Paramedics Save More Lives When They Do Not Obey Rules -- MEDICA - World Forum for Medicine

Paramedics Save More Lives When They Do Not Obey Rules

Some emergency CPR guidelines
may be reviewed; © Picture Disk

The new approach, called Cardiocerebral Resuscitation, is dramatically different from guideline-directed cardiopulmonary resuscitation (CPR) procedures. “Cardiocerebral Resuscitation eliminates certain previously recommended procedures and reprioritises the order of actions the emergency medical services deliver,” said Michael J. Kellum, M.D., physician at the University of Arizona Sarver Heart Center and lead author of the report. The study, which involved 125 patients, reports the experiences after the revised protocol was implemented in two Wisconsin counties.

Under the new approach, first responders skipped the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they did not wait for the device to analyse the patient’s heart rhythm, but started fast, forceful chest compressions. “Intubating the patient and waiting for the defibrillator to do its analysis takes time – time a cardiac arrest victim doesn’t have,” said Gordon A. Ewy, MD, director of the Sarver Heart Center.

“In laboratory experiments, we found that the most important factor of survival is to keep the blood moving through the body by continuous chest compressions,” said Ewy. "Stopping chest compressions for ventilations was far more harmful than helpful. Excessive ventilations during chest compression turned out to be harmful, too.”

First responders applying the new protocol were able to resuscitate the majority (58 percent) of out-of-hospital witnessed cardiac arrest victims, provided they had a “shockable” initial heart rhythm. “Shockable” describes a condition in which the heart quivers rather than beats but can be shocked back into normal beat with a defibrillator. In contrast, the survival rate was only 20 percent in the three years before, when the standard CPR protocol was used.; Source: University of Arizona