Team Approach To CPR Advocated

DANVILLE — One minute John Chandler was driving back from the farm bureau feeling just fine. The next thing he remembers was waking up in the hospital.

Sudden cardiac arrest happens that fast.

A 70-year-old semi-retired Danville business owner, Chandler is one of the lucky ones.

When his heart stopped on that day in October last year, he crashed into a utility pole, got pulled out of his SUV and was given CPR before the ambulance arrived. Four months later, he's doing cardiac rehab and otherwise back to his normal routine.

"Everybody tells me I was pretty lucky on the whole thing," he said.

Every minute to treatment after cardiac arrest is critical, and cardiopulmonary resuscitation started ahead of the ambulance doubles chances of survival.

But often, nobody starts CPR — or grabs a defibrillator and uses it, if there's one handy — before emergency responders arrive.

About two-thirds of all cardiac arrests strike outside a hospital, and, nationally, only 12 percent of those out-of-hospital victims survived last year, according to the American Heart Association.

Cardiac arrest is set off by an electrical malfunction of the heart. It's sometimes confused by people with a heart attack, which occurs because of a blocked artery.

Cardiac arrest disrupts the rhythm and pumping action of the heart, and death can occur within minutes without treatment.

Sometimes there are warning signs beforehand, and sometimes not, according to Dr. Kurt Bloomstrand, the regional EMS medical director for Presence Health.

When there are warnings, they can be so vague and subtle — a feeling of fatigue or shortness of breath, for example — survivors never even associate them with their hearts until they think back on the episode later, he said.

Campbell said he was putting in long days last October. He co-owns Travel Trailers Sales and Service in Tilton and was also helping his son farm. While he's diabetic, one of the risk factors for sudden cardiac arrest, he never felt sick beforehand, he said.

After hitting the utility pole, a nurse on the scene gave him CPR, Campbell said.

When the ambulance arrived, two Danville police officers were administering CPR and then the ambulance crew took over, said Jerry Beckley, an Arrow Ambulance paramedic supervisor who was on that call.

"High-quality CPR does it," Beckley said. "CPR saves lives."

Powering up CPR

Cardiac arrest outside hospitals doesn't have to have such high fatality rates, experts say.

But its widely misunderstood by the public, with most people failing to realize how highly fatal it is, and how little time there is to make a difference, according to the heart association.

A cardiac arrest victim needs immediate CPR to increase the blood flow to the heart and an electrical shock from a defibrillator to stop the abnormal heart rhythm. Every minute that goes by without those potential live-savers cuts chances of survival by 7-10 percent.

Dr. Michael Smith, the medical director of Carle Regional EMS and Arrow Ambulance, blames TV dramas for misleading people to believe most cardiac arrest victims so often survive, "and that's just not the case," he said.

More than a year ago, Arrow Ambulance moved to a high-performance CPR technique and has trained local police and firefighters to also use it.

Intended to improve survival rates, it's a team approach to CPR with minimal interruption. Smith called it a "pit crew" approach, in which everybody has an assignment and the crew members doing the chest compressions are rotated every couple of minutes to keep the compressions strong and steady.

This is important because even with the most fit people, the efficiency of delivering chest compressions will fall off after a couple of minutes when they're done by just one person, he said.

"The concept is, if you take a break, then go back to it every couple of minutes, you're more efficient at doing CPR," Smith said.

One of the biggest barriers to rolling this out was it was a new way of thinking, according to Justin Stalter, Carle regional EMS system coordinator.

The old thinking was "load and go" to the nearest hospital, Stalter said, but this means staying put and keeping CPR going longer before leaving for the hospital.

"If you throw them in the back of the ambulance, it's hard to do effective CPR bouncing down the road," he said.

Presence Health-owned Pro Ambulance has also been trained and has updated its CPR procedures to use this approach, Bloomstrand said.

"Resuscitation is something we're all kind of trying to improve," he said.

Mobilizing bystanders

The number of people surviving cardiac arrest that strikes outside a hospital in Illinois last year was just over 9 percent. But the survival rate was much higher for two subgroups of cardiac arrest victims considered to have the best survival chance.

About a third of those out-of-hospital victims survived if someone witnessed their cardiac arrest episode and their hearts were in a shockable rhythm when an ambulance arrived, and nearly 45 percent of that same group survived if they also got bystander treatment ahead of the ambulance, according to Illinois Heart Rescue, an organization working to improve sudden cardiac arrest survival rates.

Since this organization's launch in 2013, it's seen the state's overall survival rate for out-of-hospital cardiac arrest more than double.

Illinois Heart Rescue says bystanders play the most critical role in saving lives, and upping the survival rate comes from teaching thousands of people to recognize and react to cardiac arrest.

"If I had my way, every time people renewed their driver's license, they'd have to learn CPR," said Teri Campbell, the group's director.

One misapprehension that may still be keeping some from even trying — the fear of having to give rescue breaths to a stranger — has been a needless concern for bystander rescuers for nearly a decade since it was concluded "hands only" CPR, just pressing on the chest, works just as well as doing both.

Campbell said it also doesn't have to be a several-hour time commitment to learn CPR.

"We teach CPR in five minutes," she said.

Illinois high school students are already learning. A 2014 law requires mandatory training in CPR and the use of automated external defibrillator (AED) in all state high schools prior to graduation. Lauren's Law was named for Lauren Laman, a 17-year-old in St. Charles who collapsed and died from sudden cardiac arrest at school. An AED was available and wasn't used, and by the time emergency responders arrived and administered CPR, it was too late.

In the works

Presence Health is working on a project that could significantly mobilize bystander response in Champaign and Vermilion counties later this year.

"We know our resuscitation rates here and across the country are very low," Bloomstrand said.

Pending details being worked out with emergency dispatch agencies, Bloomstrand said, Presence hopes to roll out new technology in six to eight months that will allow cellphone users to sign up for an app that will alert them when anyone nearby is in need of CPR and where to locate the nearest defibrillator.

Presence plans to foot the cost of the technology, and also get more people trained in hands-only CPR, Bloomstrand said.

Well-trained emergency responders can only get there so fast, he said.

"The piece that's missing is getting the public involved," Bloomstrand said. "That can be a valuable minute saved."

Did you know?

► 70%: How many cardiac arrest incidents happen outside hospitals.

► 46%: How many of those out-of-hospital cases get immediate treatment from bystanders.

► 100-120: The number of chest compressions per minute advised for doing CPR.

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Story Credit: http://www.news-gazette.com/news/local/2017-02-19/team-approach-cpr-advocated.html