Booster Shots

Oddities, musings and news from the health world

Category: CPR

CPR in lingerie: It's never naughty to save a life!

May 20, 2010 |  4:30 pm

We share because we care, dear readers. So, when a video clip begins to circulate among physicians on one of the proliferating medblogs out there, and it deals with an important subject such as cardiopulmonary resuscitation, you know I'm going to share it with you.

Afterall, who told you about doing CPR in perfect rhythm to the disco hit "Stayin' Alive"?

This one might be more memorable still. In his medblog, RangelMD.com, a physician practicing internal medicine in Texas, shares his thoughts about important thoughts such as medical ethics, primary care, the dangers of long-term use of new antacid medicines and on treating patients whose cholesterol is normal.

But recently he shared this video of two very fit young women demonstrating CPR -- clad only in lacy skivvies. Their technique is above reproach, however, and many will find the refresher course most helpful. Dr. Rangel's post was in turn picked up by KevinMD, one of the Web's best-read medblogs, so it's a good bet your physician has seen it too.

"Take home point: To be effective, CPR is best done in lingerie," Dr. Rangel comments.

--Melissa Healy 


More defibrillators in the community mean fewer deaths from cardiac arrest

March 18, 2010 | 10:33 am

If you go into cardiac arrest while you’re out shopping for groceries or watching your child’s Little League game, your odds of survival are low. But there’s something that can help – widespread deployment of automated external defibrillators.

Aed The latest evidence comes from Japan, where the country’s Fire and Disaster Management Agency tracked 312,319 out-of-hospital cardiac arrests that occurred between January 2005 and December 2007. In 12,631 of those cases, the arrest was of cardiac origin, involved ventricular fibrillation and was witnessed by a bystander.

At the beginning of the study, when there were 0.11 public-access AEDs per square kilometer of inhabited area, only 1.2% of the victims got a shock from a bystander. By the end of the study, there were 0.97 AEDs per inhabited square kilometer, and bystanders gave shocks 6.2% of the time.

And how did those patients do? Nearly 32% of those who received shocks from bystanders using public-access AEDs were alive and had “minimal neurologic impairment” after one month. That may not sound very high, but it’s much better than the 14.4% rate for all patients who had a cardiac arrest in the presence of a bystander but didn’t get a shock until emergency medical crews arrived on the scene.

The researchers found that as more AEDs were deployed at schools, offices, sports facilities and other public venues throughout the country, the average time it took for someone to administer a shock or begin CPR fell from 3.6 minutes to 2.9 minutes.

Previous studies, including one from the United States, have shown that stationing defibrillators in the community is helpful to victims of cardiac arrest. But the Japanese study is the first to show that those results hold up when AEDs are distributed throughout an entire country, not just in select areas.

The Japanese researchers said they hoped their study would “encourage other countries or communities to promote public-access-defibrillation programs.”

The results were published Thursday in the New England Journal of Medicine.

-- Karen Kaplan

Photo: AEDs, such as this one on a commuter train in Boston, improve the odds of surviving a cardiac arrest. Credit: Darren McCollester / Chicago Tribune/MCT

CPR with mouth-to-mouth is better for kids, researchers say

March 2, 2010 |  3:31 pm

Since 2008, the American Heart Assn. has recommended a “hands only” approach to CPR, emphasizing the importance of performing rapid chest compressions on victims of sudden cardiac arrest. The group decided to nix the mouth-to-mouth portion of cardiopulmonary resuscitation in part because studies show that it doesn’t improve overall survival, and in part to increase the odds that a bystander would perform any kind of CPR at all.

CPR But a new study finds that the old-fashioned version of CPR is more effective at resuscitating children in cardiac arrest.

Japanese researchers examined the medical records of 5,170 minors (ages 17 and younger) who were treated by emergency medical personnel for an out-of-hospital cardiac arrest in the years 2005, 2006 and 2007. Unfortunately, only 9% of those children survived, and even fewer – 3% – had a “favorable neurological outcome.” But the ones who got CPR from a bystander stood a much better chance of preserving their neurological function than those who didn’t – 4.5% vs. 1.9%, according to a report being published online Wednesday by the journal Lancet.

The researchers also found that conventional CPR was more likely to result in a “favorable neurological outcome” than compression-only CPR. In their analysis, 7.2% of children given chest compressions and mouth-to-mouth had a good outcome, compared with 1.6% of kids who got compressions only.

In a commentary accompanying the study, Spanish researchers say the reason is probably that most cases of sudden cardiac arrest in children – 71% in the Japanese study and more than 90% in other studies – are probably caused by non-cardiac events. (Only about a third of cases in adults are thought to have non-cardiac origins.) In such cases, mouth-to-mouth resuscitation is helpful. When cardiac arrest has a cardiac cause, either type of CPR works equally well.

They conclude that bystanders should continue to provide traditional CPR to children in cardiac arrest.

-- Karen Kaplan

Photo: These kids are participating in a disaster drill, but if it were an actual emergency, bystanders should give them chest compressions AND mouth-to-mouth, according to a new study. Credit: Glenn Koenig / Los Angeles Times


No CPR training? No problem!

December 23, 2009 | 12:52 pm
Cpr To all you would-be good Samaritans out there: if someone looks like they're in need of mouth-to-mouth, but you don't have CPR training, call emergency services and they will guide you through it. Odds are, it won't hurt.

That’s according to a study published online Monday in the journal Circulation. Study co-author Thomas Rea of King County’s emergency services division said the survey came about because of an observation that bystanders were not performing CPR as frequently as they could have. “There's reticence and fear on the part of the bystander — and the dispatcher — that they may cause injury to the victim,” Rea said in an interview.

Researchers from the University of Washington and King County emergency services examined 1,700 calls made between June 2004 and January 2007 in which an emergency dispatcher directed a caller on how to perform CPR over the phone. Of those 1,700 incidents, more than half (938) of the subjects were determined to be in cardiac arrest – so those first clumsy chest compressions may have helped sustain the patient until paramedics arrived. The other 762 were found to not be in arrest at the time. For the 247 who weren't actually in cardiac arrest but did, for some reason, receive chest compressions, 12% (29 people) "experienced discomfort," and 2% (six people) were injured, possibly as a result of the well meaning bystander's ministrations. Five people sustained fractures, but nothing more serious than that. 

In that time period, there were likely a total of about 4,000 calls relating to possible cardiac arrest, Rea said.

So given the potential for saving lives, if you think someone is in arrest, amateur CPR is worth the rare possibility of a cracked rib. But if you want to make sure you know the symptoms of a heart attack, the American Heart Assn. gives a helpful primer.  If you want to read up on how to perform CPR, just in case, click here

-- Amina Khan

Photo credit: John M. Glionna / Los Angeles Times


Old blood raises death risk in trauma patients receiving transfusions

September 23, 2009 |  4:10 pm

A victim of severe trauma who gets as little as a single unit of blood that's been stored for more than a month is twice as likely to die as an equally injured patient who gets transfused with fresher blood, a new study finds.

Red blood cells stored longer than 28 days significantly increased trauma patients' risk of developing fatal deep vein thrombosis or multi-organ failure for six months after transfusion, a team of pediatric intensive-care specialists in Connecticut reported today in the journal Critical Care.

The new study is the latest to raise concerns about rules governing the use of about 29 million units of blood transfused every year in the United States. The American Red Cross says donated blood has a "shelf life" of 42 days, after which it must be discarded if not used.

Two earlier studies -- one looking at a general hospital population requiring transfusion and a second at heart surgery patients -- found that the use of longer-stored blood in transfusions resulted in poorer outcomes. Hospital patients administered blood stored longer than four weeks were three times as likely to acquire an infection in the hospital than those who got fresher blood. Heart patients infused with blood stored longer than two weeks were 64% more likely to die than those whose red blood cells were more briefly in storage.

Though hospitals typically use their longest-stored blood first to avoid wasting the precious resource, the authors of the Critical Care study suggest that physicians might consider the "preferential use" of younger blood on the most critically injured trauma patients. The result would likely mean more blood reaches its expiration date before it can be used. But lives could be saved.

-- Melissa Healy


Getting a speedy response to 'code blue'

July 27, 2009 |  1:00 pm

CardiacCardiac arrest happens frequently in hospitals, and efforts have been made in recent years to hasten the response of emergency resuscitation teams. According to a recent study, as many as 30% of in-hospital cardiac arrests from ventricular arrhythmias are not treated within the recommended two minutes or less. A delay of more than two minutes is linked to a 50% lower rate of survival.

It appears no one can be certain he or she is in a hospital with a speedy response time. A study published today in the Archives of Internal Medicine found rates of delayed defibrillation vary widely among hospitals for reasons that are hard to define. For example, traditional factors that suggest a hospital's level of expertise -- such as patient volume and being a teaching hospital -- were found in the study to be a poor predictor of how well cardiac arrest was handled at such facilities.

The researchers looked at defibrillation practices at 200 hospitals participating in the National Registry of Cardiopulmonary Resuscitation. They found rates of delayed defibrillation -- longer than two minutes -- varied from 2.4% to 50.9% among hospitals. The study had trouble identifying characteristics that seemed related to poor performance, such as hospital size or hospital-wide mortality rates. Only the number of beds in the hospital (larger hospitals performed better) and geographical location (such as whether the patient was in an intensive care unit) were linked to response time. Instead, how a given hospital responds seems to be related to such factors as how the individual hospital approaches the resuscitation process and develops tactics to improve response time, the authors said.

"This lack of correlation between 'conventional' hospital-level factors and defibrillation time suggests that other unmeasured characteristics are responsible for certain institutions achieving extremely low rates of delayed defibrillation," the authors wrote.

-- Shari Roan

Photo: Mohammed Abed / Agence France-Presse


Lifesaving chest compressions near-perfect when done to disco hit

October 15, 2008 | 12:05 pm

Travolta200 Finally, a reason to have lived through the 70s -- and another fine reason to relive one of disco's most enduring triumphs, the 1977 hit by the Brothers Gibb, "Stayin' Alive": it could save someone's life.

In performing Cardiopulmonary Resuscitation -- CPR -- the perfect rhythm is 100 compressions per minute, and done properly, it can triple a heart arrest victim's chances of survival. But how, when you're saving a life, do you achieve that ideal rhythm of life-saving compressions? Think "Stayin' Alive."

Medical students and physicians trained to perform CPR to the bouncing beat of "Stayin' Alive" maintained close to the ideal rhythm recommended by the American Heart Assn. for chest compressions during CPR, according to a study to be presented Oct. 27 at a Scientific Assembly of the American College of Emergency Physician's annual meeting.

The small study set five med students and 10 physicians to the task of performing CPR to the soundtrack of "Stayin' Alive," a song with exactly 103 beats per minute. Five weeks later (it's not clear whether they got to return to the "Saturday Night Fever" soundtrack for a little disco refresher), the subjects still had their CPR rhythms close to perfect, at an average of 113 beats per minute.

Sure there are other pop songs that clock in at close to 100 beats per minute, said Dr. David Matlock of the University of Illinois Medical School. But could you do better than "Stayin' Alive" under the circumstances?

-- Melissa Healy 

Photo credit: Paramount Pictures



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