Pulse
Citizens' Arrest
A St. Cloud physician wants to reduce the number of deaths from sudden cardiac arrest by training every member of the public in CPR.
Keith Lurie, M.D., found his inspiration for helping people survive sudden cardiac arrest in, of all things, a bathroom plunger.
Twenty years ago, Lurie was a junior faculty member at the University of California, San Francisco, when a man was brought to the emergency department after a family member had used a plunger to deliver CPR compressions to his chest. “We all thought it was pretty funny, but it was shortly after that that I realized how many people died every day from cardiac arrest because there really was no good therapy,” he says, impressed with the rescuer’s ingenuity and how the more forceful compressions delivered by the plunger could better circulate blood than standard CPR.
That experience made Lurie want to improve treatment for people in sudden cardiac arrest, a condition the American Heart Association (AHA) estimates kills 300,000 people each year. And he’s spent the last 20 years doing so.
A cardiologist and cardiac electrophysiologist at St. Cloud Hospital, Lurie invented several devices during the 1990s that use the same mechanism as the plunger to pump more blood to the heart and brain during ventilation than CPR. He has also served as a member of the AHA’s basic life support subcommittee, which came out with new recommendations in 2005 for treating sudden cardiac arrest, one of the most important of which is starting CPR.
Lurie notes that there’s been a shift in thinking about CPR. “Over the last 20 years, we made some observations that we could improve blood flow more significantly if we turned the chest into a more active bellows to move blood rather than air.”
That change prompted the AHA to revise its guidelines on how to perform CPR. The AHA now recommends that rescuers do more compressions (100 per minute) and fewer ventilations (two one-second breaths for every 30 compressions) than before. Compressions should be done continuously with the chest fully recoiling between pushes. CPR also should be done before and immediately after shocking a patient with an automated external defibrillator (AED).
“By doing this, we can deliver three to four times as much blood to the heart and brain than we could before,” Lurie says, adding that a number of physicians have yet to be trained in the new techniques.
Spreading the Word
The same year the AHA came out with its new guidelines, Lurie and colleagues from Minnesota and Columbus, Ohio, launched Take Heart America, one of the goals of which is to teach members of the community to do CPR. The AHA basic life support panel had discovered that less than one-third of the public knew how to do CPR, and many of those who were once certified weren’t schooled in the latest method. “We know that people who do survive sudden cardiac arrest typically have had CPR by a layperson,” he says.
But a well-trained public isn’t all that’s needed to improve survival. Take Heart America also recommends that first responders be retrained in CPR and have access to AEDs and circulation-enhancing devices such as the ResQPOD, one of the plunger-like devices Lurie invented. In addition, hospitals should employ therapeutic hypothermia to decrease the brain’s demand for oxygen, thus, protecting it from damage.
Although therapeutic hypothermia was first described nearly 50 years ago, two studies published in the New England Journal of Medicine in 2002 showed that inducing a coma and cooling the body to 92.5 degrees F for two to four hours after resuscitation decreased the chance that the patient would die or be disabled.
“Each of these interventions had been tested, but no one had put the entire sequence of events together and evaluated it,” Lurie says.
With funding from the CentraCare Health Foundation, the Medtronic Foundation, and St. Jude Medical, Lurie and the Take Heart America team began testing their protocol in St. Cloud in 2005. The pilot project involved teaching 9th- and 10th-grade students and others in the community CPR basics and to use an AED, then having those individuals train family members and friends; retraining all first responders in CPR; streamlining communications between the 911 operators and the area’s ambulance service; and setting up a “resuscitation center” in the hospital where patients can be cooled once blood flow is restored.
So far, 7,500 area students and other members of the public have gone through CPR training. Since it started using therapeutic hypothermia in December of 2005, St. Cloud Hospital has seen the survival rate for sudden cardiac arrest patients increase from 25 percent to 58 percent, according to Scott Davis, M.D., medical director of the hospital’s ICU. “Anytime you can double a survival rate, it’s breathtaking,” he says.
The pilot is now being extended to three other sites—Travis County, Texas; Columbus, Ohio; and Anoka County, Minnesota.
In addition to expanding the program throughout the United States, Lurie hopes to see the day when patients in cardiac arrest are brought to emergency departments connected to an automatic CPR device, taken directly to the cath lab where their blocked arteries are opened, placed in a coma and cooled for 24 hours, then connected to a peripheral bypass machine in order to give their stunned hearts a chance to recover. “I think if we’re able to execute that chain of events,” he says, “we will have made huge progress in the true save rate for these patients.”—Kim Kiser