KNAU and Arizona News
Tue May 5, 2009
Arizona Pushes "Hands-Only CPR"
By Daniel Kraker
Flagstaff, AZ – Every day in this country, nearly 800 people die from cardiac arrest. Many of those people could be saved if someone performs CPR. But for a lot of reasons people are often afraid to mainly they don't want to catch anything by giving mouth to mouth. For the past few years Arizona has pushed an alternative form of CPR that only includes chest compressions. Health officials here claim it's not only easier, but more effective.
A few months ago Scott Harden was just about asleep when he heard his 33-year old wife gasping for air.
"I turned on the lights, she was not the right color, she was starting to go pale."
Harden, who's a Coconino county sheriff's deputy, called 9-1-1. Then he started giving CPR, the way he was first taught five years ago, with 15 compressions and two breaths.
"I started that and I wasn't able to get a breath in and I just thought, you better just do chest compressions. And dispatch had actually told me the same thing."
The phone dispatch counted out the compressions with him, 100 per minute. Pete Walka with Flagstaff's Guardian Medical Transport was one of the first paramedics on the scene.
"She's alive because he did really good compressions until we got there."
Arizona health officials are convinced compression-only, or "hands-only" CPR gives them the best chance to save someone's life from cardiac arrest. The man behind that conviction is cardiologist Dr. Gordon Ewy (AVEY) at the University of Arizona. Ewy says he stumbled on the importance of chest compressions when he listened to a recording of a woman trying to resuscitate her husband.
"She came back to the phone and said why is it every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep."
Ewy says a victim's blood is already oxygenated for several minutes after a cardiac arrest. What's most important he says is to keep both the heart AND THE BRAIN alive by pumping that blood around the body. And his research based on animal models shows rescue breathing can interfere with that. Just last year the American Heart Association acknowledged Ewy's findings, in part. It updated its guidelines to say if you're not trained in CPR it's OK to do compressions only. Ewy doesn't think that goes far enough.
"Because if you're trained or not you want to do chest compression only CPR, you want to get the blood going to the head to the brain and you don't want it to stop until somebody gets there to defibrillate the patient."
A recent study in the British medical journal The Lancet supports Dr. Ewy's point of view. The study is the largest on the issue so far. It tracked four thousand victims of cardiac arrest in Japan. Those who received compression-only CPR had a survival rate nearly twice as high as those who received compressions plus mouth-to-mouth.
But Dr. Michael Sayre, who helped write the new guidelines for the American Heart Association, still isn't convinced compression only CPR is better. Sayre teaches emergency medicine at the Ohio State University. He says there just isn't enough evidence yet.
"And honestly I think the research that we have to date shows that the outcomes for patients seems to be very similar regardless of the kind of CPR they get."
So Arizona has forged ahead on its own. The state began promoting chest compression-only CPR about five years ago. Doctor Ben Bobrow directs Arizona's Bureau of Emergency Medical Services.
"We found that 3 out of 100 people who had a cardiac arrest outside the hospital in AZ went home with their family, so 97% of everybody died. We basically said that's not good enough, we have to do better. We felt we should be urgent about it, we shouldn't wait for example until the next set of guidelines got updated."
Bobrow helped convince most emergency responders across the state including Guardian and the Flagstaff Fire Department to adopt a new protocol also developed by Dr. Ewy called "Cardio-Cerebral Resuscitation." C-C-R involves long sets of 200 chest compressions. And instead of forcing air into the lungs through a tube, paramedics give oxygen passively with a mask. Bobrow then compared the new results using compression-only with historic data.
"What we pretty much consistently found is that at least three times as many people survived neurologically intact and went home, if they got this new form of resuscitation."
Bobrow's research has been published in the Journal of the American Medical Association and elsewhere. Still the American Heart Association remains skeptical. It wants more conclusive evidence before it changes its guidelines any further. But other areas of the country are starting to follow Arizona's lead. Health officials in Kansas City and parts of Wisconsin say they're also saving lives by focusing on chest compressions.