In 1988, a 65-year-old man’s heart stopped at home.His wife and his son didn’t know CPR and desperately grabbed the toilet plunger to move his heart until an ambulance arrives.
Later, after the man recovered at San Francisco General Hospital, his son gave the doctors there some advice. Put toilet plungers next to every bed in the coronary ward.
The hospital didn’t, but the idea prompted doctors to think of a better way to perform CPR, the traditional method of chest compressions after cardiac arrest. More than 30 years later, at a meeting of emergency medical services directors in Hollywood, Fla., this week, researchers found that using a plunger-like setup significantly improved patient resuscitation outcomes. published data showing
Conventional cardiopulmonary resuscitation (CPR) is not very successful. According to national statistics, on average, only 7% of people who receive CPR before reaching a hospital are eventually discharged with full brain function. registry Number of cardiac arrests treated by emergency medical workers in communities nationwide.
“It’s tragic,” said Dr. Keith Lurie, a cardiologist at the University of Minnesota School of Medicine who treated a plunger patient in 1988.
This new procedure, known as neuroprotective CPR, has three components. First, the silicone plunger raises and lowers the chest, not only pushing blood out of the body, but also pulling it back to replenish the heart. A plastic valve is attached to the face mask or breathing tube to control pressure in the lungs.
The third part is a body positioning device sold by AdvancedCPR Solutions, an Edina, Minnesota company founded by Dr. Lurie. A hinged support gently lifts the supine patient to a partial sitting position. This allows oxygen-starved blood in the brain to drain more effectively and oxygen-rich blood to replenish more quickly.
Three pieces of gear that fit in a backpack will cost around $20,000 and will last for several years. These devices are individually approved by the Food and Drug Administration.
About four years ago, researchers began investigating combinations using all three devices in tandem. At a conference this week, longtime cardiopulmonary resuscitation researcher and director of the Dallas County Emergency Medical Service, Dr. reported the results. Among those who received the new CPR technique within 11 minutes of cardiac arrest, 6.1% survived with intact brain function, compared with only 0.6% who received conventional CPR.
He also reported that the probability was significantly higher for the subgroup of patients who had no heartbeat but had random electrical activity in the myocardium. People in this situation have a typical chance of survival of about 3%. However, patients who received neuroprotective CPR in Dr. Pepe’s study had a 10 percent chance of leaving the hospital neurologically intact.
last year, study Similar results were obtained in experiments conducted in four states. Patients who received neuroprotective CPR within 11 minutes of calling 911 were nearly three times more likely to survive with good brain function than those who received conventional CPR.
“This is the right thing to do,” Dr. Pepe said.
A few years ago, Jason Benjamin suffered cardiac arrest after training at a gym in St. Augustine, Florida. A friend took him to a nearby fire station, where trained personnel deployed a neuroprotective cardiopulmonary resuscitation machine. It took 24 minutes and several defibrillations before he was resuscitated.
After recovering, Benjamin, himself a former emergency medical technician, was surprised to learn about a new approach that saved his life. He read his research results and interviewed Dr. Lurie. The three-part procedure had some complicated names at the time. It was Benjamin who came up with the term neuroprotective CPR, “because that’s what it’s for,” Benjamin recalled, adding that “the emphasis was on protecting my brain.”
Dr. Karen Hirsch, Neurologist A Stanford University professor and member of the American Heart Association’s Cardiopulmonary Resuscitation Standards Board said the new approach was intriguing and physiologically sensible, but the board would not formally recommend it as a treatment option. I said earlier that we need to see more research on patients. .
“There are limited data available,” he said, adding that the panel wants a clinical trial that randomly assigns people in cardiac arrest to conventional and neuroprotective CPR. No such trial has taken place in the United States.
Dr. Joe Hawley, medical director of emergency medical services serving Memphis and the surrounding area, isn’t waiting for a larger trial. He said two of his teams achieved a neurologically intact survival rate of about 7 percent with conventional CPR. With neuroprotective cardiopulmonary resuscitation, the rate rose to about 23%.
Most recently, his crew returned from an emergency call very happy and the patient thanked them for showing up at the fire station to help.
“It was a rare occurrence,” said Dr. Hawley. “Now it’s almost the norm.”
