When a person goes into sudden cardiac arrest, seconds matter. It is a race against time not only to get the heart started again but to make sure there is continuous blood flow to all parts of the body, especially the brain.
An automated external defibrillator will help shock the heart back into its rhythm. But the classic go-to for many bystanders and trained first responders is CPR. The combination of chest compression and ventilation forces oxygenated blood through the body in an attempt to keep vital organs functioning.
But even with highly trained professionals administering CPR, the procedure can still be inefficient.
“People either compress too slow or too fast. Or the compressions are too deep or too shallow. Or they ventilate too much,” CentraCare cardiologist Dr. Keith Lurie said.
Those inefficiencies can influence the likelihood of survival.
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For over 25 years, Lurie has been developing a way to combat the limitations of traditional CPR in out-of-hospital situations. In March, his work received pre-market approval by the U.S. Food and Drug Administration. With the eventual distribution to first responders across the nation, Lurie hopes his simple, yet effective invention will give more cardiac arrest patients a fighting chance.
The toilet plunger effect
1988.
Lurie was completing his fellowship at the University of California-San Francisco Medical Center when a man was admitted to the hospital, suffering from sudden cardiac arrest.
“The patient was resuscitated by the family,” Lurie said. “They didn’t know CPR, so they used a toilet plunger. And it worked.”
But why?
That question began a quest to understand this unusual case of impromptu CPR.
“The problem was never compression,” Susie Osaki Holm, program manager for Take Heart St. Cloud said. “The problem was the recoil.”
Lurie discovered manual CPR was not able to fully re-inflate the chest between compressions. Without proper re-inflation, blood was not effectively returned to the heart from other parts of the body. Lurie estimated that traditional CPR only provided the body with 20 percent of normal blood flow.
What Lurie learned with the help of that patient’s family was the suction action of the plunger was able to provide that extra lift in the chest wall, allowing a continuous flow of blood to and from the heart.
While still toying with the idea of a toilet plunger-style device, Lurie began his career in Minnesota, working both at St. Cloud Hospital and at the University of Minnesota-Twin Cities.
Together with several colleagues, Lurie was able to further explore the concept.
“It wasn’t enough to pull up (the chest) with suction,” Lurie said.
Lurie and his colleagues found while the plunger-style device was able to lift the chest and increase blood flow, there was still room for improvement.
And that improvement came by happenstance.
Lurie said a doctor he was working with had an idea. While a patient was being resuscitated in a hospital, Lurie’s colleague placed his thumb over the breathing tube, momentarily stopping the constant stream of airflow into the patient’s lungs.
“It created a vacuum,” Lurie said.
By temporarily blocking the airway, the chest was able to draw in even more blood from the outer portions of the body. Lurie estimated that sudden decrease in ventilation tripled the amount of blood flow to the brain.
“That was our ah-ha moment,” Lurie said.
The ResQCPR System
The two major discoveries in CPR techniques allowed Lurie to develop a rescue system ideal for first responders.
The two-part ResQCPR System combines suction and decreased ventilation to fully inflate the chest and ensure proper blood circulation during a sudden cardiac arrest.
The ResQPUMP, the suction cup portion of the device, contains a metronome tone to help users obtain the appropriate compression rate. Lurie said the device is designed to recoil the chest wall 1 centimeter above the normal level to help boost circulation.
The ResQPOD, the mouth piece, stops unnecessary air from entering the body. Serving as a buffer between the patient’s mask and the air bag, the mouth piece lights up when a patient needs air, preventing over-ventilation.
The ResQCPR system components were first developed in early 1990s. Widespread clinical trials of the system started in 2005.
Osaki Holm said proving to doctors the improvements in the technology were better for patients proved to be a challenge for Lurie.
“Ten to 15 years ago people just weren’t expected to live after having a cardiac arrest,” Osaki Holm said.
But Lurie said there has been a fundamental shift in recent years about this perception.
“We’ve gone from thinking people (with cardiac arrest) would die to thinking why are they not coming back,” Lurie said.
Between 2005 and 2010, nearly 5,000 patients in seven test sites throughout the country participated in the trial. In 2014, a panel discussion was held to decipher the data collected.
The clinical trial found the ResQCPR System was able to provide a 49 percent survival increase one year after CPR among patients who had an out-of-hospital cardiac arrest.
“The (ResQCPR System) showed it could save thousands of lives each year in the United States,” wrote Tom Aufderheide lead investigator for the ResQCPR System manufacturer.
From trials to real life
Even with the immediate application of life-saving measures, the chances of surviving a cardiac arrest outside of a hospital are slim. The American Heart Association/American Stroke Association estimate an 11 percent national survival rate for sudden cardiac arrest. The odds of having quality brain function are even lower, at 8.3 percent.
In St. Cloud, survival for sudden cardiac arrests that occur outside of a hospital are nearly double the national average. With the development of the Take Heart Program, now a statewide initiative, CentraCare has a cardiac arrest survival rate of 19 percent.
But by adding the ResQCPR System, Lurie hopes this will prove to be a stepping stone in the field of cardiac arrest care.
“It’s not just about the device, it’s about a system,” Lurie said. “It’s about using this in a system that is poised to do good care.”
For about $800, the ResQCPR System in the hands of first responders will only help strengthen the cardiac care system.
The ResQCPR System is already in the hands of a few first responders in the state. Lurie hopes St. Cloud will be added to that list shortly. The Minnesota Resuscitation Consortium, a leader in sudden cardiac arrest procedural development, has adopted use of the system over traditional CPR.
With the development of the ResQCPR System and other advances in cardiac care, Lurie and Osaki Holm hope all areas of the country will be able to achieve higher cardiac arrest patient survival rate numbers.
“The faster we can get the heart going again, the better off the patient will be,” Osaki Holm said
CREDIT: Vicki Ikeogu
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