sourcegraph
October 2, 2023

In 1988, a 65-year-old man suffered cardiac arrest at home.Wife and child don’t understand CPR, so they grab the toilet plug in desperation make his heart beat until the ambulance showed up.

Later, after the man recovered at San Francisco General Hospital, his son gave doctors there some advice: Put toilet plugs next to all the beds in the coronary ward.

The hospital didn’t do it, but the idea got doctors thinking about better ways to perform CPR, or cardiopulmonary resuscitation, the routine method of chest compressions after cardiac arrest. More than three decades later, at a meeting of emergency medical services executives in Hollywood, Fla., this week, researchers presented data showing that the use of a plunger-like device can dramatically improve patient resuscitation.

Conventional CPR is not well documented: According to a national survey, an average of only 7% of people who receive CPR before going to the hospital are eventually discharged with full brain function registration form Cardiac arrest treated by community emergency medical personnel across the country.

“It’s frustrating,” said Dr. Keith Lurie, a cardiologist at the University of Minnesota School of Medicine who treated plunger patients in 1988.

The new procedure, called neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood through the body, but sucking it back up to refill the heart. Plastic valves are fitted to the mask or breathing tube to control pressure in the lungs.

The third is a body positioning device sold by AdvancedCPR Solutions, an Edina, Minnesota-based company founded by Dr. Lurie. The hinge support slowly raises a supine patient to a semi-sitting position. This allows deoxygenated blood in the brain to drain more efficiently and replenish oxygenated blood more quickly.

The three pieces of equipment in one backpack cost about $20,000 and last for years. These devices have each been approved by the U.S. Food and Drug Administration.

About four years ago, the researchers began looking at combinations of all three devices used in tandem. At this week’s meeting, Dallas County Emergency Medical Services Director Dr. Paul Pepe, a longtime CPR researcher, reported the results of 380 patients who were unable to be resuscitated by defibrillation, making their odds of survival particularly low. Brain function remained intact in 6.1 percent of people who received the new method of CPR within 11 minutes of cardiac arrest, compared with 0.6 percent of people who received traditional CPR.

He also reported that the odds were significantly higher in the subgroup of patients who did not have a heartbeat but had random electrical activity in the heart muscle. People typically have about a 3 percent chance of surviving this condition. But patients in Dr. Pepe’s study who received neuroprotective CPR had a 10 percent chance of leaving the hospital with their nervous system intact.

last year, a study Surveys conducted in four states found similar results. Patients who received neuroprotective CPR within 11 minutes of a 911 call were about three times more likely to survive with good brain function than those who received conventional CPR.

“It’s the right thing to do,” Dr. Pepe said.

Several years ago, Jason Benjamin suffered a cardiac arrest after working out at a gym in St. Augustine, Florida. A friend took him to a nearby fire department, where trained crews deployed neuroprotective CPR equipment. It took 24 minutes and multiple defibrillations to revive him.

After recovering, Mr. Benjamin, himself an emergency medical technician, was amazed to learn of the new procedure that saved his life. He read the studies and interviewed Dr. Lurie. The three-part procedure had several complicated names at the time. It was Mr. Benjamin who came up with the term neuroprotective CPR “because that’s what it was doing,” recalls Mr. Benjamin, adding that “the point was to protect my brain.”

Dr. Neuroscientist Karen Hirsch Stanford University and members of the American Heart Association’s CPR standards committee said the new approach is interesting and makes physiological sense, but the committee needs more research in patients before it can officially recommend it as a treatment option.

“We are limited by the data available,” she said, adding that the committee would like to see a clinical trial in which cardiac arrest patients are randomly assigned to either conventional CPR or neuroprotective CPR. No such trials have been conducted in the United States.

Dr. Joe Holley, medical director of Emergency Medical Services, which serves Memphis and several surrounding communities, isn’t waiting for a larger trial. He said his two teams achieved about a 7 percent neurologically intact survival rate with conventional CPR. With neuroprotective CPR, this rate rose to around 23%.

These days, his staff are happier when they return from emergency calls, and patients even show up at fire stations to thank them for their help.

“It’s rare,” Dr. Hawley said. “Now it’s almost a routine.”



Source link

Leave a Reply

Your email address will not be published. Required fields are marked *