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New CPR method boosts survival

18th March 2008

Researchers in the United States have developed a new technique for resuscitating patients who suffer cardiac arrest outside hospital, which they say boosts survival rates significantly.

Ambulance

The new technique, known as minimally interrupted cardiac resuscitation (MICR), tries to keep up an uninterrupted series of chest compressions.

This is because the amount of blood pumped out of the heart by someone pressing on the patient's chest is minimal, so chances of survival are greatly increased by doing it as much as possible, the study found.

The team, led by Bentley J Bobrow of Mayo Clinic in Scottsdale, Arizona, developed the technique because cardiac arrest that occurs outside a hospital is a major public health concern and a leading cause of death.

In 2004, just 3% of patients in Arizona with cardiac arrests outside a hospital survived.

MICR involves a complex series of interventions which include 200 uninterrupted chest compressions, rhythm analysis with a single shock, followed by 200 more immediate chest compressions before pulse check or rhythm re-analysis.

It also entails the early administration of epinephrine - a heart-stimulating form of adrenaline, and the delay of lung ventilation with a tube in the windpipe, compared with traditional resuscitation methods.

The team trained emergency services personnel in the technique, then examined survival data for patients who received MICR compared with another group who received standard advanced life support procedures.

Survival-to-hospital discharge increased from 1.8% in the before MICR training group to 5.4% in the after MICR training group among the 886 patients with cardiac arrest in the two cities.

A subgroup of 174 patients had a witnessed cardiac arrest and ventricular fibrillation (chaotic heart rhythm) increased survival from 4.7% in the before MICR training group to 17.6% in the after MICR training group.

Overall, the survival rates for people receiving MICR for cardiac arrest was 9.1%, compared with 3.8% in the non-MICR group.

The effect was even more marked among patients who also had ventricular fibrillation, with survival rates of 28.4% for those receiving MICR in this category compared with 11.9% in the non-MICR group.

Further randomised trials were needed to confirm the result, according to Bobrow and colleagues.


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Comments

Sunday 30th March 2008 @ 11:39

The use of minimally interrupted cardiac resuscitation (MICR) would seem to be a great step forward in survival rates, but it does depend on the availablity of paramedics with epinephrine and a defibrillator, or at very least an AED onsite. Is there any evidence as to what the best process is (e.g. the current 30 compressions to two breaths) whilst waiting for the ambulance?


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