Continuous Chest Compression Adopted by Tucson EMS Providers, Taught to General Public

July 2005, MERGINET—The University of Arizona Sarver Heart Center and the Tucson Fire Department (TFD) have collaborated in a city-wide effort to adopt Continuous Chest Compression (CCC) CPR in Tucson, Arizona.

In November 2003, TFD accepted CCC protocols after members of the Sarver Heart Center Research Group helped persuade the paramedic/firefighter staff of the efficacy of continuous chest compressions. The science supporting the value of continuous chest compressions coupled with the data collected by TFD over 17 years—showing that out-of-hospital witnessed ventricular fibrillation cardiac arrest had reached a survival plateau of 12.5 percent—necessitated the change.

In the journal Resuscitation, collaborators outlined the potential hindrances Tucson faced in increasing these survival rates, including:

• A lack of bystander CPR. Of all the cardiac arrests between 1990 and 2003, 53.3 percent were witnessed out-of-hospital cardiac arrests with only 19.2 percent receiving bystander CPR; and just 15 percent of surveyed Arizonians expressed willingness to perform mouth-to-mouth ventilations on a stranger, but 68 percent said they would perform chest-compression-only CPR.

• The complexity of standard CPR for lay rescuers. A study assessing standard vs. CCC CPR revealed just 39 compressions per minute on average in the standard group compared with 84 in the CCC group.

• The emphasis on defibrillation first, regardless of the duration of ventricular fibrillation. Data collected in 2002 by TFD showed EMS response intervals averaged about six and one-half minutes, missing the four-minute electrical phase when AED intervention is most effective, and

• Frequent interruptions of chest compressions during resuscitation efforts. Sarver Heart Center research showed that coronary perfusion pressure decreases significantly during interruption of chest compressions and this decrease results in adverse neurologic outcomes.

To address these hindrances, the Sarver Heart Center and the TFD adopted the following:

• A public education campaign including training courses and television broadcasts of CCC CPR for lay rescuers and sending a three-step CCC CPR instruction insert in electric bills mailed to 300,000 Tucson homes.

• A TFD protocol to deliver 200 chest compressions before assessing heart rhythm for all cardiac arrest patients older than eight years and not involved in a traumatic event, not obviously deceased, and where there is no evidence of a primary respiratory arrest. Patients then showing “Vfib/Pulseless VT,” receive an additional 200 chest compressions prior to defibrillation.

• A TFD defibrillation protocol of a single maximum-energy shock followed by 200 chest compressions for up to three rounds.

“The initial local response to this effort has been gratifying,” the Sarver Heart Center authors wrote, adding “This type of community approach to improving resuscitation results based upon a locally kept database appears to be a unique and promising way to move resuscitation science forward.”

Reference

Kern KB. Valenzuela TD. Clark LL. Berg RA et al: “An alternative approach to advancing resuscitation science.” Resuscitation 64 (2005) 261-