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Performing 38 minutes of CPR can save patient’s life, study finds

Performing CPR for 38 minutes or longer can improve a patient’s chance of surviving cardiac arrest, a new study has found.

The findings, presented at the American Heart Association’s Scientific Sessions 2013, revealed that sustaining CPR that long also improves the chances that survivors will have normal brain function.

Cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, causing it to suddenly stop beating.

In the US, about 80 percent of cardiac arrests, nearly 288,000 people, occur outside of a hospital each year, and fewer than 10 percent survive.

Research has found that the early return of spontaneous circulation — the body pumping blood on its own — is important for people to survive cardiac arrest with normal brain function.

However, little research has focused on the period between cardiac arrest and any return of spontaneous circulation.

The Japanese Circulation Society Resuscitation Science Study group tracked all out-of-hospital cardiac arrests in Japan between 2005 and 2011.

The researchers studied how much time passed between survivors’ collapse and the return of spontaneous circulation, and how well brain function was preserved a month later.

Survivors were considered to have fared well neurologically if they were alert and able to return to normal activities, or if they had moderate disability but were well enough to work part-time in a sheltered environment or take part in daily activities independently.

“The time between collapse and return of spontaneous circulation for those who fared well was 13 minutes compared to about 21 minutes for those who suffered severe brain disability”, said Ken Nagao, M.D., Ph.D., professor and director-in-chief of the Department of Cardiology, CPR and Emergency Cardiovascular Care at Surugadai Nihon University Hospital in Tokyo.

After adjusting for other factors that can affect neurological outcomes, the researchers found that the odds of surviving an out-of-hospital cardiac arrest without severe brain damage dropped 5 percent for every 60 seconds that passed before spontaneous circulation was restored.

Based on the relationship between favourable brain outcomes and the time from collapse to a return of spontaneous circulation, the researchers calculated that CPR lasting 38 minutes or more was advisable.

“It may be appropriate to continue CPR if the return of spontaneous circulation occurs for any period of time”, concluded Nagao.

See on www.theinformationdaily.com

What is Public Access Defibrillation (PAD)

Public access defibrillation is the term used to describe the use of AEDs by laypeople. Two basic strategies are used.

In the first, AEDs are installed in public places and used by people working nearby. Impressive results have been reported with survival rates as high as 74% with fast response times often possible when an AED is nearby.

In a complementary strategy, first responders are dispatched by an ambulance control centre when they might reach a patient more quickly than a conventional ambulance. The greater delay in defibrillation resulting from the need for such responders to travel to a patient has been associated with more modest success rates. However, this strategy does enable treatment of people who arrest at home, the commonest place for cardiac arrest to occur.

Further information may be found on the RC(UK) web site.

Mystery of the world’s most-kissed woman

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Millions of people around the world have learned CPR on a mannequin known as Resusci Anne. The story of the 19th Century beauty behind the model – or at least, one version of it – will be told at a symposium in London to mark European Restart a Heart Day. But does anyone really know anything about her?

The Lorenzi workshop is a small haven of peace and antiquity in the busy Parisian suburb of Arcueil. And it’s the last of its kind. Downstairs the mouleurs, or cast-makers, create figurines, busts and statues, pouring plaster into moulds in much the same way they have since the family business started in the 1870s.

But if you want to be face-to-face with history, pick your way up the dusty wooden stairs to a room above the workshop. It’s an unsettling experience. Hanging all around you in the narrow attic are life and death masks of poets and artists, politicians and revolutionaries: Napoleon, Robespierre, Verlaine, Victor Hugo, the robust, impatient face of the living Beethoven and the sallow, diminished features of the composer’s death mask.

Yet, surprisingly, of all the visages of the great and the good on display at Lorenzi’s, the best-seller is the mask of a young woman. She has a pleasant, attractive face, with the hint of a smile playing on her lips. Her eyes are closed but they look as if they might spring open at any moment. Hers is the one mask that has no name. She’s known simply as the Inconnue, the unknown woman of the Seine.

See on www.bbc.co.uk

My HeartMap Seattle Challenge enlists the public to locate city’s life-saving devices | UW Today

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Seattleites can join in a life-saving scavenger hunt. Players will compete to identify and report the locations of Seattle’s automatic external defibrillators, or AEDs, for a cash reward. Prizes range from $50 to $10,000.

AEDs are electronic briefcase-size devices designed to allow bystanders on scene at a medical emergency to help someone who has collapsed with loss of mechanical activity of the heart, or cardiac arrest.

“Our list of AED locations may be incomplete. We are seeking the public’s help to learn where more of these devices are,” said Dr. Graham Nichol, University of Washington professor of medicine in the Center for Pre-Hospital Emergency Care at UW Medicine’s Harborview Medical Center.

AEDs are cost-effective lifesavers that are often placed where cardiac arrests are most likely, such as airports, sports clubs and shopping malls, according to Nichol, who explained why it is important for a bystander to be able to locate an AED immediately.

“Cardiac arrests are a leading cause of death in the United States but can be treated if recognized and responded to quickly with an AED.”

Often cardiac arrest is due to ventricular fibrillation, in which the lower chambers of the heart quiver instead of contracting in a steady beat. AEDs simplify analysis of the heart rhythm. This enables lay people to recognize and treat ventricular fibrillation before emergency medical services providers arrive. Each device has voice and visual prompts that guide bystanders through the necessary steps.

More than 1.2 million AEDs are now in public places in the United States, and about 180,000 more are installed each year. Sometimes bystanders cannot find the nearest AED during a medical emergency. That’s where the My HeartMap Seattle challenge comes in. Game players will assist UW clinicians by reporting the location of AEDs in community settings throughout Seattle.

Here are the basic rules of the game.

The contest starts Tuesday, Oct.15, and ends Friday, Nov. 15. Complete your free registration to participate in the contest. When you locate an AED in Seattle, report a brief description of it on the contest website, including the building address for the AED, its location within the building, and whether the device appears to be ready for use. A $10,000 grand prize will be awarded to the individual or team that identifies the most unique AEDs. “Unique” means no other player or team has already found the AED. The grand prize will be “unlocked” when at least one individual or team identifies 500 AEDs or all contest participants collectively identify 750 AEDs. Twenty $50 prizes are also available. Twenty AEDs in the city of Seattle have been pre-selected by the research team as “Golden AEDs.” These are unmarked, and those who are first to report a “Golden AED” will win $50. You can follow MyHeartMap Seattle on twitter (@cprnation, #MyHeartMapSeattle) or at the CPR Nation website.

The AED scavenger hunt aims to build public awareness about AEDs, which are commonly contained in a clear glass wall box, sometimes near a fire extinguisher. The spot is generally marked with a symbol of an electrical charge passing through a heart shape.

The contest is modeled after a similar Philadelphia County project at the University of Pennsylvania, which in turn adapted an approach from the Defense Advanced Research Projects Agency for its Red Balloon Challenge. Dr. Raina Merchant, University of Pennsylvania assistant professor of emergency medicine, directed the My HeartMap Philadelphia Challenge. She is the director of the Penn Medicine Social Media Lab and an expert in the use of digital strategies to educate the public on at-the-scene emergency aid. Merchant is collaborating with UW scientists on the My HeartMap Seattle Challenge.

“This is an exciting collaboration that could have a real impact on access to emergency care in Seattle and other regions throughout the country,” noted Merchant.

During the MyHeartMap Philadelphia challenge, participants submitted data about AED locations via a website and a phone app. Some 313 individuals and teams reported more than 1,400 AEDs. Prizes were given for reporting the most AEDs found or for being the first to report the location of specific previously selected devices.

“Most people realize that AEDs are simple enough to use,” Nichol said. “Just follow the voice and visual prompts. They are designed to provide a shock only when needed.”

An AED is usually activated by opening its lid. The commands then begin with visual, recorded and text instructions for baring the patient’s chest and sticking on the pads. Then the machine asks everyone to step back while it analyzes the heart rhythm. It repeats the request to stand clear if it decides to administer a shock. If the rhythm suddenly normalizes before a shock is delivered, the machine will report a rhythm change and announce that no shock will occur.

Most machines also instruct in CPR and coach the timing of compressions and breaths.

“My HeartMap Seattle will help us improve care for patient with out of hospital cardiac arrest,” Nichol said. “The methods and results of this AED scavenger hunt in Seattle will be applied to scavenger hunts in other large cities throughout the United States. In the future, we will have a comprehensive record of AED locations throughout the country.”

My HeartMap Seattle is funded by the U.S. Food and Drug Administration, Zoll Medical Inc., Philips Healthcare Inc., Physio-Control Inc., HeartSine Technologies Inc. and Cardiac Science Inc.

The collaborating sponsors include the American Heart Association, Medic One Foundation, Nick of Time Foundation, University of Pennsylvania and University of Washington.

See on www.washington.edu

Record number survive cardiac arrest after rise in CPR training

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The number of people surviving cardiac arrest in London has hit a record high thanks to bystanders who help to resuscitate them.

See on www.standard.co.uk

Defib as easy to use as a smartphone?

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The latest scientific studies show the importance of the bystander as a first responder

(HealthNewsDigest.com) – Sudden cardiac arrest (SCA) differs from a heart attack in a couple of important ways. First, SCA is the leading cause of death in the U.S., according to the Mayo Clinic, and is more common than heart attack. Second, SCA can be successfully treated by a bystander with an automated external defibrillator (AED), according to several peer-reviewed medical studies.

Virtually every day in America, AED technology enables an individual with little or no medical training to save the life of another human being. This fact makes SCA unique among other leading causes of death such as heart attack, stroke and cancer – afflictions that require interventions from medical professionals.

SCA is an arrhythmia – an electrical disorder of the heart – that can be corrected by a shock from an AED. Heart attack is caused by a blocked artery, which must be cleared or bypassed in a medical facility. Still, only about 8 percent of about 380,000 annual SCA victims in America survive to hospital discharge – primarily because they do not receive shocks quickly enough from an AED. This 8 percent survival rate is dismal, especially when compared to the roughly 85 percent survival rate of heart attack victims.

In any workplace, every employee can be and should be a potential lifesaver.

Too often, workers suffer SCA and die because a defibrillator is not available in time to save them. Conversely, about 90 percent of SCA victims who receive shocks within the first minute after arrest survive, according to the Sudden Cardiac Arrest Association. The chances of survival decrease by 7 to 10 percent with each passing minute. After 10 minutes, less than 5 percent of victims survive.

The aggregate SCA survival rate, recorded across various populations, has remained around 8 percent for the past 30 years, according to a study published in the American Heart Association’s Circulation: Cardiovascular Quality and Outcomes. However, the authors noted that survival was “greatest in locations in which a defibrillator is available.” They also said that because most out-of-hospital cardiac events are witnessed, efforts to improve survival should focus on the prompt use of an AED and CPR by those who witness the event.

While receiving AED/CPR training obviously has its benefits, a Johns Hopkins study published in the Journal of the American College of Cardiology emphasized that “speed is more important than training.” In a review of 13,759 out-of-hospital cardiac arrests, the authors found an average survival rate of 7 percent. However, the survival rate increased to 38 percent when patients received an AED shock before EMS arrival. Non-medical volunteers operating the AED achieved the highest survival rate (40%), followed by healthcare workers (16%) and police (13%). “On average, early AED defibrillation before EMS arrival seems to nearly double a victim’s odds of survival after OHCA,” the authors wrote.

Speed saves

With speed recognized as the most important aspect of AED lifesaving, the focus shifts away from relying on EMS response to having AEDs available in workplaces and public places. While AED/CPR-trained individuals are sometimes present in these areas, SCA victims are often rescued by untrained bystanders.

These Good Samaritans use AEDs successfully, even though they may have never used them before. A survey of 1,018 travelers from 38 nations passing through the Amsterdam central railway station found that roughly half of these individuals would be willing to use an AED in an emergency. Among those expressing reluctance, the most common barriers to using an AED were a lack of knowledge of how to work the AED and concerns about harming the victim.

Approaching the tipping point to higher SCA survival

Today, AEDs are approaching a tipping point similar to the one that happened with the introduction of the iPhone. Before Apple launched this product, most consumers were intimidated by smart phones. The iPhone made smart phones easy – this innovation and its impact on other manufacturers made text and email by phone commonplace, turned mobile devices into the most common way to access the Internet, and merged it all with music, video and a world of apps. Now, many people manage their lives from their smart phone.

In a similar fashion, new AED technology merges audio, video, training and maintenance capabilities into an easy-to-use lifesaving device that inspires confidence in the minds of potential rescuers. A survey by AED designer and manufacturer Defibtech and Harris Interactive asked the question: In addition to audio instruction (provided by the AED during a rescue situation), what would give you greater confidence to use an AED? The answer? Video. With video, text and voice, 97 percent of the respondents said they would be able to use an AED to save a life.

In response, Defibtech introduced the VIEW AED, which has an innovative, exclusive LCD video feature that literally shows rescuers how to perform each step of an SCA rescue in real time – in accordance with the latest American Heart Association (AHA) guidelines. The color video is reinforced by loud and clear audio and corresponding text that can be understood in noisy environments. For example, when the VIEW’s audio says and text reads, “Place pads on patient’s chest,” the video shows exactly where to place the pads.

The VIEW also has embedded help videos that can be used during training to review the critical steps of a rescue, providing reassurance to rescuers that they will be ready during the stress of an emergency. In addition to the help videos, the VIEW has a patented status screen that shows the readiness of defibrillation pads and the AED’s battery, as well as the overall AED operational status. The VIEW AED virtually maintains itself through automated daily self-tests. Choosing an AED that’s easy for bystanders to use is important because not all AEDs are created equal.

Enable your workers to rescue a fellow employee

From any standpoint, it makes complete sense to encourage and enable workers to rescue a fellow employee striken by the most common killer of Americans. While medical advances in virtually every area of medicine have reduced mortality rates, SCA mortality has remained the same for 30 years, even though it can be treated by a person with no medical training if there is an AED onsite. That fact alone calls for workplaces to have AEDs available and to empower their employees with the confidence to use them.

Greg Slusser is a vice president for Defibtech, the designer and manufacturer of the Lifeline™ and ReviveR™ families of AEDs and related accessories, Click Here 1-866-DEFIB-4-U (1-866-333-4248).

Abridged with permission from the August 2012 edition of Facility Safety Management magazine (www.fsmmag.com)

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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

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.

See on medicalxpress.com

All Liverpool primary schools to get defibrillators after £100k boost to Oliver King Foundation / Liverpool ECHO Heartbeat campaign

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ALL Liverpool primary schools will be given life-saving defibrillators thanks to a £100,000 boost to the Oliver King Foundation and the ECHO’s Heartbeat campaign.

The machines, which restart the heart when a person suffers cardiac arrest, will be placed in all 122 of the city’s junior schools.

Today supporters of the Oliver King Foundation said the news would greatly improve the chances of youngsters’ lives being saved across the city.

Oliver was swimming in the pool at King David High School in March last year the killer condition Sudden Arrhythmic Death Syndrom (SADS), struck, and despite efforts to revive him he died.

Oliver’s dad Mark, 51, said he was “shaking with excitement” over the news that all primary schools would have the machines – especially as SADS , which causes the heart to suddenly stop, tends to strike healthy, active youngsters.

He added: “It’s absolutely fabulous news, and a great push in the right direction.

“The government should take note now of the need to have these in all schools.

“It’s not rocket science to see that they save lives.”

See on www.liverpoolecho.co.uk