Many were stunned by the death of young Brazilian soccer player Serginho Chulapa, after he collapsed on the field in 2004. Few, however, likely felt the added tinge of frustration that Dr. Gordon Ewy felt as he watched shoddy chest compressions and mouth-to-mouth performed on someone with clearly no airway obstruction. Multiply that tinge by a few hundred thousand, for all those who die of cardiac arrest in the U.S. each year, and a much more desperate situation can be imagined.
As Chief of Cardiology at the UA Sarver Heart Center, Dr. Ewy has been attempting to change the “”P”” in CPR since 1993. In the event of sudden cardiac arrest, which constitutes the majority of cases requiring out-of-hospital resuscitation, Dr. Ewy and colleagues have instead been advising an amended version of CPR called cardio cerebral resuscitation that calls for “”hands only.””
The reasons for the transition are many, according to a stream of studies out of Sarver and elsewhere. As reported in the Jan. 19 issue of The Arizona Republic, survival rates after cardiac arrest are dismal and not helped by the fact that bystanders make rescue attempts less than one-third of the time. Many believe the reason for inaction to be the fear of complicated and slightly unpleasant mouth-to-mouth breathing. Indeed, cities in Arizona, Texas, Missouri, Washington and Wisconsin that promote the simplified “”CCR”” that eliminates the “”gross factor,”” have seen an increase in bystander intervention and survival rates.
Even if the new technique were of only comparable efficacy, as some argue, its increased “”user-friendliness”” would seem to sufficiently justify its use over traditional CPR. However, clinical, statistical and animal research studies have indicated that the continuous chest compressions are actually more effective, and can result in a “”near 300-percent improvement in neurological normal survival of patients with witness cardiac arrest and a shockable rhythm.””
This increased efficacy is due to the fact that victims of cardiac arrest often have oxygen still in their lungs and bodies that merely needs to be moved around to sustain life long enough for a defibrillator to shock the heart back into action. The compressions may also allow passive inhalation of air as the chest wall recoils. According to a 2006 report in Science Daily, “”performing powerful chest compressions with minimal interruptions is of utmost importance.”” Tucson and Phoenix Fire Departments were easily persuaded to adopt the new technique. Hopefully, as a result of a statewide campaign launched by the Arizona Department of Health Services in 2005, both professional and lay rescuers will be using hands-only CCR.
It is unclear whether a simple allegiance to tradition, or something more sinisterly political is fueling the American Heart Association’s stubborn resistance to change. Luckily, Dr. Ewy and his formerly radical ideas have found a friend in CNN’s chief medical correspondent Dr. Sanjay Gupta. Hopefully the handsome young neurosurgeon and his actor-friend Matthew McConaughey will have more luck affecting change with the American Heart Association than the older, assuredly irritated Dr. Ewy.
— Andrew Kenyon Busch is a first-year doctoral student in physiological sciences.
He can be reached at letters@wildcat.arizona.edu.
