Category Archives: CPR

Cardiac arrest more common in young than thought

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Cardiac arrest is relatively rare in young people, but it may be more common than experts have thought, according to a new study.

Using 30 years of data from King County in Washington, researchers found that the rate of cardiac arrest among children and young adults was about 2.3 per 100,000 each year.

That’s not a big risk. But the figure is substantially higher than the “widely accepted” estimate for young athletes (not just young people in general), said senior researcher Dr. Jonathan Drezner.

According to that estimate, one in 200,000 young athletes (up to age 35) suffers cardiac arrest each year.

Cardiac arrest occurs when the heart suddenly stops pumping blood to the rest of the body. It is fatal within minutes without immediate treatment.

A major cause of cardiac arrest is ventricular fibrillation, where the heart’s main pumping chamber starts to quiver chaotically. A device called a defibrillator can “shock” the heart back into a normal rhythm – though even with treatment, cardiac arrest is often deadly.

The good news from the current study is that young people’s survival of cardiac arrest got much better over the 30-year period. It rose from 13 percent in the 1980s, to 40 percent between 2000 and 2009.

“It’s very gratifying to see that our efforts are paying off,” said Dr. Dianne L. Atkins, a pediatric cardiologist at the University of Iowa in Iowa City.

Research over the years has allowed experts to figure out the best way to perform cardiopulmonary resuscitation (CPR), and public campaigns have been done to encourage more people to learn CPR.

CPR cannot “restart” the heart, but it can keep blood and oxygen moving through the victim’s body until medical help arrives.

“Learn CPR and be willing to do it,” said Atkins, who wrote an editorial published with the study in the journal Circulation.

The true rate of cardiac arrest among kids and young adults has long been debated.

Drezner said he thinks his team’s findings come closer to the “real” figure than most past studies, because of its methodology.

The findings come from a cardiac arrest database kept by King County in Washington State. Emergency medical services report all cases of cardiac arrest to the registry.

Drezner’s team also used other records, like autopsy reports and hospital records, to try to figure out the cause of each cardiac arrest.

Between 1980 and 2009, there were 361 cases of cardiac arrest logged for children and adults age 35 and younger – including 26 toddlers under 3, most of whom had congenital abnormalities.

That amounted to a rate of 2.28 cases for every 100,000 young people each year.

Atkins agreed that this study gives a clearer picture of the true incidence of cardiac arrest in young people. “It’s the best data we have.”

And, she said, researchers should know how common the problem is before widespread screening programs, if any, can be put in place.

The idea of screening kids for heart problems that could cause cardiac arrest is controversial. Some countries, including Italy and Israel, have mandatory electrocardiogram (EKG) screening for young athletes. The U.S. is not one of them.

For now, Atkins suggested that parents be aware that cardiac arrest can strike children — but also keep the risk in context.

“It is still a very uncommon event,” she said. “I don’t think the message is that parents should be so frightened that they don’t let their kids go out for competitive sports.”
See on www.reuters.com

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First aid training for primary students has long-term benefits

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“When children are given professional first aid training at primary school, the benefits can be felt long term. That’s why training in the early years is so incredibly important,” says Fritz Sterz from the University Department of Emergency Medicine at the MedUni Vienna as pupils start school this week. The results of a recent study by Katrin Steiner from the MedUni Vienna, who is writing her thesis, also highlight this fact. The anaesthetist and emergency medicine physician has demonstrated that primary school children who are given first aid training in the first to fourth grades of school score highly when it comes to using a defibrillator or performing chest compressions.

 

The study centres around a class of 25 school children from Vienna’s 16th district. In first grade, the children were given a professional first aid lesson as part of a project organised by Thomas Uray from the University Department of Emergency Medicine which involved practical exercises, video clips and questionnaires. After it, 47.8 per cent of the children were able to execute an emergency call perfectly, 56.6 per cent were able to operate the defibrillator correctly and 28.6 per cent were able to perform chest compressions appropriately. The class has now undergone further training and testing in fourth grade by a team led by Katrin Steiner from the MedUni Vienna. “The children were able to remember the practical, hands-on actions very well and tackled the problems in a very motivated way without any inhibitions. Only the theory side of things had slipped a little in their memories,” explains Steiner. Three years later, 100 per cent of the children were able to operate the defibrillator correctly after a refresher course, 95 per cent made the emergency call clearly and understandably, while 72.2 per cent were able to perform chest compressions correctly. Parents learn from their children “The results clearly speak in favour of first aid training at primary school,” says Steiner. In Austria, this training is not currently on the curriculum – unlike countries such as Canada, the Czech Republic or Norway, for example. Just two to three hours of training per academic year are enough to perfectly prepare children for these types of emergency. The added bonus is that “parents learn from their children and benefit from their lower inhibitory threshold for providing first aid,” says Steiner. First aid courses for children are currently provided by the Austrian Red Cross Youth, the Samaritans and as part of the Children’s University programme at the MedUni, which is held every year during the summer holidays. One third can be saved A recent study by the MedUni Vienna has shown that someone who is given cardiac massage by a first aider straight after a cardiac arrest has a 70% higher chance of survival. “Unfortunately, there is often no first aider on hand, or people are afraid of doing something wrong during resuscitation. Chest compressions never do any harm, unlike doing nothing,” says Fritz Sterz from the University Department of Emergency Medicine at the MedUni Vienna. In Vienna alone, around 3,000 people die every year from cardiac arrest.

 
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James Barry (16) real CPR story

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Having practiced CPR and attending many first aid courses that my dad has run I was amazed that when I needed to perform CPR for real how my reflexes took over and I automatically got on with the job in hand.

I was at college when the caretaker collapsed. People stood around looking but not doing anything. When I approached the man a member of staff was shaking him trying to get him to respond. I immediately tilted the casualties head to open his airway, I then listened for breathing whilst counting to 10. This seemed an eternity but I was sure that the man was not breathing. I asked the member of staff to call for an ambulance and say that this was a cardiac arrest.

I started CPR. This felt similar to what I had practiced on the courses but there was a little bit more resistance on the chest than on the Brad manikin. I actually felt the chest give on a couple of occasions as ribs gave way.

Giving breaths was as practiced in the classes and I used a face shield which I keep in a pouch on my keys. I continued with CPR for about 3 minutes and then an ambulance arrived. I continued with the CPR whilst I spoke to the paramedics and explained what had happened. It was only at this time that I realised how out of breath I was. It was a real relief to see the paramedics although I had heard the sirens of the ambulance as they came along the driveway.

The paramedics told me to keep doing chest compressions whilst they set up their equipment and inserted an airway. One paramedic stuck defib pads to the mans chest, I was told to move away from the casualty and they delivered a shock. The casualty lifted off the floor when he received the shock. Just as this was happening a second ambulance arrived.

It appeared that the shock from the defib had worked as the paramedics could see a heart beat on their monitor and the man was trying to breath himself. All 4 paramedics got the casualty onto a stretcher and set off for hospital on blue lights and sirens.

I have since met the man involved in this incident at a college open evening and will be starting this college in September.

I was really surprised how the training I had just took over but I must admitted I was in shock afterwards and felt sick. I would get involved in a medical emergency again and this has given me confidence to want to become a first aid instructor and follow my dream of becoming a paramedic.

James Barry (aged 16)

See on blog.protrainings.eu

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Understanding Sudden Cardiac Arrest

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Sudden cardiac arrest is often confused with a heart attack. Although a prior heart attack increases one’s risk for sudden cardiac arrest, the two are quite different, with distinct risk factors, treatment options and outcomes.

Anatomy of a Heart Attack

A circulation problem of the heart causes a heart attack when one or more of the arteries delivering blood to the heart are blocked. Oxygen in the blood cannot reach the heart muscle, and the heart muscle becomes damaged. You can think of a heart attack as a “plumbing problem” in the heart.

This damage to the heart muscle can lead to disturbances of the heart’s electrical system. And a malfunction of the heart’s electrical system may cause dangerously fast heart rhythms that can lead to sudden cardiac arrest.

Anatomy of Sudden Cardiac Arrest

In contrast to a heart attack, sudden cardiac arrest is caused by an “electrical problem” in the heart. It occurs when the heart’s lower chambers (ventricles) suddenly develop a rapid, irregular rhythm (ventricular fibrillation) causing the ventricles to quiver rather than contract. The chaotic quivering motion of the ventricles renders the heart an ineffective pump that can no longer supply the body and brain with oxygen.

Within seconds, the person loses consciousness and has no pulse. Only immediate emergency treatment, such as cardiopulmonary resuscitation (CPR) and external defibrillation, can prevent death from sudden cardiac arrest. Time is key to surviving sudden cardiac arrest, with chances of survival decreasing about 10 percent every minute without defibrillation. The American Heart Association recommends defibrillation within five minutes of collapse or sooner.
See on heartfeltcardiacprojects.wordpress.com

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Is Hands On Defibrillation Safe (giving CPR during defibrillation)?

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One of the important aspects of advanced life support is minimisation of the interruptions to CPR.
Hands on defibrillation has been suggested as being a safe means of achieving this, however Sullivan (2012) suggests that this may not be as safe as expected.
4 different types of gloves were tested (chloroprene, latex, nitrile and vinyl) with 2 current levels being passed through them (0.1 mA and 10 mA). 45% of single gloves and 77% of double gloves allowed current flow of 0.1 mA within the normal defibrillation voltage range. 7.5% of single gloves and 6.2% of double gloves allowed current flow over 10 mA.
A significant proportion of all gloves tested showed current flow across them, and even if no sensation was felt, it does not guarentee a safety margin.
Take home message – Hands on defibrillation is not entirely safe, so it’s back to minimisation rather than elimination of the pause for defibrillation.

See on emergencyeducation.net

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‘Cough CPR’

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The BLS/AED Subcommittee has received a number of enquiries from people who have been informed about “cough CPR” and “How to survive a heart attack when alone”. Advice has been put on the Internet that someone who thinks he or she is suffering a heart attack should repeatedly cough and go at once to a hospital, by car if necessary.

This advice is based (very loosely) on published case reports of people being able to maintain some sort of cardiac output during cardiac arrest by vigorous coughing – so-called “cough CPR”. The scenario has usually been of a patient developing ventricular fibrillation whilst being monitored, often whilst undergoing cardiac catheterisation. The patient has been encouraged to cough and a measurable circulation has been recorded. This anecdotal evidence supports the theory that chest compressions during CPR are successful because they increase intrathoracic pressure and result in a flow of blood. The collapsed veins and patent arteries at the thoracic inlet result in this flow being in a forward direction. Coughing produces the same effect.

The BLS/AED Subcommittee knows of no evidence that, even if a lone patient knew that cardiac arrest had occurred, he or she would be able to maintain sufficient circulation to allow activity, let alone driving to the hospital.

December 2005
Reviewed August 2010

References:

Criley JM, Blaufuss JH, Kissel GL. Cough-induced cardiac compression: self-administered form of cardiopulmonary resuscitation. JAMA. 1976;236:1246-1250.
Miller B, Cohen A, Serio A, Bettock D. Hemodynamics of cough cardiopulmonary resuscitation in a patient with sustained torsades de pointes/ventricular flutter. J Emerg Med. 1994;12:627-632.
Petelenz T, Iwinski J, Chelbowczyx J, Czyx Z, Flak Z, Fiutowski L, Zaorski K, Petelenz T, Zeman S. Self-administered cough cardiopulmonary resuscitation (c-CPR) in patients threatened by MAS events of cardiovascular origin. Wiad Lek. 1998;51:326-336.
Saba SE, David SW. Sustained consciousness during ventricular fibrillation: case report of cough cardiopulmonary resuscitation. Cathet Cardiovasc Diagn. 1996;37:47-48.
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