Survival after cardiac arrest increases three-fold with new resuscitation protocol

Mar 11 2008

A new paramedic resuscitation method called Cardiocerebral Resuscitation has resulted in a three-fold increase in the survival rates of out-of-hospital cardiac arrest. The results are published in the March 12 issue of one the world's foremost medical journals, the Journal of the American Medical Association (JAMA).

Data were gathered from Arizona emergency medical service agencies for almost three years, before and after firefighters and paramedics were trained in this new resuscitation protocol for out-of-hospital cardiac arrest (referred to as Minimally Interrupted Cardiac Resuscitation in the JAMA article). Developed at The University of Arizona Sarver Heart Center in Tucson, Ariz., Cardiocerebral Resuscitation focuses on uninterrupted chest compressions and delays placement of a breathing tube.

One subset analyzed the outcomes of 886 cardiac arrests that occurred outside a hospital setting in two metropolitan areas in Arizona. Survival to hospital discharge increased from 1.8 percent before providers were trained in Cardiocerebral Resuscitation to 5.4 percent after training. Survival increase was even better (4.7 to 17.6 percent) in the subgroup of patients with the most favorable circumstances, in which bystanders witnessed the arrest and called 911 immediately and the heart was fibrillating (quivering), making it more receptive to shocks from a defibrillator.

"We encourage all emergency medical providers to evaluate their survival rates and, if they are not satisfactory, to institute Cardiocerebral Resuscitation and see if it improves survival," says Gordon A. Ewy, MD, who co-authored the JAMA article. Dr. Ewy heads the Sarver Heart Center at The University of Arizona College of Medicine in Tucson, whose Resuscitation Research Group developed Cardiocerebral Resuscitation.

The study is part of the resuscitation evaluation project, Save Hearts in Arizona Registry and Education (SHARE), a collaboration between The University of Arizona Sarver Heart Center and the Arizona Department of Health Services' Bureau of EMS and Trauma System, which is lead by Bentley J. Bobrow, MD, an emergency medicine physician at Mayo Clinic in Scottsdale, Ariz.

"Our state has shown that emergency medical systems can make inexpensive, simple changes to their protocol that will dramatically improve meaningful survival," Dr. Bobrow said. "This was truly a collaboration among public health, emergency medical providers and higher education."

For the study, EMS personnel were trained to administer an initial series of 200 uninterrupted chest compressions over a period of approximately two minutes, then perform standard rhythm analysis and administer a single electrical shock, if indicated. Another 200 compressions are immediately performed, and the cycle is repeated three times. EMS workers also administered epinephrine intravenously as soon as possible and with each cycle of chest compressions.