Cardiac arrest myths debunked in EMS World 2012 keynote

During address in New Orleans, Dr. Ed Racht outlined the past, present and future for patient care

By Sarah M. Smart
EMS1 Editor

NEW ORLEANS — Dr. Ed Racht, chief medical officer of AMR, focused on debunking two still-prevalent myths during the keynote address at EMS World Expo 2012 on Wednesday:

1. The more medications, procedures and science we throw at cardiac arrest, the better the outcomes will be.
2. No one survives cardiac arrest, so CPR is pointless.

It's true that for a long time cardiac arrest was basically a death sentence. Early "treatments" to revive those who suffered it included rolling the patient over a barrel and blowing tobacco smoke into the patient's anus (we are not making this up), but rarely has anything seen game-changing success.

Cardiac arrest has evolved into a focal point for EMS systems.

"If we can't or won't do our job right, the outcome is death," Dr. Racht said.

Newer, more complicated resuscitation procedures like epinephrine administration and airway management have turned the public off of bystander CPR.

“Anything we can stick in 'em, through 'em, or on 'em,” he added.

These additional rules have actually not increased survival rates from cardiac arrest for the 383,000 who will suffer cardiac arrest this year: They've hovered around 8 percent for the past 30 years.

"We're in this mode where all our cardiac arrest patients seem to die," Dr. Racht said.

However, that's not the case everywhere. An Ariz. agency, for example, made the bold move of switching to compression-only CPR... and found dramatic improvement in ROSC, bystander involvement and neurologically intact survival to hospital discharge.

Survival rates do vary, even though most agencies are using the same or similar products, defibrillators and protocol. Why? And, more importantly, how do we increase them across the board?

"Somewhere there's a secret sauce," Dr. Racht said.

And that sauce is the science behind the 2010 guidelines recommending compression-only CPR: Maintain forward bloodflow.

“Let's take a walk,” Dr. Racht said to illustrate this point. “Say your heart stops. How far are you going? But if you hold your breath, you can get farther... Normal bloodflow and perfusion save lives.”

Another key to cardiac arrest survival is public CPR education. A number of unusual, attention-grabbing PSAs have been released recently to build interest.

Dr. Racht told the story of an agency that roared up to the beach, sirens blaring, lights blazing, pulled out the mannekins and approached beachgoers to ask if they were interested in learning CPR right then.

Finally, when your patient regains a pulse, what's the next step? In addition to focusing on the chest, providers need to take a look at post-resuscitation care. The problem (stopped heart) might be fixed, but the body needs protection and support while it recovers.

The goal of the Heart Rescue Project is to take all the pieces of the puzzle, public CPR education/bystander involvement, prehospital care and hospital care, and analyze them across the spectrum to increase survival rates.

Change happens, Dr. Racht said, when all key players (directors, emergency departments, EMTs, etc.) necessary to create an integral system of care are identified and engaged. Here are a few tips to keep in mind when trying to drive this change:

  • Not everyone will have the same motivation, but everyone will be at the table working toward the same goal.
  • Culture change is also necessary. "They don't all die anymore," Dr. Racht said.
  • Turf battles are deadly.
  •  The perfect is the enemy of the very good. Pay attention to details, but don't get lost in them.
  • Capitalize on emotions. Publicize survivor stories. Use them to motivate and inspire, both within the field and with the general public.
  • Capture attention in unique ways.

Only when bystander, prehospital and hospital care align can cardiac arrest survival rates increase.

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