Tag: CPR

Categories : Emergency MedicineTags :

CPR with Breaths Essential for Cardiac Arrest after Drowning

On By ModernMedia
Photo by Kampus Production

Updated guidance reaffirms the recommendation for cardiopulmonary resuscitation (CPR) and highlights the importance of compressions with rescue breaths as a first step in responding to cardiac arrest following drowning, according to a new, focused update to Special Circumstances Guidelines from the American Heart Association and the American Academy of Pediatrics. The recommendations were published simultaneously in Circulation (focusing on adults) and Pediatrics (focusing on children).

Drowning is the third-leading cause of death from unintentional injury worldwide. The World Health Organization estimates there are about 236 000 deaths due to drowning each year globally. According to the CDC, it’s the number one cause of death for children ages 1-4 years old in the US.

“The focused update on drowning contains the most up-to-date, evidence-based recommendations on how to resuscitate someone who has drowned, offering practical guidance for health care professionals, trained rescuers, caregivers and families,” said writing group Co-Chair Tracy E. McCallin, M.D., FAAP, associate professor of paediatrics in the division of paediatric emergency medicine at Rainbow Babies and Children’s Hospital in Cleveland. “While we work on a daily basis to lower risks of drowning through education and community outreach on drowning prevention, we still need emergency preparedness training that can be used in tragic circumstances if a drowning occurs.”  

Detailed in the new guideline update:

  • Anyone removed from the water without showing signs of normal breathing or consciousness should be presumed to be in cardiac arrest.
  • Rescuers should immediately initiate CPR that includes rescue breathing in addition to chest compressions. Multiple large studies over time show more people with cardiac arrest from non-cardiac causes such as drowning survive when CPR includes rescue breaths compared to Hands-Only CPR (calling 911 [10111 in South Africa] and pushing hard and fast in the centre of the chest).

Drowning generally progresses quickly from initial respiratory arrest (when a person is unable to breathe) to cardiac arrest, meaning that the heart stops beating. As a result, blood cannot circulate properly throughout the body, and it is starved of oxygen.

“CPR for cardiac arrest due to drowning must focus on restoring breathing as well as restoring blood circulation,” said writing group Co-Chair Cameron Dezfulian, MD, FAHA, FAAP, senior faculty in paediatrics and critical care at Baylor College of Medicine in Houston.

“Cardiac arrest following drowning is most often due to severe hypoxia, or low blood oxygen levels,“ Dezfulian said. ”This differs from sudden cardiac arrest from a cardiac cause where the individual generally collapses with fully oxygenated blood.”

The updated guidance advises untrained rescuers and the public to:

  • Provide CPR with breaths and compressions to all people who have a cardiac arrest after drowning. If a person is untrained, unwilling, or unable to give breaths, they can provide chest compressions only until help arrives. 
  • In-water rescue breathing should be given only by rescuers trained in this special skill if it doesn’t compromise their own safety. Trained rescuers should also provide supplemental oxygen if available.
  • The initiation of CPR should always be prioritised and begin as soon as possible as early lay responder CPR has been shown to improve outcomes from drowning.
  • The writing group recommends an automated external defibrillator (AED) should be placed in public facilities where aquatic activities are present such as swimming pools or beaches. They can be used once the person is removed from the water, if available, yet should not delay initiation of CPR. If available, the AED should be connected to the patient to assess for shockable rhythms once CPR is ongoing. Although most cases of cardiac arrest following drowning do not have shockable rhythms, if a primary cardiac event such as a heart attack occurs while in the water, the best outcomes are when defibrillation is done quickly. AED use is safe and feasible in aquatic environments.
  • All individuals requiring any level of resuscitation following drowning, including those who only need rescue breaths, should be transported to a hospital for evaluation, monitoring and treatment.

In addition to the recommendations on drowning resuscitation, the guideline update also highlights the Drowning Chain of Survival, which includes the steps needed to improve chances of survival: prevention, recognition and safe rescue.

Prevention

It has been estimated that more than 90% of all drownings are preventable. Research has found most infants drown in bathtubs, and the majority of preschool-aged children drown in swimming pools. The American Heart Association and the American Academy of Pediatrics recommend being water aware and practicing water safety. See: Prevention of Drowning and other guidelines.  

Recognition

Recognition of drowning may be challenging because someone who is drowning may not be able to verbalise distress or signal for help. Drowning happens quickly. People in distress will rapidly submerge, lose consciousness and may be hidden from anyone not actively seeking them.

Safe Rescue and Removal

The guideline update recommends that appropriately trained rescuers, such as lifeguards, swim instructors or first responders, should provide in-water rescue breathing to an unresponsive person who has drowned if it does not compromise their own safety. Previous studies have proven this leads to more favourable survival outcomes. A drowning person who is unconscious and likely in cardiac arrest should be removed from the water in a near-horizontal position, with the head maintained above body level and airway open. If the drowning individual is conscious, a more vertical position may be preferable to reduce the risk of vomiting.

In summary, “These updated guidelines are based on the latest available evidence and are designed to inform trained rescuers and the public how to proceed in resuscitating people who have drowned. Drowning can be fatal. Our recommendations maximise balancing the need for rapid rescue and resuscitation, while prioritising rescuer safety,” Dezfulian said.

Source: American Heart Association

Categories : Cardiovascular Disease Emergency MedicineTags :

Bystander CPR up to 10 Minutes after Cardiac Arrest may Protect Brain Function

On By ModernMedia
Photo by www.testen.no on Unsplash

The sooner a lay rescuer (bystander) starts cardiopulmonary resuscitation (CPR) on a person having a cardiac arrest at home or in public, up to 10 minutes after the arrest, the better the chances of saving the person’s life and protecting their brain function, according to preliminary research to be presented at the American Heart Association’s Resuscitation Science Symposium 2024.

Cardiac arrest, which occurs when the heart malfunctions and abruptly stops beating, is often fatal without quick medical attention such as CPR to increase blood flow to the heart and brain. More than 357 000 out-of-hospital cardiac arrests happen each year in the US, with a 9.3% survival rate. “Our findings reinforce that every second counts when starting bystander CPR and even a few minutes delay can make a big difference,” said first author Evan O’Keefe, MD, a cardiovascular fellow at Saint Luke’s Mid America Heart Institute and the University of Missouri-Kansas City. “If you see someone in need of CPR, don’t dwell on how long they’ve been down, your quick actions could save their life.”

The study analysed nearly 200 000 cases of witnessed out-of-hospital cardiac arrest to determine whether initiating CPR within different time windows, compared to outcomes with no bystander CPR administered, made a difference in survival and brain function after hospital discharge.

“We found that people who received bystander CPR within the first few minutes of their cardiac arrest were much more likely to survive and have better brain function than those who didn’t,” O’Keefe said. “The longer it took for CPR to start, the less survival benefit one received. However, even when CPR was started up to 10 minutes after cardiac arrest, there was still a significant survival benefit compared to individuals who did not receive CPR from a bystander.”

Results also found: 

  • People who received CPR within two minutes of out-of-hospital cardiac arrest had an 81% higher rate of survival to release from the hospital and 95% higher rate of surviving without significant brain damage compared to people who did not receive bystander CPR.
  • Even people who received bystander CPR up to 10 minutes after cardiac arrest were 19% more likely to survive to hospital discharge and 22% more likely to have a favorable neurological outcome than those who did not receive bystander CPR at all.
  • For those who did not receive bystander CPR, about 12% survived to be released from the hospital, and more than 9% survived without significant brain damage or major disabilities. When bystander CPR was initiated more than 10 minutes after cardiac arrest, bystander CPR, compared to not receiving the lifesaving assistance, was no longer associated with improved survival.

“These results highlight the critical importance of quick action in emergencies. It suggests that we need to focus on teaching more people how to perform CPR, and we also need to emphasise ways to get help to those suffering cardiac arrest faster,” O’Keefe said. “This might include more widespread CPR training programs, as well as better public access to automated external defibrillators (AEDs) and improved dispatch systems.”

O’Keefe noted that future research could explore how technology (like apps that alert nearby trained bystanders or alert dispatchers to likely cardiac arrest) may help to reduce the time to first intervention, information that could be important for emergency dispatchers and policymakers in the development of public interventions for cardiac arrest.

“This study highlights the need for prompt recognition and treatment of cardiac arrest by bystanders. Time is of the essence when a cardiac arrest occurs, and late interventions can be as ineffective as no intervention. Community education and empowerment are critical for us to save lives,” said American Heart Association volunteer expert Anezi Uzendu, MD, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas and a cardiac arrest survivor.

A limitation of the study includes that the average time of arrival for emergency medical technicians (EMTs) to the person having cardiac arrest was roughly 10 minutes. This means that in this study, the people who received bystander CPR 10 minutes after their cardiac arrest were likely being compared to a group receiving professional medical attention.

Study details and background:

  • The study identified 160 822 witnessed out-of-hospital cardiac arrests that occurred from 2013-2022.  Among the people whose data was analysed, the average age was 64 years old and about 34% were women.
  • Researchers used data from the Cardiac Arrest Registry to Enhance Survival (CARES), a national, web-based health registry focused on helping communities improve care for and survival of out-of-hospital cardiac arrest.
  • The research categorized time to initiation of bystander CPR in two-minute intervals and analysed the link between each time interval, compared to the group who did not receive CPR, with survival to hospital discharge and favourable neurological survival, or surviving with minor disabilities.

Source: American Heart Association

Categories : UncategorizedTags :

In Public Places, Bystanders are Less Likely to Start CPR on a Woman

On By ModernMedia
Photo by www.testen.no on Unsplash

Bystanders are less likely to give cardiopulmonary resuscitation (CPR) to women than men, particularly if the emergency takes place in a public area, according to research presented at the European Emergency Medicine Congress. The study also shows that in private locations older people, especially older men, are less likely to receive CPR.

The researchers say that CPR saves lives and urge people to learn how to perform CPR and to give it without hesitation to anyone who needs it, regardless of gender, age or location.

The research was presented by Dr Sylvie Cossette, a PhD nurse researcher at the Montreal Heart Institute research center, Canada. She conducted the research with Dr Alexis Cournoyer, an emergency medicine physician and researcher at the Hôpital du Sacré-Coeur de Montréal, Canada.

Dr Cournoyer said: “In an emergency when someone is unconscious and not breathing properly, in addition to calling an ambulance, bystanders should give CPR. This will give the patient a much better chance of survival and recovery.”

Dr Cossette added: “We carried out this study to try to uncover factors that might discourage people from delivering CPR, including any factors that might deter people from giving CPR to a woman.”

The researchers used data from records of cardiac arrests that happened outside of hospital in Canada and the US between 2005 and 2015, including a total of 39 391 patients, average age 67. They looked at whether or not a bystander performed CPR, where the emergency took place, and the age and gender of the patient.

They found that only around half of patients received CPR from a bystander (54%). Overall, women were slightly less likely to be given CPR (52% of women compared to 55% of men).

However, when the researchers looked only at cardiac arrests that happened in a public place, such as the street, the difference was greater (61% of women compared to 68% of men). These lower rates of CPR in public were found in women regardless of their age.

When the researchers looked at cardiac arrests that happened in a private setting, such as a home, the data indicated that with every ten-year increase in age, men were around 9% less likely to be given CPR during a cardiac arrest. For women having a cardiac arrest in a private setting the chances of receiving CPR were around 3% lower with every ten-year increase in age.

Dr Cournoyer said: “Our study shows that women experiencing a cardiac arrest are less likely to get the CPR they need compared to men, especially if the emergency happens in public. We don’t know why this is the case. It could be that people are worried about hurting or touching women, or that they think a woman is less likely to be having a cardiac arrest. We wondered if this imbalance would be even worse in younger women, because bystanders may worry even more about physical contact without consent, but this was not the case.”

Dr Cossette said: “We would like to study this issue in greater detail to understand what lies behind the difference. This could help us make sure that anyone who needs CPR gets it, regardless of gender, age or location.”

Source: EurekAlert!

Categories : Cardiovascular DiseaseTags :

Better Outcomes with Earlier Adrenaline Treatment in Cardiac Arrest

On By ModernMedia
Source: Mat Napo on Unsplash

Earlier adrenaline treatment during a cardiac arrest is linked to better recovery compared to later treatment, according to preliminary research to be presented at the American Heart Association’s Resuscitation Science Symposium (ReSS) 2021.

“Our study’s findings should guide emergency medical services professionals towards earlier administration of epinephrine [adrenaline] during out-of-hospital cardiac arrest management,” said lead study author Shengyuan Luo, MD, MHS, an internal medicine resident physician at Rush University Medical Center in Chicago.

Previous research found that only about 1 in 5 people survive a cardiac arrest outside of the hospital and those who do survive often have long-term impairment in the ability to perform daily living tasks.

During a cardiac arrest, immediate CPR (cardiopulmonary resuscitation) is critical. For some types of cardiac arrest, an AED (automated external defibrillator) also is used to deliver an electric shock through the chest to the heart to restore a heartbeat. For these ‘shockable’ cardiac arrests, adrenalineis injected to help restore blood flow. Previous research indicated that adrenaline should be given after three unsuccessful electric shocks with an AED, however, it was unclear whether it should be given even earlier – such as after the first electric shock.

To compare the effects of earlier versus later administration of adrenaline, the researchers examined medical records to compare epinephrine timing to patient recovery. Study subjects included 6416 multi-ethnic adults across North America who had an out of hospital cardiac arrest with shockable initial rhythm from 2011-2015. They were an average age of 64 years, and most were men.

Overall, adrenaline administration within four minutes after the first shock from an AED was associated with greater chances of recovery, while administration after four minutes was associated with reduced chances. Specifically, people who received adrenaline after four minutes were nearly half as likely to have heartbeat and blood flow restored before hospital admittance and half as likely to survive to hospital discharge or be able to perform daily tasks, as measured by a standard test, at discharge. Additionally, the risks of later adrenaline treatment rose with each minute of delayed treatment.

“It is crucial that whenever a cardiac arrest event is suspected, the emergency medical system be notified and activated immediately, so that people with cardiac arrest receive timely, life-saving medical care,” Dr Luo said.

These findings support the latest American Heart Association CPR and Emergency Cardiovascular Care Guidelines, which were released in October 2020. The guidelines indicate adrenaline should be administered as early as possible to maximise good resuscitation outcome chances. The guideline recommendation was based on previous observational data that suggest better outcomes when adrenaline is given sooner.

Source: EurekAlert!