Heart Disease :: Guidelines, hypothermia improve survival

A patient?s chance of survival falls 7 percent to 10 percent per minute when CPR is delayed after cardiac arrest, and post-arrest survival for out-of-hospital events is as low as 2 percent in one large Chicago hospital.

Both statistics may now improve, thanks to widespread application of the new ACLS/ECC guidelines for CPR, as well as the increased use of therapeutic hypothermia. These were the conclusions of two presenters on Saturday at a Pre-Sessions Symposium on Advances in the Care of the Hospitalized Cardiac Patient.

Bystander CPR can triple a patient?s chance of survival, but only if the bystander follows the correct protocol, according to Mary Fran Hazinski, R.N., M.S.N., FAAN, of Vanderbilt University Children?s Hospital, Nashville, Tenn. Hazinski discussed the ACLS/ECC guidelines for CPR and ECC, including changes from previous guidelines.

Continuous quality improvement is one of the secrets to improved survival. According to Hazinski, the new guidelines? decreased emphasis on advanced airway and ET drug administration.

Overzealous compressions can compromise the ventilation-to-perfusion match, she added.

?Teams must practice code performance,? Hazinski said.

Asked for an easy way to find the correct compression speed, Hazinski recommended doing CPR to beat of the Bee Gees song ?Stayin? Alive.? The clinical ideal is 30 compressions in 18 seconds, she added.

Survival statistics may also be improved by hypothermia, according to Terry L. Vanden Hoek, M.D., associate professor of emergency medicine at the University of Chicago, in his presentation on hypothermia after cardiac arrest.

The idea isn?t new; Hippocrates packed patients in snow. More recently, a trial reported in the New England Journal of Medicine in 2002 observed favorable neurologic outcome in 55 percent of patients receiving hypothermia versus 39 percent of those receiving conventional treatment.

Many factors complicate therapy, Dr. Vanden Hoek said. Temperature monitoring is critical, and choices for cooling range from ice blankets to the endovascular cooling catheter. Cooling should start a few hours after the return of spontaneous circulation, and target 32 degree to 34 degrees Fahrenheit. Most adult protocols call for 24 hours of cooling after resuscitation from arrest. Dr. Vanden Hoek invited the audience to visit http://hypothermia.uchicago.edu for more information on this therapy being practiced at the University of Chicago.

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