dies right here,” Phillips said Tuesday.

As Phillips and the nurses began CPR, more than 100 people, many with histories of heart problems, watched.

“What I’m hoping is that they got the lesson about calling 911,” he said. “They got to see firsthand the importance of immediate response.”

The lecture had begun in the usual way.

Folks gathered Monday evening in a conference room at 12 High St. beside Central Maine Medical Center. The topic was a comparison of bypass surgery versus stenting for heart patients.

“We were talking about angina and this man raised his hand and said, ‘I’m having it right now,’” Phillips said. “I said, ‘Are you kidding?’

“And he said, ‘No.’”

That’s when Phillips got serious.

“I said to one of the nurses, ‘Could you get a wheelchair and take him over to the emergency room?’” Phillips said.

There wasn’t time, though. The man collapsed and Phillips ran to his side.

“In the meantime, he had completely arrested,” the doctor said. “He had no pulse. He wasn’t breathing. We started CPR and everybody’s standing around.”

Three cardiac rehab nurses — Brenda Robitaille, Nicola Adams and Heidi Langois — were there, too.

“It wasn’t just me,” Phillips said. “If I had been alone, it would have been terrible.”

One of the nurses brought in an automated external defibrillator, a portable electronic device that diagnoses a sudden, life-threatening heart problem and shocks the heart back into rhythm.

“The AED saved his life,” Phillips said.

“Then, (paramedics) came in the door,” he said. “They started an IV. They gave him an EKG and took the patient over to the emergency room.”

Later, Phillips checked in on the man.

“I went over to the emergency room, and he was sitting up in the bed, talking with his wife and waiting for test results,” the doctor said. Central Maine Medical Center declined to identify the patient, citing confidentiality laws.

But before Phillips checked on the man, he had a lecture to finish.

“After we had taken a breather, everybody wanted to continue on with the talk,” he said. “It was a pretty impressive event. I think the people there will remember the lecture for that.”

Phillips hopes the attendees will remember the importance of rapid response to heart problems.

“What if the man had been driving himself to the hospital?” Phillips said. The incident also highlighted the use of AEDs.

A West Paris man used one to save his father on June 12. The devices are becoming more common in local institutions such as schools.

“This is the second time in as many weeks that a local (AED) has saved a life,” Phillips said.

To see more of the Sun Journal, visit sunjournal.com.

Good News From Sweeden

Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia: bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective

Anna Adielsson1, Jacob Hollenberg2, Thomas Karlsson3, Jonny Lindqvist3, Stefan Lundin1, Johan Silfverstolpe4, Leif Svensson4, Johan Herlitz3,5
+ Author Affiliations

1Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
2Stockholm Pre-hospital Centre, South Hospital, Stockholm, Sweden
3Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
4Emergency Medical Services, KAMBER, Regionhuset, Lund, Sweden
5The Centre for Pre-hospital Research in Western Sweden, University College of Borås, Borås, Sweden
Correspondence to
Johan Herlitz, Institution of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg SE-413 45, Sweden; johan.herlitz@gu.se
Accepted 5 May 2011
Published Online First 29 June 2011

Abstract
Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance?

Design Observational register study.

Setting Sweden.

Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology.

Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation.

Main outcome measures Survival to 1 month.

Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home.

Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.

I'm not allowed to...

Here's the deal:

The AP put out a story that reported the drowning death of a 3 year old at a birthday party. I won't re-write the story or reproduce it here, because the AP specifically forbids that.

The only point worth taking from the article - and they didn't make this point - is that, when you have vulnerable people in the area of dangerous hazards, it's really up to everybody - in particular, the parents of the vulnerable people - to make sure that if a vulnerable one - a child, an intoxicated adult, whatever - doesn't get harmed by the dangerous hazard.

The number one way to prevent cardiac arrests is prevention.

Bob

Saw it on TV. Used it to save son's life.

Morris Plains father urges parents to learn CPR
Matt Manochio: (973) 428-6627; mmanochio@njpressmedia.com

MORRIS PLAINS — Arif and Nadia Mahmood didn’t know CPR before their son’s heart stopped.

They’d seen it performed on television before, so when their 20-month-old baby, Sarim, stopped breathing on June 18, they did the best they could — and forunately it worked.

Sarim is genetically predisposed and at high risk for sudden cardiac death because he has what’s known as Long QT Syndrome, an inherited condition that causes disruptions in the heart’s electrical system, said Lauren Woods, senior media relations specialist for NYU Langone Medical Center, where the youngster is a patient.

“It can trigger the heart’s pumping rhythm to go suddenly awry anytime before stopping altogether,” she said.

“My wife started screaming,” Arif Mahmood, a borough resident, said Friday. “He was not moving, he was not breathing.”

Arif Mahmood said he began performing mouth-to-mouth and chest compressions on his son. He said his wife took over for him so he could call 911.

Sarim began breathing, weakly, when police and an ambulance arrived, and he began crying when an oxygen mask was placed over his tiny mouth.

“We had no CPR training,” he admitted.

That, and much else, has changed.

Dr. Steven Fishberger, an NYU Langone pediatric electrophysiologist, on June 20 installed inside little Sarim an implantable cardiac defibrillator, Woods said.

Just like a pacemaker, this ICD device helps prevent a patient from suffering sudden cardiac death, Woods said. It works by monitoring the heart to detect any abnormal rhythms.

If a dangerous arrhythmia is detected, the ICD delivers an electrical shock to restore the heart’s normal rhythm and prevent sudden cardiac death.

Fishberger credited Mahmood and his wife for being able to perform CPR, without knowing it, under pressure.

“To be able to do it under those circumstances is remarkable,” he said Friday.

Fishberger recommended people who think they might have this condition to see a doctor for an electrocardiogram.

He said if people have unexpected fainting spells, or fainting during exercise, they should also be screened for Long QT Syndrome.

Arif said he and his wife knew about the Long QT Syndrome, and that Sarim was taking medicine for it.

Doctors discovered Sarim had trouble hearing after he was born, and this led to further testing which uncovered the Long QT Syndrome. Sarim also wears a cochlear implants to help him hear.

They just didn’t think his heart would stop, even though they knew there was that possibility.

That’s why he’s urging parents not to risk anything when it comes to their child’s condition.

He said he’s grateful for the help NYU gave his son, and the education they gave to him and his wife.

An NYU Langone social worker taught them CPR, and Sarim is doing well. He’s scheduled to return there Monday for his first post-surgery appointment.

Fishberger said he expects Sarim to live an otherwise normal life.

200,000 patients treated for cardiac arrest annually in US hospitals, Penn study shows

Public release date: 24-Jun-2011
Contact: Holly Auer
holly.auer@uphs.upenn.edu
215-200-2313
University of Pennsylvania School of Medicine


First analysis of national in-hospital cardiac arrest rate underscores need to identify preventable causes, implement best practices in resuscitation care

(PHILADELPHIA) -- More than 200,000 people are treated for cardiac arrest in United States hospitals each year, a rate that may be on the rise. The findings are reported online this week in Critical Care Medicine in a University of Pennsylvania Perelman School of Medicine-led study.

Though cardiac arrest is known to be a chief contributor to in-hospital deaths, no uniform reporting requirements exist across the nation, leaving experts previously unable to calculate its true incidence and study trends in cardiac arrest mortality and best practices in resuscitation care.

The authors, led by Raina M. Merchant, MD, MS, an assistant professor of Emergency Medicine, used three different approaches – involving the American Heart Association's Get With the Guidelines data, a voluntary registry of hospital resuscitation events –to estimate the total number of treated cardiac arrests that take place in United States hospitals each year.

While some of these events occur among terminally ill patients, the authors suggest that many of the cardiac arrests they catalogued may be preventable through better monitoring of patients, quicker response time to administer CPR and defibrillation, and improved adherence to best practices in resuscitation guidelines. Patients who suffer in-hospital cardiac arrests are more than twice as likely to survive than those who arrest in public settings -- 21 percent survive to go home, compared to less than 10 percent of out-of-hospital cardiac arrest patients – but both areas suggest opportunities to improve and standardize care.

"Our study proves that cardiac arrest represents a tremendous problem for hospitals in the United States," Merchant says. "Until now, we could only guess about how many patients were suffering these events. It's impossible to make improvements in something we can't measure. These numbers finally provide us with a roadmap for improving allocation of resources to care for these critically ill patients and further our study of ways to identify patients who are at risk of cardiac arrest in the hospital and improve survival."

West Pierce: Bystander Saves Boy From Drowning

The man saw that the boy was underwater their apartment complex's pool and pulled him out of the water. He also performed CPR on the boy as crews arrived.
By Patch Staff | Email the author | June 21, 2011

A bystander likely saved an 11-year-old's life today, according to West Pierce Fire & Rescue.

The department reports that shortly before 3 p.m. today, crews responded to reports of a drowning at the Forrest Village Apartments, located at 8300 Phillips Road SW in Lakewood, about a mile outside of University Place.

Firefighters arrived at the apartment complex and found an 11-year-old boy conscious and breathing after being pulled from the pool by a bystander.

The man had been watching the boy and his friend play catch in the shallow end of the pool, when he noticed one of the boys underwater for a length of time. He told his friend to check on him, but the boy couldn’t dive that deep. He dropped everything and dove into the pool, only to find the 11-year-old unconscious and without a pulse.

He started CPR and the boy began to breathe as firefighters and police arrived on scene. Paramedics transported the boy to a local hospital for medical evaluation. Without the quick actions of this bystander, the outcome of this situation would have been very different, according to the fire department.

With today being the first day of summer, the fire department that serves both University Place and Lakewood wants to remind everyone to know their limits when it comes to the water.

Custom-fit life jackets are available for purchase at West Pierce Fire & Rescue for $12. Life jackets will also be sold at the City of Lakewood’s SummerFest event this Saturday from noon to 7 p.m. at Fort Steilacoom Park.