By Samara Kalk Derby
The Capital Times
Copyright 2008 Madison Newspapers, Inc.
MADISON, Wisc. — The Madison Fire Department is implementing new cardiac protocols that could potentially triple the survival rate of someone having cardiac arrest.
The new protocol for cardiac arrest emphasizes chest compressions over mouth-to-mouth resuscitation, and today, Mayor Dave Cieslewicz was set to become one of the first local “lay responders” to be trained in the relatively new form of CPR, called CCR, for cardiocerebral resuscitation.
CPR isn’t always successful because sometimes lay responders are reluctant to put their mouths to another person’s mouth. CCR doesn’t involve mouth-to-mouth contact, and it’s so easy that doctors say anyone can do it if they see someone collapse.
“The question that I have for you is, ‘If you saw somebody that you didn’t know, would you want to do that kind of a procedure?’ ” said Assistant Fire Chief Jim Keiken about mouth-to-mouth resuscitation.
“In the past, if you didn’t do that, there was a belief that you didn’t do anything, where now with this information you do the compressions, the compressions are moving the blood, they are moving the oxygen, and you are doing what needs to be done especially in those first few minutes,” he said.
CCR uses continuous chest compressions at a rate of 100 per minute. The idea is to keep the heart beating by pressing repeatedly on the chest and moving the stored oxygen in the blood to vital parts of the body, particularly the brain.
“Under the old compression ventilation process there was only approximately 60 percent of the time where you are circulating blood,” Keiken said. “That makes a difference.”
He said the resuscitation rates in most communities around the country, where somebody walks out of the hospital after a cardiac arrest, are only about 10 percent. In places such as Rock and Walworth counties, where they have been doing CCR for a few years, success rates have been between 35 and 45 percent, “which is dramatic,” he said.
Cardiac arrest is different from a heart attack. In cardiac arrests, the heart suddenly stops beating. In heart attacks, a blood vessel blockage impairs blood flow to the heart.
Through the efforts of Dr. Darren Bean, medical director of the Madison Fire Department and a University Hospital physician, the Fire Department has gotten approval from the state to allow its paramedics and emergency medical technicians to revise their practices for cardiac resuscitation. The department is also launching a countywide program designed to improve survival rates from out-of-hospital cardiac arrest - rates that have not changed locally or nationally in 20 years.
With changes under way for health care providers in the field, there is a desperate need to train lay responders.
“The importance of bystander initiated chest compressions cannot be overstated,” said Bean. “The single most important predictor of survival from cardiac arrest is whether or not the person received bystander chest compressions. What you do in the first minute after collapse is often the difference between life and death.”
Fire Department spokeswoman Lori Wirth said the protocols have gone through the state fairly rapidly.
“The medical community is rather excited about it because it really is the first time in probably 20 years we’ve seen real movement in the numbers. And not just being able to revive somebody at the scene, but actually being able to send them home with no neurological damage,” she said.