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    Default CardioCerebral Resuscitation

    Just read another thread, and thought how many departments use CCR? If you haven't heard of CCR, It is like CPR, but uses all compressions, and uses the oxygen already in the blood to circulate to vital organs. It also triples survival rate.

    EDIT: It was developed by doctors from the University of Arizona. I also saw it successfully used by an off-duty paramedic during a street fair when a man suddenly collapsed.


    New CCR CPR triples survival chances
    by

    The data proves it.

    If you're going to have a heart attack anywhere in the United States, you're almost best off having it in Rock or Walworth county, emergency room doctors say.

    The area's emergency medical personnel and first responders, such as police officers and sheriff's deputies, for nearly three years have been learning a relatively new form of CPR.

    Since its introduction in early 2004, survival rates have tripled for people in cardiac arrest who had a "shockable" or quivering heart rhythm.

    It's called cardiocerebral resuscitation, or CCR, and it's so easy that doctors say anyone can do it if they see someone collapse.

    A better way
    The new method works better than traditional CPR, experts say.

    Michael Kellum, Mercy-Walworth Hospital and Medical Center director, along with other hospital medical directors in the two counties have worked to bring CCR to the area because the survival rates with traditional CPR are "horrible, and they haven't changed," Kellum said.

    Although CCR is not yet endorsed by the American Heart Association because of its newness, Kellum said it's the "better way to do it."

    CCR has saved the lives of dozens of local people since early 2004, when it was introduced in Delavan and started to filter out to other rescue squads and police departments in the area.

    CCR involves no mouth-to-mouth rescue breathing, as used in traditional CPR. Instead, it's continuous chest compressions at a rate of 100 per minute.

    The idea is to keep the heart beating by pressing repeatedly on the chest and moving the stored oxygen in the blood to vital parts of the body, particularly the brain.

    Cardiac patients differ from respiratory arrest patients in that their heart stops beating even thought their blood still has normal amounts of oxygen, explained Dr. Gordon A. Ewy, director of the University of Arizona Sarver Heart Center, where CCR was developed.

    Ewy, a professor and chief of cardiology at the university, said patients suffering from respiratory arrest, such as near-drowning or choking victims, will have used up the oxygen in their blood and still require rescue breathing from traditional CPR.

    "In cardiac arrest, when you arrest, arterial blood oxygenation is perfectly normal," Ewy said. "In respiratory arrest, because you're not breathing and your heart is pumping, the body is using up the oxygen in the blood. When blood pressure gets too low, the heart stops. It's totally different."

    Repeated chest compressions can actually move the lungs enough so oxygen is inhaled, Kellum said. Cardiac patients often will gasp for breath, which is a good sign, but not a sign to stop CCR, Ewy said.

    "When a lay person or early responders breath for them, it's a huge cost," Kellum said. "The brain probably doesn't last more than eight seconds without blood supply."

    Shocking numbers
    Because CCR is relatively new and only a few places in the United States are using it regularly, there's no broad statistical data available.

    But Kellum said he amazed by what he's found locally.

    Kellum studied 92 patients who between 2001 and 2003 went into cardiac arrest, had "shockable" heart rhythms and were treated with traditional CPR.

    Of the 92 patients, 18 were saved and 74 died using traditional CPR-a survival rate of 19.6 percent.

    Between 2004 and early 2005, when emergency medical personnel were using CCR, the percentage of lives saved rose three-fold.

    In that period, there were 33 "shockable" patients. Nineteen patients lived because of the new method, a survival rate of 57.6 percent. Even though there were fewer victims, more survived, Kellum said.

    After hearing of the successes in southern Wisconsin, Ewy was delighted.

    "Those results correspond with the results we had in our animal (testing) labs," Ewy said. "We found the same sort of thing here.

    "To me, this is a lifelong work at something that is going to make a huge difference in the world."

    Walworth County deputies have caught on to CCR and enjoy using it, said Sgt. Chuck Hall, an instructor at the sheriff's department. Deputies don't have to do mouth-to-mouth and are seeing more people come out alive.

    "For the people that are doing it (in the field), you notice a difference immediately," Hall said. "I've been a paramedic for six years. I've not seen many positives with (standard) CPR. Once in a while you would.

    "With this, the positives are all over the place," Hall said. "Percentage-wise, it's been proven."


    http://www.defrance.org/artman/publi...cle_1758.shtml
    Last edited by alpha4; 06-05-2007 at 01:58 PM.

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    So the only stat they are using for their claim of success is how many died vs survived? No other variables taken into account? Wow.
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    but there seeing success in the states/areas that do use it. not enough states/areas are using CCR. And they even give you reasons as to why it works well.

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    Quote Originally Posted by alpha4 View Post
    but there seeing success in the states/areas that do use it. not enough states/areas are using CCR. And they even give you reasons as to why it works well.
    Im not debating whether it works well or not. But using death vs live stats, without taking ANYTHING else into consideration, is very misleading.
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    New CPR prototols for Virginia, via AHA, are 30 compressions to two ventilations. Sounds a lot like what Alpha describes.

    The Canadian Heart Association has been directing us as instructors to a requirement of min 100 compressions per minute for the past 5 or 6 years now, as well. Until this past year, we were still teaching the cycle of 15:2, but the speed of the compressions was to maintain 100/min. This was a pet peeve of my old instructor.... 15 minutes of CPR during training was a "norm" for him, and it had to be done RIGHT.
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    I believe that Phoenix and Tucson FD's are currently using this method.
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    Quote Originally Posted by AZFF25 View Post
    I believe that Phoenix and Tucson FD's are currently using this method.
    Not so much. It hasn't been approved by the AHA, but there have been successful saves using this.

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    I have tired-head from reading the original post. 2 much info.

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    First, how the heck did this end up under the firefighters forum?

    Secondly, AHA now endorses 30:2 for healthcare provider cpr at a rate of 100 per minute. Similar but not quite the same. CPR takes prescedence over just about everything.

    That being said there are alot of considerations that need to be addressed in these "statistics":

    1. Are they having a higher thresehold for workable vs non workable cardiac arrests?
    2. What are they considering "survival"?
    3. Any other new technology/techniques being incoparated into the arrest?
    4. Medication changes?

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    I have heard of this being taught, but for the lay person that is afraid of giving mouth to mouth. The reasoning is that people would be more likely to do something if they witnessed an arrest because they wouldn't have to do the mouth to mouth. You should try this in the EMS forums.

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    Quote Originally Posted by Firemedic 61 View Post
    I have heard of this being taught, but for the lay person that is afraid of giving mouth to mouth. The reasoning is that people would be more likely to do something if they witnessed an arrest because they wouldn't have to do the mouth to mouth. You should try this in the EMS forums.
    yeah, i just don't like blue color of the forums hard to read. But i will post in EMS forums
    Last edited by alpha4; 06-06-2007 at 12:02 AM.

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    This was perhaps one of the craziest articles I have ever read on Resuscitation. They have basically begun to realize that what is killing people's cells during a heart attack is actually our efforts to revive them. When the blood stops pumping during a heart attack the cells just go into standby, when we reintroduce a bunch of oxygen and drugs that is what screws the cells up. Now they just have to figure out how to bring the cells back gradually, and reboot the system.



    To Treat the Dead

    The new science of resuscitation is changing the way doctors think about heart attacks—and death itself.


    May 7, 2007 issue - Consider someone who has just died of a heart attack. His organs are intact, he hasn't lost blood. All that's happened is his heart has stopped beating—the definition of "clinical death"—and his brain has shut down to conserve oxygen. But what has actually died?

    As recently as 1993, when Dr. Sherwin Nuland wrote the best seller "How We Die," the conventional answer was that it was his cells that had died. The patient couldn't be revived because the tissues of his brain and heart had suffered irreversible damage from lack of oxygen. This process was understood to begin after just four or five minutes. If the patient doesn't receive cardiopulmonary resuscitation within that time, and if his heart can't be restarted soon thereafter, he is unlikely to recover. That dogma went unquestioned until researchers actually looked at oxygen-starved heart cells under a microscope. What they saw amazed them, according to Dr. Lance Becker, an authority on emergency medicine at the University of Pennsylvania. "After one hour," he says, "we couldn't see evidence the cells had died. We thought we'd done something wrong." In fact, cells cut off from their blood supply died only hours later.

    But if the cells are still alive, why can't doctors revive someone who has been dead for an hour? Because once the cells have been without oxygen for more than five minutes, they die when their oxygen supply is resumed. It was that "astounding" discovery, Becker says, that led him to his post as the director of Penn's Center for Resuscitation Science, a newly created research institute operating on one of medicine's newest frontiers: treating the dead.

    Biologists are still grappling with the implications of this new view of cell death—not passive extinguishment, like a candle flickering out when you cover it with a glass, but an active biochemical event triggered by "reperfusion," the resumption of oxygen supply. The research takes them deep into the machinery of the cell, to the tiny membrane-enclosed structures known as mitochondria where cellular fuel is oxidized to provide energy. Mitochondria control the process known as apoptosis, the programmed death of abnormal cells that is the body's primary defense against cancer. "It looks to us," says Becker, "as if the cellular surveillance mechanism cannot tell the difference between a cancer cell and a cell being reperfused with oxygen. Something throws the switch that makes the cell die."

    With this realization came another: that standard emergency-room procedure has it exactly backward. When someone collapses on the street of cardiac arrest, if he's lucky he will receive immediate CPR, maintaining circulation until he can be revived in the hospital. But the rest will have gone 10 or 15 minutes or more without a heartbeat by the time they reach the emergency department. And then what happens? "We give them oxygen," Becker says. "We jolt the heart with the paddles, we pump in epinephrine to force it to beat, so it's taking up more oxygen." Blood-starved heart muscle is suddenly flooded with oxygen, precisely the situation that leads to cell death. Instead, Becker says, we should aim to reduce oxygen uptake, slow metabolism and adjust the blood chemistry for gradual and safe reperfusion.

    Researchers are still working out how best to do this. A study at four hospitals, published last year by the University of California, showed a remarkable rate of success in treating sudden cardiac arrest with an approach that involved, among other things, a "cardioplegic" blood infusion to keep the heart in a state of suspended animation. Patients were put on a heart-lung bypass machine to maintain circulation to the brain until the heart could be safely restarted. The study involved just 34 patients, but 80 percent of them were discharged from the hospital alive. In one study of traditional methods, the figure was about 15 percent.

    Becker also endorses hypothermia—lowering body temperature from 37 to 33 degrees Celsius—which appears to slow the chemical reactions touched off by reperfusion. He has developed an injectable slurry of salt and ice to cool the blood quickly that he hopes to make part of the standard emergency-response kit. "In an emergency department, you work like mad for half an hour on someone whose heart stopped, and finally someone says, 'I don't think we're going to get this guy back,' and then you just stop," Becker says. The body on the cart is dead, but its trillions of cells are all still alive. Becker wants to resolve that paradox in favor of life.

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    We just switched to 50:2 for our CPR, not sure if it's similar theory, they just told us to do that as of 6/1.
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    What I dont understand is what makes the chance of survival triple by doing all compressions using the same oxygenated blood? I would think it'd be a good thing to introduce the 16% of new oxygen exhaled during the 2 respirations
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    Quote Originally Posted by Slaytallica45 View Post
    What I dont understand is what makes the chance of survival triple by doing all compressions using the same oxygenated blood? I would think it'd be a good thing to introduce the 16% of new oxygen exhaled during the 2 respirations
    The compressions also cause some respirations as the lungs are being compressed and relaxed, so the body is still getting some new 21% O2 air.

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    Quote Originally Posted by NonSurfinCaFF View Post
    The compressions also cause some respirations as the lungs are being compressed and relaxed, so the body is still getting some new 21% O2 air.
    I wouldnt think that the change in the intrathoracic pressure would be enough to ventilate more than the anatomical dead space. Any numbers or research on how much tidal volume is achieved?

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    I found it interesting that this IS now in both forums. FF and EMS react differently, for all the right reasons. No right, no wrong. Just opinions and questions.
    Good work everyone.
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    Phoenix is using 200 compression CPR on all unwitnessed (by us) codes. Surprisingly, it has worked out very well.

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    Quote Originally Posted by pfdaz1 View Post
    Phoenix is using 200 compression CPR on all unwitnessed (by us) codes. Surprisingly, it has worked out very well.
    pfdaz1:

    Off this subject, but sorry to hear of your recent loss there. Thoughts are with you guys. RIP FF Carter.
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    Heard of this for bystander CPR... Yes the studys show it works, it will also attract someone who wouldn't do cpr due to the breaths and isn't familar with CPR and the numbers..... As for resonders we are trained at a higher level, Most carry Bags, combi tubes, AED's And o2. Mayo clinic changed our proticals to 2 minutes of CPR then shock 1 time/ 2 Min then shock.....Securing the air way is also a priority, we breath on every 3-5 compressions to Hyperventilate the PT for drugs and IV/ Et tube if the medics pull our Combi-tube ( some want the ET tube for Drugs) As for first responders just doing chest compressions, your wasting your time. The body uses about .9 % O2 each Cycle, if 3-5 minutes goes by the air in the lungs would be about 17% o2 leaving to much CO2, anything below 18% o2=death so do the math, When your blood O2 reaches 60-70% you might as well call it.....because they will be pushing up daisys... Maybe a medic can clarify the numbers but they are close....
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    Quote Originally Posted by feedtheflame View Post
    This was perhaps one of the craziest articles I have ever read on Resuscitation. They have basically begun to realize that what is killing people's cells during a heart attack is actually our efforts to revive them. When the blood stops pumping during a heart attack the cells just go into standby, when we reintroduce a bunch of oxygen and drugs that is what screws the cells up. Now they just have to figure out how to bring the cells back gradually, and reboot the system.
    Well, that's an interesting viewpoint on cardiac cells, but it never mentions brain cells. How long are they going to fart around with ice and salt before they give my brain some oxygen?
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    Quote Originally Posted by EastKyFF View Post
    Well, that's an interesting viewpoint on cardiac cells, but it never mentions brain cells. How long are they going to fart around with ice and salt before they give my brain some oxygen?
    Right after the Tequila runs out.
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    Quote Originally Posted by MalahatTwo7 View Post
    Right after the Tequila runs out.
    Then what...switch to whiskey????

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    Lol Thats Funny Right There

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    Quote Originally Posted by EastKyFF View Post
    Well, that's an interesting viewpoint on cardiac cells, but it never mentions brain cells. How long are they going to fart around with ice and salt before they give my brain some oxygen?
    You're still using your brain? I quit using mine long ago. Just rely on instincts now...

    In all seriousness though, not being an MD I don't know all the specifics, it left some questions in my head too like does this apply to all cells or just cardiac or? I will leave that up to the guys with 12 years of student loans to figure out though. When they write the book on it we can implement.

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