Friday, February 17, 2012

Protecting Children From Sudden Cardiac Arrest in Youth Sports Due To Blunt Force Impact: Understanding Commotio Cordis

A blunt force to the chest by a ball, helmet or elbow during a sporting event can cause sudden cardiac arrest and is fatal in most cases. Children are especially vulnerable. Check out the facts and what action to take to prevent and avoid.

Tuesday, February 7, 2012

Teen's Sudden Passing Sparks Crusade For CPR In Schools
4:10 AM, Feb 7, 2012  
Written by
Michael Wooten

AKRON, N.Y. -- More than 400 students at Akron High School are equipped with life-saving training, following the loss of a fellow student. Now, the goal is to make that happen in schools statewide.

Two years ago, Emily Rose Adamczak was at a local soccer practice, when she collapsed. Doctors didn't know it beforehand, but Emily had a serious medical condition that caused sudden cardiac arrest.

Emily didn't receive CPR for five minutes after she collapsed, and her family and friends always wonder if her life could have been saved.

Since that day, Emily's mother Annette has made it her mission to get more people trained in CPR. She worked with Rural Metro, the local fire departments, and other organizations to do community CPR training sessions.

Then, Annette set her sights on t he high school. With the wholehearted support of the principal, she worked with the American Heart Association, Rural Metro and others to train every high school student in CPR and how to operate an automated external defibrillator or AED.

That training recently wrapped up.

"I just don't think that any other family should have to go through this," Annette said. "Not at such a young age should their child, should their sibling have to pass."

REMEMBERING EMILY

Emily Rose Adamczak was as outgoing a 14-year-old as you could find. She was active in many sports, including soccer, track, swimming and volleyball.

"She loved sports," her mom said. "She loved the outdoors. She could tell you a million and one facts about animals."

Emily Rose was extremely close to her siblings, especially her younger sister Shelby, who spoke with 2 On Your Side.
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"She was a very perky, fun-filled, cheerful girl," Shelby said. "She was always looking for the greater good in things."

Shelby was also at the soccer practice, out on the field, when Emily collapsed.

"Honestly, it pulled me apart from the inside out," Shelby recounted. "It was my best friend. It was my big sister. She was mine."

Shelby said the entire communi ty has been affected by the loss, and many have attended community CPR training sessions in Emily's honor.

THE COST

Until recently, Annette was unaware of a bill in the New York State Legislature that would require CPR and AED training in all high schools. Now, Annette joins the Heart Association in their lobbying effort for that bill.

Bills like this have faced opposition in the past -- and continue to -- because some consider this proposal to be an unfunded mandate. However, Josh Lawrence, a board member with the local American Heart Association, said a cost-benefit analysis shows the bill is needed.

"(If) you think of the minimal cost it would be to implement this, you really realize that this bill makes a lot of sense," Lawrence said.

Principal Joe Lucenti said he normally opposes requirements from Albany, but this is a bill he fully supports.

"Personally I hate mandates," Principal Lucenti said. "But you know, when you think about this, the cost of this is so minimal if anything that it's almost ridiculous not to do it."

Lawrence said the only cost to districts would be for the mannequins, which may cost a couple hundred dollars; however, most districts could partner with non-profits and health care businesses to provide them for free. For instance, Rural Metro provided the mannequins used at Akron.

"It's sad that it would take a mandate to do it, but it would be one of the few mandates that I would ever support," the principal said. "It makes sense, it's very very cost-efficient, and you're teaching kids a skill for a lifetime."

AED MACHINES

In addition to championing CPR training, Annette and others have raised thousands of dollars to install 3 AED machines at the local athletic fields in Akron. This year, they plan to add a fourth.

The machines, which cost about $2,500 each, are connected to a phone line, and when removed immediately call 911.

&quo t;By having this hooked up to the auto-dial system, 911 can be immediately dispatched, and you asve critical moments when you're talking about a life," Annette said. "Every minute does really count... Every second counts."

A fund is set up in Emily Rose Adamczak's name at the Bank of Akron, and the money raised supports the purchasing of more AED machines and a scholarship at Akron High School.

INACTION IN ALBANY

Several bills dealing with CPR training in school s have been proposed in the legislature over the past decade or so; some of the proposed bills even passed one house of the legislature. But there hasn't been enough support to get them into law.

Proponents hope this year may be different.

Before 2 On Your Side started digging into this story, three local legislators were co-sponsors of the bill -- Senators Maziarz and Grisanti and Assemblyman Burling.

2 On Your Side contacted the other 15 members of the WNY delegation.

Now, three more have either signed on as co-sponsors or plan to do so this week -- Senator Gallivan and Assemblymen Ryan and Giglio.

Four other legislators -- Senators Young and Ranzenhofer and Assembly Members Peoples-Stokes and Gabryszak -- said they will vote yes if the bill comes to a vote. Ranzenhofer already did so in a Senate Education Committee vote. A fifth legislator, Assemblyman Schimminger, said he supports the requirement if it gets support from schools. He said he will be "watching for their position."

Several other members of the Assembly said they are supportive of the idea of CPR training, but they cannot support the current bill, because they called it an unfunded mandate. Those Assembly members include Corwin, Smardz, Walter and Hawley.

2 On Your Side has not yet heard back from Senator Kennedy and Assemblymen Ceretto and Goodell.

According to the American Heart Association, only 3 states -- Alabama, Iowa and Rhode Island -- require all students be trained in CPR before graduation. Many hope New York will become the fourth.
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2 On Your Side will continue to follow this story as well as the national conversation to explore if federal intervention is needed and what New York can learn from other states.

LAWMAKERS' STATEMENTS

Several members of our WNY delegation released statements to explain their positions on this issue:

        Assemblyman Ray Walter: "I have been very supportive of the Adamczak family in the past, working with them during my time in the County Legislature to get the AEDs installed at the athleric fields in Akron Falls Park.  While I support the concept of requiring CPR training in schools, I would only support such a mandate if it came with funding from the state.  Our schools and municipalities are already overburdened with Albany's unfunded mandates."

        Assemblywoman Jane Corwin: "The safety of our students and CPR training are top priorities, since they are top priorities I want to make sure that a program like this is fully funded. Because our schools are struggling with their budgets, they do not have the resources to fund additional programs. That is why I am working for Unfunded Mandate Relief for sch ools. I am prepared to sign on this bill as a co-sponsor, when schools have the resources to fund new programs. In the meantime, I am going to continue to advocate for community-based training programs."

        Assemblyman Robin Schimminger: "I certainly encourage students, faculty and staff of school districts to learn how to perform CPR and how to operate an AED machine. If, indeed, school districts support such a state law requiring training in schools, then I would concur. I'll be watching for their position."

        Senator Patrick Gallivan: "This legi slation will save lives and protect students, faculty, and staff in Western New York's schools. The cost to install and maintain an Automated External Defibrillator devide in close proximity to athletic facilities, and to conduct basic CPR training in schools is minimal when compared to many other frivolous mandates. I will work with the New York State Board of Regents to eliminate other mandated items, to ensure every district can afford to implement these lifesaving tools."

        Assemblyman Sean Ryan: "It is usually best to avoid putting new mandates in place, but this legislation will offer students the opportunity to learn a critically important life skill. The best case scenario is to have as many students as possible who are properly trained in CPR."

Monday, February 6, 2012

Updated 02/03/2012 09:32 PM

Lacrosse Player Hospitalized After Hit To The Chest

By: Casey J. Bortnick

A 12-year-old boy is in guarded condition at Strong Hospital after police say he was hit in the chest with a lacrosse ball during an indoor game in Gates Thursday night. Ambulance crews performed CPR and used a defibrillator to restart his heart. For hundreds of local lacrosse players and their families, it's a strong reminder of how important player safety is.
Lacrosse, at any level, is a game of speed and flexibility. That's why the equipment is lightweight and flexible.
"Football pads are used to deliver a blow, whereas these (pads) are used to protect the player from incidental contact,” said Tim Britton, youth lacrosse coach.
Britton and Scott Nitti coach youth lacrosse. They say safety comes first.
"You've got sticks coming down, balls flying through the air. You've got to make sure you're dressed properly for the game,” said Nitti.
Eleven-year-old Jake Jamieson isn't worried about safety, but his father Ralph is.
"We bought an upgraded helmet, made sure that was top of the line."
An ex-lacrosse player himself, Ralph says today's gear has come a long way.
"I think it's a lot better. I mean we had chintzy thin pads, thin shoulder pads, gloves didn't wear elbow pads."
Even the best gear isn't perfect.
Thursday night, around 6, emergency crews were called to the total sports experience in Gates.
"There was a 12-year-old patient who suffered a serious sports related injury,” said Randy Campbell of Gates Volunteer Ambulance.
A young lacrosse player was hit in the chest with a ball. When EMS crews arrived, an off-duty Rochester firefighter was already performing CPR. EMTs used a defibrillator to restart the boy's heart.
As he fights for his life, parents and coaches are taking a second look at what's protecting these players.
"I think the lacrosse community was greatly affected by what happened here last night,” said Britton.
Britton says some players on the JV and Varsity levels are tampering with their gear in the hopes of gaining a greater range of motion, leaving their shoulders and chest unprotected.
"We will be more conscious to alterations to equipment to make sure that's not the case,” said Britton.
"The heart has got to be protected and they've got to make sure these shoulder pads are snug around their waist area, so there's no room for the ball to enter into that area."
Ralph says you can't prevent a freak accident, but you can put a bigger emphasis on safety.
"You want to have fun, you want to all go home at the end of the night, you know, same way you came in that for sure,” Ralph said.
YNN is not releasing the name of the boy who was injured out of respect for the family.
The boy’s coach, Dan Merola, was clearly shaken over the incident. He's asking the community for prayers to help his player "pull through this."

Sunday, January 29, 2012

Comsewogue's Reindl's heartwarming story

January 29, 2012 by STEPHEN HAYNES / stephen.haynes@newsday.com
Hope Reindl, center, poses for a portrait with
Candace Reindl remembers the phone call -- "Come to the school! Hope collapsed!" -- and the frantic, frightening sequence that followed.
As the mother ran from their home to Comsewogue High School, little more than a block away, her initial thought was, "She must've injured her knee."
Candace entered the gymnasium to find her 17-year-old daughter unconscious on the basketball court, with two coaches performing CPR and more than 50 students huddled nervously. Candace joined in the resuscitation effort. No response, she said.
Hope stopped breathing for six minutes.
"You can't put into words what that's like," Candace said of that May 4 evening last year. "There are no words."
Inscribed on the back of Hope Reindl's Comsewogue bowling jersey, in place of her name, is "D-Fibb." It's short for defibrillator, the electronic device that shocked her heart back into rhythm and saved her life.
The senior joined the team this winter and has adopted the moniker. That she can make light of it now, nearly nine months later, "is nothing short of a miracle," Hope said.
Thanks to the quick thinking of coaches Justin Seifert and Rick Miekley, Hope survived a near-fatal heart attack in what doctors termed an "aborted sudden cardiac death."
"She would've died had she not had an immediate intervention," said Dr. Laurie Panesar, a Stony Brook University Medical Center cardiologist who treated Hope. "Sudden cardiac death is what it sounds like. It's scary because it's sudden and doesn't come with many warning signs."
It's also rare (one in 300,000) in youngsters with no genetic predisposition, Panesar said.
Hope, a lifelong athlete in good physical condition with no history of heart problems, according to her parents, collapsed eight minutes into an intramural basketball game.
"She scored a basket early but looked lethargic a couple minutes later," said Seifert, the girls varsity basketball coach. He was supervising the game, which started at about 7 p.m. "She suddenly stopped and went into a crouch, and I ran to her. I started talking to her, then she collapsed."
Seifert said he signaled for Miekley, the boys coach, and called 911. Hope's breathing was "labored," Seifert said, "and within a minute, it stopped."
The coaches said they had a student retrieve the AED (automated external defibrillator) from the hallway just outside the gym while they performed CPR. Shortly thereafter, Hope's mother arrived.
"I was yelling, 'Come back! Fight!' '' said Candace Reindl, a former elementary schoolteacher who had received CPR training.
Once the device was set up, "it started looking for a heartbeat and then warned that a shock was advised," Seifert said. He and Miekley were putting their AED training to use for the first time. "You hit the button, stand back and pray."
Hope soon gasped for air, he said, and they continued CPR until the paramedics arrived.
"The stars aligned well for this girl," Panesar said, adding that the resuscitation was "tantamount to what she'd have gotten in an ER."
Hope was taken to Mather Hospital in Port Jefferson, where she was stabilized before being transferred to Stony Brook that night. Hope's father, Carl Reindl, said she regained consciousness the next morning (May 5), though she had difficulty processing and retaining information.
She had an internal defibrillator implanted (above the heart, beneath the pectoral muscle) on May 6, her parents said, and was discharged the next day. "All her organs were functioning normally," Panesar said, and she made quick progress.
Hope, who said she has no memory of the collapse or her time in the hospital, returned to school 10 days later.
"I never used to think anything could happen to me," Hope said. "To think, if I wasn't where I was, the outcome would've been very different . . . I can't thank enough."
Hope's May 4 varsity softball game had been rained out, and friends invited her to play pickup basketball. She was a star catcher drawing college interest and her parents, fearing a basketball injury, reluctantly permitted her to go.
What Hope suffered was "catecholaminergic polymorphic ventricular tachycardia," Panesar said. "It's an episode brought on by stimulation from the nervous system. In her case, it was sports."
Hope's life has mostly returned to normal, but she says she no longer can play sports that involve contact or can induce bursts of adrenaline. That includes softball.
She's now looking at colleges with visual arts and culinary programs. The ordeal and subsequent restrictions are "extremely frustrating," Hope said.
As well, Candace has concerns that her other children (Emma, 18, Owen, 14 and Aidan, 13) could be susceptible to a similar episode.
The positive, obviously, is that Hope survived and now is aware of the condition. She had felt palpitations "a few times" while catching on hot days, she said, "but I didn't think it was abnormal."
Monthly visits to the cardiologist have returned clean results and the internal defibrillator, which monitors heart rate, has detected no irregularities thus far, Carl said.
Last fall, Hope was cleared to participate in two scholastic sports: bowling and golf. She had bowled only recreationally ("maybe once a year'') previously, but she tried out two weeks before the season and earned a starting position. The 234 she rolled in her first game Dec. 6 "was like hitting a home run," she said.
Turns out Hope, who had received all-district honors in softball after batting .474 in her junior year, was good at even more sports than she realized. She finished the regular season with a 147 average and helped Comsewogue clinch the League III bowling title last week. The Warriors will compete in Saturday's Suffolk championship tournament.
"For someone who hadn't really bowled before to do so well," teammate Christina Raccasi said, "it's amazing."
Since the incident, the Reindls and Comsewogue have raised money for the Louis J. Acompora Memorial Foundation, which helps provide AEDs to schools. The Comsewogue boys and girls bowling teams share a device, coach Brian Frimmer said, and at home matches, it's kept in a bag at the foot of their scorer's table.
Hope has promised to be careful -- and Frimmer monitors her pace -- but at Hope's behest, teammates have agreed to "not baby me."
As for the "D-Fibb" nickname: "There's no point in being down about it," Hope said. "Why not have a little fun with it?"
Teammates Renee Rocco and Deanna Clark said Hope "being able to joke about it" makes everyone less worried.
"Remembering that day and then seeing her smile now is the most rewarding thing," Seifert said. "How happy she looks to be alive."

Monday, January 23, 2012

  • AHA Scientific Statement

Reducing Barriers for Implementation of Bystander-Initiated Cardiopulmonary Resuscitation

A Scientific Statement From the American Heart Association for Healthcare Providers, Policymakers, and Community Leaders Regarding the Effectiveness of Cardiopulmonary Resuscitation

  1. Benjamin S. Abella, MD, MPhil;
  2. Tom P. Aufderheide, MD, FAHA;
  3. Brian Eigel, PhD;
  4. Robert W. Hickey, MD, FAHA;
  5. W.T. Longstreth Jr, MD, FAHA;
  6. Vinay Nadkarni, MD, FAHA;
  7. Graham Nichol, MD, FAHA;
  8. Michael R. Sayre, MD;
  9. Claire E. Sommargren, RN, PhD, FAHA;
  10. Mary Fran Hazinski, RN, MSN, FAHA
Key Words:

Introduction

Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada. In the United States, each year ≈330 000 people die of coronary heart disease out of the hospital or in emergency departments. Of these, >150 000 SCAs occur out of the hospital.1,2 Despite the development of electrical defibrillation and the more recent implementation of lay rescuer defibrillation programs, the vast majority of these victims do not leave the hospital alive. In studies over the past 15 years, only 1.4% of patients with out-of-hospital arrest in Los Angeles, Calif, survived to hospital discharge3; in Chicago, Ill, the number was 2%,4 and in Detroit, Mich, it was <1%.5 Conversely, a few municipalities such as Seattle, Wash, report much higher survival rates from SCA—more than 15% in 1 study6—which suggests that survival rates need not remain so low. Recent work in Europe and elsewhere has confirmed that a higher survival-to-hospital discharge rate is indeed a realistic goal, with survival rates as high as 9% reported in Amsterdam7 and 21% in Maribor, Slovenia.8
The American Heart Association (AHA) uses 4 links in the “chain of survival” to illustrate the time-sensitive actions required for victims of SCA: (1) early recognition of the emergency and activation of emergency medical services (EMS), (2) early bystander cardiopulmonary resuscitation (CPR), (3) early delivery of shock(s) from a defibrillator if indicated, and (4) early advanced life support and postresuscitation care. Immediate bystander recognition of the emergency and EMS activation are critical. In many communities, however, these actions may be followed by significant delays, because the time interval from activation of EMS to arrival of these medical personnel may be 7 to 8 minutes or longer.4 Therefore, initial care in the first critical minutes after SCA, including performance of CPR and potential use of an automated external defibrillator (AED), depends on the actions of people near the victim. Although the majority of cardiac arrests occur in the home, the presence of trained and willing rescuers and the availability of an AED are critical whether the cardiac arrest occurs in a public space or at home.
Every 5 years, the AHA Emergency Cardiovascular Care (ECC) Committee publishes revised guidelines for resuscitation care.9 The “2005 American Heart Association Guidelines for CPR and ECC” emphasize 3 important concepts:
  • High-quality CPR is an important determinant of survival from SCA.
  • More victims of out-of-hospital SCA should receive bystander CPR.
  • CPR must be performed effectively by bystanders and healthcare providers.
CPR is an inexpensive and readily available technique that can save lives. Therefore, the number of people trained in CPR must increase, and the quality of CPR provided by every rescuer must improve.

Background: Bystander CPR Can Save Lives

Cardiac arrest is defined as the sudden cessation of functional cardiac mechanical activity, as confirmed by the absence of signs of circulation, including absence of response to stimulation, absence of breathing, and absence of a detectable pulse. SCA is often precipitated by a sudden arrhythmia, ventricular fibrillation, which causes the heart to quiver so that it cannot generate blood flow. The treatment of ventricular fibrillation requires chest compressions and delivery of shocks with a defibrillator. Chest compressions during CPR can generate a small but critical amount of blood flow to vital organs such as the brain and heart until circulation is restored by defibrillation or other therapy.
A number of reports have illustrated that bystander CPR can substantially improve rates of survival from SCA.10–14 A bystander is a person who happens to be near the victim and who is not part of the organized emergency response system. In most events, the bystanders do not have professional healthcare education. Earlier initiation of CPR improves survival rates, and when bystanders perform CPR well, the victim’s chance of survival improves. In several studies, high-quality CPR was associated with a marked improvement in survival to hospital discharge.10–12 Furthermore, recent evidence suggests that CPR may be particularly important in cases of prolonged cardiac arrest (ie, an arrest duration of >4 to 5 minutes without treatment).15,16
CPR is a highly accessible therapy that requires little medical training and no equipment when provided in its most basic form. Potential rescuers from school age to the elderly can learn CPR skills. In places where widespread first-responder CPR training has been provided (eg, as part of community lay rescuer AED programs), survival rates from witnessed SCA associated with ventricular fibrillation have been reported to be as high as 49% to 74%.17,18 Therefore, equipping the public with the skills to perform the first 3 links in the AHA chain of survival can make a dramatic difference in survival from SCA.

The Problem: Bystander CPR Rates Are Low

If bystander CPR can markedly improve outcomes, why are survival rates from out-of-hospital SCA still so poor? The low rate of bystander CPR performed is a significant contributor. Studies have documented that in many communities, only 15% to 30% of SCA victims receive bystander CPR before EMS personnel arrive at the scene.19,20 Low rates of bystander CPR have been documented even in settings where trained rescuers were present. Given that the time interval for EMS arrival is often 7 to 8 minutes or longer and that survival falls 7% to 10% for each minute without CPR,13 the lack of bystander CPR has a large impact on outcomes.
Some investigations have shown that even when CPR is performed by trained healthcare professionals, the quality of CPR delivered is often poor and often does not comply with AHA guidelines.21,22 These observational studies documented the fact that experienced providers delivered chest compressions that were too shallow, were interrupted frequently, and, in 1 report, were accompanied by an excessive rate of rescue breathing.
A number of theories have been proposed to explain why bystanders hesitate to perform CPR even when trained. Some surveys indicated a reluctance among some potential providers to perform mouth-to-mouth breathing, in part because of concern about transmission of infectious disease. However, a recent survey of bystanders who were present at actual arrest events does not support this concern.23 Another impediment to the learning and delivery of bystander CPR may be the complexity of resuscitation guidelines and instructional materials. Such complexity increases the likelihood that bystanders will fail to learn CPR skills, will fail to recall them, or may lack the confidence to perform CPR because they fear performing it incorrectly. This “fear of failure” is the most commonly cited concern in a recent survey of bystanders who witnessed an SCA event.23 In addition, some bystanders may decline to perform CPR because of fear of legal liability because they may not be aware of the “Good Samaritan” legislation that provides limited immunity for rescuers in the majority of states and municipalities.

Recommendations to Increase Rates of Bystander CPR

CPR is a potentially lifesaving intervention that can be implemented by the public without the need for expensive equipment or professional credentials. If the rate and quality of bystander CPR are increased substantially, the potential exists to save the lives of thousands of victims of SCA each year. A number of straightforward methods can achieve this goal.

Broaden CPR Training

To accelerate CPR education, creative new approaches are required to reach a larger public audience. The development and validation of a 22-minute self-instructional CPR course by the AHA (Family and Friends CPR Anytime) has provided a tool for education outside the classroom (Table).24 Community and corporate programs should be developed to encourage CPR education with both traditional and self-instructional CPR training programs. One route to broader CPR training might be through recently developed AED programs. The Cardiac Arrest Survival Act (CASA; Public Law 106-505) mandated establishment of lay rescuer AED programs in federal buildings (Table). A large number of municipal and state governments have recently instituted mandates for AED programs in public sites such as schools, shopping malls, and gymnasiums. Governmental agencies should be encouraged to provide CPR training for anticipated rescuers as part of a comprehensive community lay rescuer AED program. Creative approaches might yield important results. For example, legislators might consider training in basic CPR as a prerequisite for high school graduation or encourage programs to provide hospital-based CPR training to family members of patients at risk for SCA. The AHA has provided information to schools to help them prepare to respond to medical emergencies, including SCA.25
Table. Examples of Internet Resources for CPR Training and Implementation
However, expanded CPR training may not provide a solution for the large fraction of cardiac arrests that occur in the home, where only a few untrained witnesses may commonly be present. The development of dispatcher-assisted “telephone CPR” may allow for CPR instruction in real-time even when rescuers have not received prior training and otherwise might not participate in a resuscitation attempt. This may be especially important for the majority of arrests that occur at home, without the availability of either trained rescuers or AEDs. Studies have investigated variations of dispatcher-assisted CPR instruction26,27 and have found this “training” method to be a promising technique to engage bystanders in direct resuscitation care. Communities should implement dispatcher-assisted CPR programs based on currently available models, because they represent a cost-effective method to reach the most important population: untrained witnesses to actual cardiac arrests. Such programs will require special attention to the actual recognition of cardiac arrest itself so that CPR can be initiated. For example, bystander reports of patient “breathing” must not overlook the gasping respiratory pattern common in early cardiac arrest and therefore miss opportunities for bystanders to provide CPR.28

Provide Reassurance to Increase Participation

Bystander reluctance to perform CPR is a crucial barrier to lay rescuer action during an emergency and must be addressed. The public should be informed that the risk of disease transmission is very small. There have been no reported cases of transmission of human immunodeficiency virus (HIV) or hepatitis through performance of CPR. In conjunction with Occupational Safety and Health Administration recommendations for workplaces, policymakers should mandate that mouth-to-mouth barrier devices and gloves be available wherever AEDs are stationed, to facilitate CPR performance in addition to AED use. Information about Good Samaritan legislation should be included in CPR classes and materials and posted prominently near AED installations. The public must understand that when bystanders perform CPR immediately, the victim’s chance of surviving cardiac arrest can double or triple at little risk to the rescuer.

Improve EMS and CPR Quality

Community lay rescuer and EMS programs should include a process for continuous quality improvement that includes a review of resuscitation efforts, quality of CPR, and CPR instructions provided to bystanders by dispatchers. Healthcare provider systems that deliver CPR should implement continuous quality-improvement processes that include monitoring the quality of CPR delivered during any attempted resuscitation. These monitoring data should be used to maximize the quality of resuscitation care delivered, including the quality of CPR performance. At present, a variety of devices have been developed to both measure and provide feedback on the performance of CPR in the form of either defibrillators with additional CPR monitoring capabilities or stand-alone devices that can be used by rescuers even before a defibrillator can be brought to the scene of an arrest.21,22,29–31 Some of these devices can also record CPR performance and provide opportunities for debriefing and training. Such tools may have an important impact on this quality-improvement goal in coming years.

Future Directions

Several newer training modalities may have a great impact on CPR training in the near future. The use of Internet–based CPR education and certification may augment the reach of current training programs, especially in light of the expanding access to the Internet via television, mobile telephone, and other personal devices.32 Under certain circumstances, simpler methods of bystander resuscitation, such as chest-compression-only CPR, may also encourage broader participation and remain an area of active scientific investigation.27 For EMS, hospital systems, and other professional CPR providers, the use of rigorous simulation with video recording and debriefing may serve as a staple in resuscitation training; the use of such patient simulators is a rapidly expanding area of current research.33,34

Research Recommendations

To address possible methods to increase bystander CPR participation, a number of important research questions deserve attention. What educational methods lead to the highest quality of CPR in the broadest fashion possible? What are the optimal target populations for CPR education (ie, who is most likely to witness a cardiac arrest event)? Can dispatch-assisted CPR successfully provide “just-in-time” training in a variety of communities? What are the public perceptions that serve as barriers to CPR participation? Targeted funding for such research questions may yield new directions to strengthen the CPR link in the chain of survival.

Recommendations Summary

On the basis of the above discussion, the following recommendations can be made:
  • Government agencies at the local, state, and federal level should provide CPR education in such settings as school systems and government-funded hospital and clinic systems.
  • EMS and 9-1-1 systems should implement and support dispatch-assisted CPR programs.
  • CPR instructors, EMS leaders, and government agencies should strengthen public awareness of Good Samaritan laws and of the dramatic lifesaving potential of bystander CPR.
  • EMS systems and CPR instructors should focus efforts on rigorous CPR performance and quality-improvement efforts in resuscitation care; when CPR certification is needed, CPR instructional programs should always include an objective CPR quality assessment for certification.
  • Research funds should be targeted toward improving methods of CPR education, improving skill retention, and developing creative methods to widen the scope of current CPR training and education.

Conclusions

To maximize the chance of a successful resuscitation outcome, CPR must be started as soon as possible after a victim of SCA collapses. Improved survival rates depend on a public trained and motivated to recognize the emergency, activate EMS or the emergency response system, initiate high-quality CPR, and use an AED if available.
Ample evidence has shown that CPR works. “Pushing hard and pushing fast” maintains a small but critical amount of blood flow to the brain and heart that can significantly improve the chance of survival for victims of SCA. Performance of high-quality bystander CPR can be increased through widespread dissemination of self-instructional CPR courses, effective public education about the low risks of performing CPR, continuous CPR quality-improvement processes for lay and professional rescuer programs, and meaningful legislative initiatives designed to support and encourage layperson action during an emergency. Through these actions, which are intended to encourage and broaden CPR training, thousands of additional lives can be saved every year.

Acknowledgments

Disclosures
Writing Group Disclosures
Reviewer Disclosures

Footnotes

  • The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
  • This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 13, 2007. A single reprint is available by calling 800-242-8721 (US only) or by writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0436. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.
  • Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier=3023366.
  • Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml?identifier=4431. A link to the “Permission Request Form” appears on the right side of the page.

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