Survival from out-of-hospital cardiac arrest is at an all-time high in King County, and a new method of resuscitation used by emergency medical responders in King County may be the reason. Since the protocol was adopted in 2005, survival rates jumped to 46% from 33% for the period of 2002 through 2004.
These findings were published as part of a study released today in Circulation: Journal of the American Heart Association. The new guidelines, which place more emphasis on CPR (chest compressions and ventilations), reflect the recommendations published by the American Heart Association in 2005.
?King County is known as one of the best places in the country to receive emergency medical care, and we have set a new standard with this survival rate,? said King County Executive Ron Sims. ?Our innovation and cooperative effort is providing better emergency care and saving lives.?
Cardiac arrest is a dangerous, acute event in which the heart rhythm often suddenly becomes erratic, rendering the heart unable to effectively pump blood. Victims quickly collapse and die unless they are resuscitated within a few minutes.
?The new way of thinking is that emergency medical responders should administer shocks from a defibrillator only at key times in order to provide more CPR during the resuscitation,? said Thomas Rea, M.D., M.P.H., Medical Director for King County Medic One, lead author of the study and associate professor of medicine at the University of Washington School of Medicine based at Harborview Medical Center. ?The idea is that the CPR prepares the heart to better accept the shock and have the shock work.?
Prior to 2005, traditional guidelines for emergency medical technicians (EMTs) called for some CPR, but emphasized giving shocks from a defibrillator. The new guidelines call for emergency medical technicians to give a single shock from a defibrillator followed immediately by two minutes of CPR, beginning with chest compressions, compared to the old guidelines which called for repeated shocks and a pulse check before starting CPR.
To test whether the new approach improves survival compared to the traditional protocol, Rea and colleagues trained King County emergency medical technicians to provide the new protocol and re-programmed defibrillators to support the new guidelines. ?The change in the protocol required substantial collaboration and effort by emergency medical responders and agencies across King County,? said Rea. ?This is a shining example of how everyone is working together to deliver the very best emergency care possible.?
To determine whether EMTs were able to focus more on CPR, Rea and colleagues looked at how quickly they started providing CPR after a shock with the previous protocol versus the new recommendations. They found that the median interval between the first shock and the onset of CPR dropped from 28 seconds to 7 seconds.
The King County study is part of an accumulating body of scientific evidence suggesting the importance of EMTs providing high-quality CPR, particularly chest compressions, with minimal interruptions to increase survival rates for cardiac arrest.
?These are not definitive results, but our findings are encouraging,? said Rea. ?Based on what we know now, changing to the new guidelines should be a high priority for other Emergency Medical Systems across the country.?
Electronic copies of the published study are available to media upon request. For more information on Emergency Medical Services in King County, visit www.metrokc.gov/health/ems
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