In 1988, a 65-year-old man’s heart stopped at his home. His wife and his son did not know CPR, so in desperation they grabbed the toilet plunger. to get your heart going until an ambulance showed up.
Later, after the man recovered at San Francisco General Hospital, his son gave doctors some advice: Put toilet plungers next to all beds in the coronary unit.
The hospital didn’t do that, but the idea got doctors thinking about better ways to do CPR, or cardiopulmonary resuscitation, the conventional method for chest compressions after cardiac arrest. More than three decades later, at a meeting of emergency medical services directors this week in Hollywood, Florida, researchers presented data showing that the use of a plunger-like configuration leads to markedly better results in reviving patients.
Traditional CPR doesn’t have a great track record: On average, only 7 percent of people who receive it before arriving at the hospital are ultimately discharged with full brain function, according to a national study. record of cardiac arrests treated by emergency medical workers in communities across the country.
“It’s depressing,” said Dr. Keith Lurie, a cardiologist at the University of Minnesota Medical School who treated the embolus patient in 1988.
The new procedure, known as neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood out of the body, but drawing it back in to refill the heart. A plastic valve is placed over a face mask or breathing tube to control pressure in the lungs.
The third piece is a body positioning device sold by AdvancedCPR Solutions, a company in Edina, Minnesota, that was founded by Dr. Lurie. A hinged support slowly raises the supine patient to a partial sitting position. This allows oxygen-starved blood in the brain to drain more effectively and be replenished more quickly with oxygenated blood.
The three kits, which fit in a backpack, cost around $20,000 and can be used for several years. The devices have been separately approved by the Food and Drug Administration.
About four years ago, the researchers began to study the combination of the three devices used in tandem. At this week’s meeting, Dr. Paul Pepe, longtime CPR researcher and director of Dallas County Emergency Medical Services, reported the results of 380 patients who could not be revived by defibrillation, making their chances of survival are particularly low. Among those who received the new method of CPR within 11 minutes of cardiac arrest, 6.1% survived with intact brain function, compared to just 0.6% who received traditional CPR.
It also reported significantly better odds for a subgroup of patients who had no heartbeat but had random electrical activity in the heart muscles. Typical survival chances for people in those circumstances are around 3 percent. But the patients in Dr. Pepe’s study who received neuroprotective CPR had a 10 percent chance of leaving the hospital neurologically intact.
Last year, a study carried out in four states found similar results. Patients who received neuroprotective CPR within 11 minutes of a 911 call were approximately three times more likely to survive with good brain function than those who received conventional CPR.
“This is the right thing to do,” Dr. Pepe said.
A couple of years ago, Jason Benjamin went into cardiac arrest after working out at a gym in St. Augustine, Florida. A friend took him to the nearby fire department, where trained workers donned the neuroprotective CPR kit. It took 24 minutes and multiple defibrillations to revive him.
After he recovered, Mr. Benjamin, a former emergency medical technician, was shocked to learn of the new approach that had saved his life. He read the studies and interviewed Dr. Lurie. The three-part procedure had several tricky names at the time. It was Mr. Benjamin who came up with the term neuroprotective CPR “because that’s what it’s doing,” recalled Mr. Benjamin, adding that “the focus was on protecting my brain.”
Dr. Karen Hirsch, neurologist at Stanford University and a member of the American Heart Association’s CPR standards committee, said the new approach was interesting and made physiological sense, but the committee needed to see more research on patients before it could formally recommend it as a treatment option. treatment .
“We are limited to the data available,” he said, adding that the committee would like to see a clinical trial in which people who experience cardiac arrest are randomly assigned to conventional CPR or neuroprotective CPR. No such trials are taking place in the United States.
Dr. Joe Holley, medical director of the emergency medical service that serves Memphis and several surrounding communities, doesn’t expect a larger trial. He said two of his teams were getting neurologically intact survival rates of about 7 percent with conventional CPR. With neuroprotective CPR, the rates increased to around 23 percent.
Their teams also return from emergency calls much happier these days, with patients even showing up at fire stations to thank them for their help.
“That was kind of weird,” Dr. Holley said. “Now it’s almost a normal thing.”