Study results published in Journal of the American Heart Association
According to a newly published study in Circulation: Journal of the American Heart Association, survival rates for sudden cardiac arrest, outside of a hospital setting, dramatically increase when emergency medical personnel use nearly twice as many compressions than recommended by the American Heart Association during cardiopulmonary resuscitation (CPR).
“Our approach was to get rescuers to concentrate most on giving more rapid, deeper chest compressions when working with sudden cardiac arrest,” said study co-author Matthew Gratton, M.D., chair of emergency medicine at Truman Medical Centers (TMC) and associate professor of emergency medicine at the University of Missouri-Kansas City (UMKC) School of Medicine. “These changes were based on significant research into the causes and evolution of the arrested heart by Dr. Gordon Ewy of the Sarver Heart Institute”.
“The basic idea of increased continuous chest compressions are to improve circulation enough to actually deliver blood into the heart tissues.” said Joseph A. Salomone, M.D., medical director of the Kansas City EMS System, an emergency medical physician at TMC and associate professor of emergency medicine at the UMKC School of Medicine. “With the standard method of CPR, the interruptions after only 30 or fewer compressions reduce or stop blood circulation and thus after each set of breaths rescuers are starting from nearly square one. The new method helps keep the blood moving into the heart tissues, and increases the likelihood of successful resuscitation.”
The study tracked the results from changes in CPR methods as implemented by the Kansas City, Missouri Emergency Medical Services (EMS) System in 2006 and 2007. The Kansas City EMS System prioritized the use of at least 50 chest compressions before administering two breaths. The change also meant that EMS personnel focused more on compressions and less on intubating patients, starting IVs and delivering medications.
When comparing the previous three years to the year following the change in methodology the study authors found that:
- There was a marked increase in overall sudden cardiac arrest survival rates (7.5 percent to 13.9 percent).
- Those patients who were in ventricular fibrillation and who were observed to arrest improved their hospital discharge rate from 22.4 percent to 43.9 percent with 88 percent scoring well on brain function tests upon discharge if they were resuscitated with the new protocol.
“This method of delivering chest compressions along with the other changes made is significantly different from current teaching and all the EMS personnel from KCFD and MAST deserve high praise for their willingness to participate in this new approach,” Dr. Salomone added.
Each year emergency medical personnel treat nearly 300,000 sudden cardiac arrest patients across the country. Sudden cardiac arrest is defined as an abrupt loss of heart function; it usually occurs after the heart’s electrical impulses become rapid or erratic, preventing the heart from effectively pumping blood. The first five to ten minutes after the onset of sudden cardiac arrest are vital in restoring a heartbeat and delivering a live patient to a hospital emergency room. The more blood delivered to the heart in those precious moments the better chance physicians have of successful defibrillation.
“When we commenced the training of the new CPR protocol, our personnel within KCFD were very apprehensive,” stated Chief Richard “Smokey” Dyer of the Kansas City Fire Department. “The airway and oxygen administration portions of the cardiac arrest procedures had been emphasized to our personnel for many years, and over and over again during every recertification. But once our Operations Bureau personnel observed the extremely positive outcomes, our organization became strong supporters of this CPR method.”
“For decades, the emergency medical services field has sought to improve survival rates for cardiac arrest, trying every possible method imaginable with none having any significant effect,” said Darryl Coontz, Deputy Chief of Clinical Services for MAST Ambulance. “This truly is a breakthrough in emergency medicine and has the potential to save thousands of lives each year.”
Authors of the published study include Alex G. Garza, M.D., M.P.H; Matthew C. Gratton, M.D.; Joseph A. Salomone, M.D.; Daniel Lindholm, E.M.T.P, M.I.C.T.; James McElroy, E.M.T.P., M.I.C.T.; and Rex Archer, M.D., M.P.H.
Truman Medical Centers is a not-for-profit two acute-care hospital health system in Kansas City. The TMC Health System includes TMC Hospital Hill, TMC Lakewood, TMC Behavioral Health, the Jackson County Health Department and a number of primary care practices throughout Eastern Jackson County. Recently named one of the nation’s top academic medical centers, TMC is the primary teaching hospital for the University of Missouri-Kansas City Schools of Health Sciences and specializes in asthma, bariatrics, diabetes, women’s health, and trauma services. For more information, please call (816) 404-3785 or visit www.trumed.org.
About the UMKC School of Medicine
The University of Missouri-Kansas City School of Medicine was founded in 1971 as an innovative six-year medical program. From its combined baccalaureate/doctor of medicine curriculum to a docent system that emphasizes small group learning, the UMKC School of Medicine has remained a trendsetter in medical education. Visit the UMKC School of Medicine on the Web at http://www.med.umkc.edu.