Is There a Better Way to Restart a Heart?


 
 

Jennifer Boen | | Tuesday, September 25, 2007


For nearly five decades, cardiopulmonary resuscitation, or CPR, has been the normal treatment for first responders reviving or keeping alive a heart attack victim.

Now a Purdue University researcher says a different way of resuscitating an oxygen-starved heart which leads to an oxygen-starved brain may be more beneficial than chest compressions and mouth-to-mouth breathing.

Biomedical engineer Leslie Geddes says rhythmic abdominal compressions have shown to increase blood flow to the heart by 25 percent compared to traditional CPR. Geddes, the Showalter Distinguished Professor Emeritus in Purdue's Weldon School of Biomedical Engineering in West Lafayette, published his research in this month's American Journal of Emergency Medicine.

"This is totally new," he said of the abdominal compression method he calls OAC-CPR for "only rhythmic abdominal compression."

Since 2005, the American Heart Association's guidelines for adult CPR call for 30 compressions at the base of the sternum for every two rescue breaths. Before then, the AHA guidelines were 15 compressions to every two rescue breaths. The change came about after AHA policy-makers, who are mostly doctors, found compressing the chest was the most important component of CPR.

"The main change in CPR in the past couple of years is that you do it fast and do it hard," said emergency medicine specialist Dr. M. Scott Mann. He is director of the Dupont Hospital Emergency Department and medical director for Three Rivers Ambulance Authority.

In OAC-CPR, no rescue breaths are needed, Geddes said, an important factor because it eliminates risk of transferring infections with mouth-to-mouth resuscitation. Although the AHA has available small packets containing a mouth guard, the average person in a park who attempts CPR on a stranger likely does not have one immediately available.

The AHA's emphasis on effective chest compressions at a rate of 100 a minute, with a force of 100 pounds, is an even greater challenge for a bystander to keep the strong, steady pace up for five minutes until EMS arrives.

Mann says after the new AHA recommendations came out, he attended a national convention where demonstrations were done.

"They had people from different EMS systems doing correct CPR, and in 2 minutes, they were worn out," he said. AHA guidelines say the sternum should be depressed 1 1/2 to 2 inches.

Traditional CPR takes two people if it is to be done effectively, one to do the chest compressions and another person the rescue breathing. Most often, people have heart attacks in their home where usually one person, likely a spouse, is present. OAC-CPR requires only one person, which is another advantage, Geddes says.

Rib fractures can occur with traditional CPR if the rescuer pushes too hard.

"But if you don't push hard, you won't save the person," Geddes said.

While fractures can occur in a frail or elderly person, Mann says in his 20 years in emergency medicine, he has not fractured someone's ribs doing CPR. Concern of fractures "is certainly not a contraindication for doing CPR," he said.

Geddes' research is showing that 100 compressions per minute are not needed. "Eighty (compressions) seem to be enough, and 80 pounds of force," he said.

His research has been done on pigs, the closest to human subjects for this kind of research. The next step, Geddes said, is to get other researchers to duplicate the studies.

If results align with his findings, then a request would be made to the FDA for a human clinical trial. Such trials can be difficult because of the variables in patients and because of potential risk to humans. Geddes said a group of as few as five people who are terminally ill, "who have no other option of therapy," might be possible subjects.

When contacted by The News-Sentinel, AHA and American Red Cross officials said they could not comment on the abdominal compression method because they did not know enough about it.

Geddes' research was funded, in part, by the National Institutes of Health. He applied to the AHA for a research grant on the OAC-CPR method but was turned down, he said.

Meanwhile, traditional CPR is -- and should be -- continued. Although Geddes says CPR has a success rate of 5 percent to 10 percent, depending on how fast rescuers respond and how effectively CPR is done, he agrees that if CPR isn't attempted, "the person is going to die."

Mann said effective, traditional CPR improves chances of survival "dramatically" -- 50 percent or greater long-term survival if CPR is done immediately. Yet he agrees that Geddes' research holds promise.

As part of a local group of medical providers working to increase numbers of CPR-trained lay people, "We're trying to look at all sorts of novel ways," to increase participation, Mann said. Any method proved more effective and that is easier to teach and use would save more lives.

Until OAC-CPR or another method is proved superior in multiple studies, Mann said, "If you can get the CPR within 4 minutes, get the defibrillator there within 5 minutes, that's when you make your best bang for the buck."

Jennifer L. Boen covers health and social-service issues for The News-Sentinel. She can be reached at 461-8416 or by e-mailing jboen@news-sentinel.com This column is the personal opinion of the writer and does not necessarily reflect the views or opinion of The News-Sentinel.


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