In 1988, a 65-year-old man’s heart stopped at home. His wife
and son didn’t know CPR, so in desperation they grabbed a toilet plunger to get
his heart going until an ambulance showed up.
اضافة اعلان
Later, after the man recovered at San Francisco General
Hospital, his son gave the doctors there some advice: Put toilet plungers next
to all of the beds in the coronary unit.
The hospital did not do that, but the idea got the doctors
thinking about better ways to do CPR, or cardiopulmonary resuscitation, the
conventional method for chest compressions after cardiac arrest.
A remarkable outcome for reviving patients
More than three decades later, at a meeting of emergency
medical services directors this week in Hollywood, Florida, researchers
presented data showing that using a plunger-like setup leads to remarkably
better outcomes for reviving patients.
Traditional CPR doesn’t have a great track record: On
average, just 7 percent of people who receive it before getting to the hospital
are ultimately discharged with full brain function, according to a national
registry of cardiac arrests treated by emergency medical workers in communities
across the country.
“It is dismal,” said Dr. Keith Lurie, a cardiologist at the
University of Minnesota Medical School who treated the plunger patient in 1988.
A new method
The new procedure, known as neuroprotective CPR, has three
components. First, a silicone plunger forces the chest up and down, not only
pushing blood out to the body, but drawing it back in to refill the heart. A
plastic valve fits over a face mask or breathing tube to control pressure in
the lungs.
The third piece is a body-positioning device sold by AdvancedCPR
Solutions, a firm in Edina, Minnesota, that was founded by Lurie. A hinged
support slowly elevates a supine patient into a partial sitting position. This
allows oxygen-starved blood in the brain to drain more effectively and to be
replenished more quickly with oxygenated blood.
The three pieces of equipment, which fit into a backpack,
cost about $20,000 and can be used for several years. The devices have been
separately approved by the Food and Drug Administration.
About four years ago, researchers began studying the
combination of all three devices used in tandem.
New methods over old methods
At this week’s meeting, Dr. Paul Pepe, a longtime CPR
researcher and director of Dallas County’s emergency medical services, reported
results from 380 patients who could not be revived by defibrillation, making
their odds of survival particularly bleak. Among those who received the new CPR
method within 11 minutes of cardiac arrest, 6.1 percent survived with brain
function intact, compared with just 0.6 percent who received traditional CPR.
He also reported significantly better odds for a subgroup of
patients who had no heartbeat but had random electric activity in their heart
muscles. The typical odds of survival for people in those circumstances are
about 3 percent. But the patients in Pepe’s study who received neuroprotective
CPR had a 10 percent chance of leaving the hospital neurologically intact.
Last year, a study carried out in four states found similar
results. Patients who received neuroprotective CPR within 11 minutes of a 911
call were about three times as likely to survive with good brain function as
those who received conventional CPR.
“This is the right thing to do,” Pepe said.
A couple of years ago, Jason Benjamin went into cardiac
arrest after a workout at a gym in St. Augustine, Florida. A friend took him to
a nearby fire department, where trained workers deployed the neuroprotective
CPR gear. It took 24 minutes and multiple defibrillations to revive him.
A focus on protecting the brain
After he recovered, Benjamin, a former emergency medical
technician himself, was amazed to learn about the new approach that had saved
his life. He read the studies and interviewed Lurie. The three-part procedure
had several complicated names at the time. It was Benjamin who came up with the
term neuroprotective CPR “because that’s what it’s doing,” Benjamin recalled,
adding that “the focus was on protecting my brain.”
Dr. Karen Hirsch, a neurologist at Stanford University and a
member of the CPR standards committee for the American Heart Association, said
that the new approach was interesting and made physiological sense, but that
the committee needed to see more research on patients before it could formally
recommend it as a treatment option.
“We’re limited to the available data,” she said, adding that
the committee would like to see a clinical trial in which people undergoing
cardiac arrests are randomly assigned to conventional CPR or neuroprotective
CPR. No such trials are happening in the United States.
Dr. Joe Holley, the medical director for the emergency
medical service that serves Memphis, Tennessee, and several surrounding
communities, isn’t waiting for a larger trial. Two of his teams, he said, were
getting neurologically intact survival rates of about 7 percent with
conventional CPR. With neuroprotective CPR, the rates rose to around 23
percent.
His crews are coming back from emergency calls much happier
these days, too, and patients are even showing up at fire stations to thank
them for their help.
“That was a rare occurrence,” Holley said. “Now it’s almost
a regular thing.”
Read more Health
Jordan News
.jpg)
.jpg)
