Cardiac arrest revival rates up

Arkansas' largest ambulance service has doubled the percentage of patients it revives from cardiac arrest since altering its treatment protocol in November.

Metropolitan Emergency Medical Services of Little Rock said that performing uninterrupted CPR on the scene has returned cardiac activity to almost 33 percent of patients. That figure hovered around 15 percent when emergency crews r̶u̶s̶h̶e̶d̶ ̶p̶a̶t̶i̶e̶n̶t̶s̶ ̶t̶o̶ ̶h̶o̶s̶p̶i̶t̶a̶l̶s̶ treated patients on a case-by-case basis*, which was the protocol before the new guidelines took effect Nov. 23.

The agency, which responds to more than 700 cardiac arrest calls per year, is among many in the country that now favor extended CPR at the scene instead of quick transport. Ambulance services in Maine, Arizona and Washington state have seen similar increases in the number of revived patients, according to the Journal of Emergency Medical Services.

MEMS implemented the new protocol in partnership with local fire departments and the Arkansas Emergency Physicians Foundation, which is led by MEMS medical director Dr. Charles Mason.

"The folks that recognize the science -- the continuous compressions, the quality compressions -- they recognize that the things that we normally do on scene -- putting them on a cot, loading them from inside the house to outside the house, and loading them into the ambulance -- were not being performed well," Mason said. "It's just hard to do compressions and move from one spot to another spot to the hospital. If we can get someone with a pulse and a heartbeat back to the hospital, then they have a chance of surviving."

But it's a small chance. The National Academies of Medicine found in a study last year that fewer than 6 percent of those who suffered cardiac arrest outside a hospital survived. By comparison, the survival rate was 24 percent for those already hospitalized.

Cardiac arrest -- the abrupt loss of heart function caused by malfunctioning electrical impulses -- is the third-leading cause of death in America behind cancer and heart disease, according to the Academies of Medicine. It affects nearly 600,000 people per year, often those with coronary artery disease. Survivors who don't receive immediate treatment can suffer brain damage within minutes.

Nearly 80 percent of cases occur in the home, meaning ambulance services such as MEMS are usually among the first to provide aid.

MEMS equipped its ambulances with metronomes to pace the chest compressions during CPR. The devices are set to chime 110 times per minute, mimicking the elevated heart rate necessary to "diffuse the brain with blood flow when the patient can't do it themself," MEMS quality assurance manager Mack Hutchison said.

MEMS Executive Director Jon Swanson noted that CPR is strenuous when performed with the proper pace and vigor. It's not unusual for three to five medics and firefighters to alternate CPR on a single patient without interruption. Their efforts sometimes surpass an hour.

The agency considered public service announcements to inform the 530,000 residents it serves in Pulaski, Faulkner, Grant and Lonoke counties of the new cardiac arrest protocol. Officials were concerned that residents expecting hospital transport might find CPR lacking in urgency.

Instead of broadcasting the new guidelines, the nonprofit agency trained its 220 uniformed personnel to explain the benefits to patients and bystanders. The agency said explanations have been necessary on several occasions, but it declined to provide specifics, citing health privacy laws.

Mason said feedback has been positive.

"They see how much work goes into it. They see the sweat that comes off the paramedics and firefighters," he said. "They see the amount of devotion that they place into the patient. And I think, overall, it's well-received."

MEMS officials said the need for extended CPR depends on the circumstances. The new cardiac arrest guidelines do not apply to children, who may require specialized treatment. Swanson said calling 911 offers the best chance for help in any case.

Hutchison agreed.

"What we're bringing to that patient are the same medications and the same procedures that are available in the hospital," he said. "So the benefit comes from applying those uninterrupted, without trying to hurry up and move a patient."

MEMS officials said the percentage of patients revived from cardiac arrest has been steadily rising since the CPR protocol was implemented. They said they expect it to keep rising to about 40 percent, a figure that several other ambulance services in the country have reported.

"It's very basic science," Mason said. "But this is working across the country, and we need to be doing this."

Metro on 02/14/2016

CORRECTION: Metropolitan Emergency Medical Services of Little Rock has doubled the percentage of patients it revives from cardiac arrest since altering its treatment protocol in November. A headline in Sunday’s editions incorrectly stated that survival rates for cardiac arrest had increased through MEMS performing on-scene CPR. Also, Metropolitan Emergency Medical Services of Little Rock treated cardiac arrest patients on a case-by-case basis before changing its policy to favor uninterrupted CPR in November. This story incorrectly stated the previous policy was to rush patients to hospitals.

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