A three-part protocol developed at the University of Arizona's Sarver Heart Center nearly triples the survival rate among heart-attack victims, according to findings from a study published last month in the Journal of the American Medical Association (JAMA). Implemented widely, what has been dubbed Cardiocerebral Resuscitation might save thousands of lives each year.

UA researchers made headlines in April when the American Heart Association, drawing on a study conducted by the Arizona Department of Health Services and UA, updated its guidelines to recommend that bystanders who witness a cardiac arrest should employ continuous chest compressions rather than the widely taught combination of chest compressions and mouth-to-mouth ventilation. That study found a 9.2-percent survival rate among heart-attack victims given chest compressions only, compared to a 3.6-percent survival rate among those receiving chest compressions.

The new study, published in the Sept. 24 edition of JAMA, examined regional variations in survival rates among 20,520 out-of-hospital cardiac-arrest cases. In two Wisconsin counties that implemented Cardiocerebral Resuscitation (CCR), a three-part protocol developed by UA's Resuscitation Research Group, survival rates rose from 15 to 39 percent among victims whose cardiac arrests were witnessed by a bystander and had a shockable heart rhythm.

"Protocol and technique can be more important than location for survival of out-of-hospital cardiac arrest," wrote Arthur B. Sanders and Karl B. Kern, both of UA, in an editorial in JAMA accompanying the study.

The protocol for Cardiocerebral Resuscitation developed by the Resuscitation Research Group involves:

• Continuous chest compressions administered by the bystander until emergency medical care arrives;
• A modified resuscitation protocol for paramedics and firefighters, including--among other adjustments--delayed endotracheal intubation, minimal interruptions of chest compressions, prioritized defibrillation, and early administration of epinephrine (also known as adrenaline); Hospital care in which victims receive urgent cardiac catheterization and controlled mild therapeutic hypothermia.

Three other researchers underscored the argument of Dr. Sanders and Dr. Kern in the June edition of Emergency Medical Services.

"While we are intellectually convinced that CCR is now the optimal approach to patients with out-of-hospital cardiac arrest, the greatest proponents are providers in systems that have adopted CCR," wrote Gordon A. Ewy, director of the Sarver Heart Center; Michael J. Kellum of Mercy Health System in Janesville, Wis.; and Bentley J. Bobrow of Mayo Clinic, Scottsdale.

As the researchers noted, the CCR was first instituted by Tucson Fire Department (TFD) in 2003. Successful implementations followed in Rock and Walworth Counties, Wis., in 2004; in Phoenix and other areas of Arizona in 2005; in Kansas City, Mo., in 2006; and in Kansas City, Kan., in 2007.

"We have been doing it longer than anyone in the state and have no intent to change what we are doing," said Norma Battaglia, emergency medical services coordinator for TFD, in the Tucson Citizen.

"They (TFD) were the first ones to stick their necks out and do something different," said Dr. Kern in the Citizen.

With the new protocol receiving acclaim in the medical community, it is now being taught on a broad scale. Earlier this month, some 1,800 middle schools and high schools across Arizona received training kits from UA with instructions on how to perform the bystander component of CCR.

"If bystanders do just that--stand there and wait for emergency medical care to arrive, the person most likely will not survive," said Lani Clark, a member of the Resuscitation Research Group who coordinates a statewide campaign entitled, "Your Hands--Their Heart."

The kits being distributed under the campaign contain a training video and a "PocketCPR" device that students can use to practice effective chest compressions.

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For more information:

 

UA College of Medicine news release, 10/03/2008

UA news release, 09/28/2008

"Cardiocerebral Resuscitation," EMSResponder.com, 08/26/2008

UA news release, 04/01/2008

"AZ study: Continuous chest compressions better than CPR," Tucson Citizen, 01/11/2008