Posted: 03/28/07

Have a heart
Japanese study redefines CPR

Roni Reino | contributing writer
vreino@smcvt.edu

Focusing on chest compressions, rather than mouth-to-mouth, is the key to reducing brain damage in victims of cardiac arrest, according to a study published in the medical journal, The Lancet.

The Japanese study showed that people are more likely to survive cardiac arrest without brain damage during cardiopulmonary resuscitation (CPR) if rescuers focused more on chest compressions.

Rescue breaths are believed to take time away from chest compressions which keep blood circulating to the heart and brain.

The study comes more than a year after the American Heart Association (AHA) updated its CPR guidelines in December 2005.

The AHA guidelines increase chest compressions and encourage bystanders to administer CPR. The changes were created to encourage the public to conduct effective aid until professional rescuers arrive.

The demo automatic resucitation system recently issued to St. Michael's Rescue. (Photo, Roni Reino)

An estimated 330,000 out-of- hospital and emergency room deaths in the US each year are attributed to coronary heart disease, according to the AHA.

“About 75 to 80 percent of all out-of-hospital cardiac arrests happen at home, so being trained to perform cardiopulmonary resuscitation can mean the difference between life and death," according to the official AHA Web site.

Sudden cardiac arrest often occurs due to abnormal heart rhythm called ventricular fibrillation. It can also occur after the onset of a heart attack or as a result of electrocution or near drowning.

Most US and Canadian reports state that less than 6.5 percent of victims survive out-of-hospital cardiac arrest, according to the AHA.

New guidelines

Approximately 358 experts attended the 2005 International Consensus Conference. These practitioners, made up of physicians, nurses, scientists, researchers and EMS professionals from around the world, work toward employing updated guidelines, according to the AHA.

The new guidelines simplify CPR information by creating consistent ratios to remember. Before the 2005 update, the ratios varied for adult, child and infant, making it difficult for individuals to recall the information in emergencies.

Too often chest compressions by professional rescuers are too shallow and often interrupted during CPR. The new standards remind rescuers to give chest compressions that are fast and deep enough and minimize interruption, according to the AHA. Compressions should average a speed of 100 per minute.

Senior Brian Kelly, a certified CPR instructor, holds out a bag valve mask. (Photo, Roni Reino)

"Compressions should be about a third of the body deep," Brian Kelly, St. Michael's senior and AHA certified instructor says. "[The new standards] are to ensure that more adequate compressions are done."

Kelly says he knew about the new guidelines before they were adopted by the AHA.

“We had to wait for Fletcher Allen to accept the new standards,” Kelly says. “Actually, we had to wait for the district, the hospital and the state of Vermont to accept the standards before we could teach them.”

After the standards were accepted, Kelly says he was able to teach them to area schools, medical students at Fletcher Allen, and even military personnel at nearby Camp Johnson. He teaches courses once a month, but may only instruct seven participants in a single course, according to AHA standards.

Over time, Kelly says he learned to adapt to the new guidelines.

"At first, I hated them," Kelly says. "I'm a stickler for consistency, but I could see the logical changes.”

The AHA asks for 30 chest compressions to allow for human error. It is believed 17 compressions would be sufficient but the AHA understands that in an actual situation, not all compressions are effective, Kelly says.

Sign me up

St. Michael’s offers CPR certification classes three to four times a year, says Rick Battistoni, Occupational/Environmental Health Coordinator. However, only two employees can attend a session at a time. Job location determines who receives priority, with those working in higher populated area receiving precedence.

“Someone who works in the library would get priority over someone who works in Klein,” Battistoni says.

Although the college's insurance company will pay for the costs, it would be expensive to certify more than two people at a time since refresher courses are required later, Battistoni says. The school cannot certify the entire campus.

There is no set schedule for classes, but when they are offered, Battistoni says he sends an e-mail out to faculty, staff and students, with faculty and staff receiving priority.

St. Michael's alumnus, Sebastian Palmeri, along with Brian Kelly demonstrate two-man CPR. (Photo, Roni Reino)

Various organizations certify for CPR, such as the AHA and the Red Cross. While St. Michael’s offers faculty and staff Red Cross certification, Kelly offers AHA.

Mike Arena, Senior Public Services Specialist in Durick Library says he received Red Cross CPR training offered through the college last June.

“I definitely learned a lot,” Arena says. “But I still feel like I need a lot more repetition.”

AHA encourages public participation. A victim’s chance of survival can be doubled if effective bystander CPR is provided immediately after cardiac arrest, according to the AHA.

Rescue me

Members of St. Michael's Fire and Rescue are required to update their CPR certification as well.

Miryam Andrews-Ohlman, volunteer firefighter and sophomore, first became CPR certified for lifeguarding at the YMCA her junior year of high school. She updated her certification during Christmas break.

“I still work at 'the Y' so I have to keep my certification up,” Andrews-Ohlman says.

Although she took the course for lifeguarding, the fire station had also asked her to take the new course.

“I think the whole new system is easier to remember the numbers,” Andrews-Ohlman says. “It allows the people giving care a better chance to provide adequate care.”

Rescue members were required to take a "bridge" course to transition into the new standards, says Peter Cronin, sophomore and St. Michael's Rescue member. "For years they've been researching it," Cronin says. "It's supposed to be easier for the public."

Rescue recently was issued a demo model of an automatic resuscitation system. It allows rescue to properly provide chest compressions with the press of a button.

Once strapped into the system, straps fit to the victim’s body and produce appropriate pressure and consistency of compressions. This allows the rescue squad to focus on rescue breaths issued though a bag valve mask.