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From: AHA Internal Communications
Sent: Thursday, August 23, 2007 3:43 PM
Subject: FYI: AHA Weekly Pulse 08-23-2007

 

The Weekly Pulse is an electronic update for American Heart Association/American Stroke Association volunteers and staff.

In this issue...

1.       AHA/ASA science news

·         Adults, not students, more likely to suffer cardiac arrest at schools

·         More people exposed to CPR skills when students receive instruction

2.       Cause Initiatives highlights

·         Childhood Obesity

·         Go Red For Women

·         Start!

3.       AHA/ASA news

·         Get With The GuidelinesSM reaches 1 million patient milestone

4.       Other highlights

·         Improving the ‘Chain of Survival’ in Puerto Rico

·         Oregon strengthens school physical education requirements

5.       Media highlights

_________________________

1.       AHA/ASA science news

 

Adults, not students, more likely to suffer cardiac arrest at schools

 

The majority of people who suffer cardiac arrest in schools are adults, not young athletes whose sudden deaths from heart rhythm abnormalities attract the most media attention, according to research published in Circulation: Journal of the American Heart Association.

“Our retrospective study based on 16 years of emergency medical service (EMS) calls in the Seattle area found that faculty and staff were 25 times more likely than students to suffer non-trauma cardiac arrest,” said co-author Lindsay White, M.P.H., a research coordinator for King County Emergency Medical Services (EMS) in Seattle, Wash.

Only 2.6 percent of cardiac arrests occurring in public locations were at schools, but those at schools were more likely than those in other public locations to be witnessed (79 percent versus 62 percent) and more likely to receive bystander cardiopulmonary resuscitation (CPR) (74 percent vs. 51 percent).  School cardiac arrest victims were also more likely to survive to hospital discharge (39 percent vs. 27 percent), White added.

 

More people exposed to CPR skills when students receive instruction

 

Distributing self-teaching cardiopulmonary resuscitation (CPR) material to seventh graders brings the lifesaving training to people who are more likely to need the skill – their parents, researchers reported in Circulation: Journal of the American Heart Association.

Administering effective CPR immediately after cardiac arrest – the sudden, abrupt loss of heart function – can double a victim’s chance of survival, according to the American Heart Association.

In this study, Danish researchers mass distributed video-based, self-instructional CPR material to seventh graders to increase CPR knowledge.

“Adults age 40 to 50 are more likely to encounter a colleague, spouse or friend in cardiac arrest, but they are less likely than others to attend conventional CPR classes.  Training target group members at home can help overcome that barrier,” said Dan Isbye, M.D., lead study author and a research fellow in the Department of Anesthesia, Center of Head and Orthopedics, at Copenhagen University Hospital, in Rigshospitalet, Denmark.

________________

2.       Cause Initiatives highlights

Childhood Obesity

New episode of Go Healthy Challenge to air Sunday, August 26

A new episode of “Let’s Just Play: Go Healthy Challenge“ airs Sunday, Aug. 26 at 8:30 p.m. ET/PT on Nickelodeon. The episode features guest appearances from Dallas Cowboys quarterback Tony Romo, Baltimore Ravens wide receiver Derrick Mason, and Ravens offensive lineman Chris Pino.

 

Watch as challengers Kenderick and April get closer to their goals. April's goal has been to become more active through a team sport at school. She tries out for her school's volleyball team, and after a tough sweat, she succeeds in becoming the newest member of the Doylestown Athletic Association volleyball team. Kenderick appears on Good Morning Arkansas to discuss how to incorporate healthy alternatives in various dishes. He also participates in the Arkansas Canoe Jamboree Race and learns the importance of teamwork.


Go Red For Women

Mattel creates collector edition Go Red For Women Barbie® doll

Mattel has introduced the Go Red For Women Barbie® doll, created by designer Robert Best. With the sale of the doll, the American Heart Association will receive $100,000 from Mattel in support of Go Red For Women and the fight against heart disease in women. The doll is currently available online from BarbieCollector.com and will soon be more widely distributed in retail stores where dolls are sold. For more information or to purchase the doll, visit BarbieCollector.com. 

 

Start!

 

Start! Fit-Friendly Companies

A total of 350 companies submitted applications for the Start! Fit-Friendly program by the July 30 deadline. This compares to the 150 applications submitted for the January deadline. The list of recognized companies will be announced the last week in September with an ad in the Wall Street Journal.

 

Congratulations to everyone whose hard work helped to make this happen!

___________________

3.       AHA/ASA news

Get With The GuidelinesSM reaches 1 million patient milestone
The Get With The Guidelines quality improvement program reached a major milestone this month: more than 1 million patient records have now been entered into the program’s database.

More than 1,400 hospitals across the country now participate in at least one of the program’s three modules – coronary artery disease (CAD), heart failure (HF) and stroke. 


There are many examples of how patient care has improved since the program started.  Data at the end of 2006 show that more than 94 percent of GWTG–CAD patients are now being counseled on smoking cessation, compared with only 58.7 percent when the program began. For stroke patients that number has increased from 38.8 percent to 83.8 percent and for heart failure patients it has improved from 74.3 percent to 91.4 percent.

 

More than 94 percent of heart attack patients are now receiving aspirin upon admission, compared to 76.4 percent at baseline.  Stroke patients arriving at the hospital less than two hours after symptom onset are now receiving tPA more than 63 percent of the time, much improved from the 23.5 percent at baseline.  There is also significant improvement in the percentage of patients getting treatment to improve their cholesterol, as well as those getting beta blockers and other medications known to improve their health outcomes.

 

“Despite these improvements, we know there is room for us to do even more,” Fonarow said.  “Evidence shows us these interventions work, they can save lives.  Ideally every patient should get every treatment that is right for them every time.  We need to continue to work with hospitals to ensure that appropriate treatments are being given 100 percent of the time.”

 

“Get With The Guidelines helps hospitals provide the best possible treatment to heart disease and stroke patients.  We compile extensive research, convert it into treatment guidelines, and help hospitals adhere to those guidelines,” said Gregg Fonarow, M.D., chair of the American Heart Association’s Get With The Guidelines steering committee.

_____________________

4.       Other highlights


Improving the ‘Chain of Survival’ in Puerto Rico

Recently Puerto Rico approved a law requiring any government agency hosting public events or serving more than 200 people to have an automated external defibrillator on site.  The new law also mandates training requirements for agency staff in the operation and maintenance of automated external defibrillators.  Congratulations to Vice President of Advocacy Nikole Souder Schale (pronounced saw-der shale) for this important victory.  This new law will save lives.

Oregon strengthens school physical education requirements

Oregon Gov. Ted Kulongoski recently signed a bill that requires schools to meet new physical education requirements by 2017 and dedicates funds to smooth the 10-year transition. This important legislation sets the standard that physical education should be offered for 150 minutes per week in elementary schools and 225 minutes per week in middle schools. It also creates a grant program to provide funding assistance to help schools meet the new requirements by hiring new PE teachers and training current teachers on the current physical education content standards.

 

Congratulations to Oregon Government Affair Director John Valley for this very important victory.


_____________________

5.       Media highlights

 

For August 11-17, please visit http://www.heartsmarts.org/presenter.jhtml?identifier=3049898

 

_________________________

 

This online publication is intended solely for American Heart Association volunteers and staff, and is protected by federal copyright law.  Information included in it may be confidential or exempt from disclosure.  Therefore, if you are not among the registered recipients for this publication, please immediately delete and destroy all copies, and notify the person or organization responsible for providing it and tell them not to distribute it.  Thanks.

 

Staff can find links to other news stories on heart-health issues on the American Heart Association Library's intranet site at: http://www.heartsmarts.org/presenter.jhtml?identifier=4294

 

Volunteers and supporters can find American Heart Association news releases on the American Heart Association’s public Internet site at: http://www.americanheart.org/presenter.jhtml?identifier=1200031

 

 

 

Thrombolysis for Acute Stroke: Much Talk, Little Action

From 1999 to 2004, tPA was administered to only 1.2% of acute ischemic stroke patients in the U.S.

 

Myriad studies have demonstrated the effectiveness and safety of tissue plasminogen activator (tPA) when administered under the appropriate circumstances and its deleterious effects when administered improperly or in small, nonacademic, nonstroke-center hospitals without specific policies and procedures for its use. These studies have given rise to two vocal camps of emergency physicians one for and one against use of tPA largely split according to the type of center in which the EP practices.

To identify hospital and patient characteristics associated with administration of tPA, researchers analyzed data from the Nationwide Inpatient Sample for 1999 through 2004. Of nearly 370,000 patients with acute ischemic stroke who were admitted through an emergency department, 4104 (1.12%) received tPA (intravenously in 90.1% and intra-arterially in 9.9%). Most hospitals (69.5%) did not use tPA. Among hospitals that did use tPA, the mean number of patients treated with it annually per hospital was 3.06 (range, 1 to 76). Patient factors that significantly decreased the chances of a patient being treated with tPA were older age (odds ratio, 0.43 for patients85 compared with those <55), female sex (OR, 0.77), increased severity of illness (OR, 0.44 for patients with modified Charlson Index score3 compared with those with score of 0), and black or Hispanic race/ethnicity (ORs, 0.54 and 0.79, respectively, compared with whites).

Comment: The database did not provide information about reasons for not giving tPA, other than presentation after the acceptable 3-hour window. The rate of tPA administration reported in this study is very low, with the hospitals divided mostly into those that rarely if ever use it and those that give it comparatively more often. The time has come for implementing systems of care that allow rapid screening and transport of eligible patients directly to centers that can safely administer tPA.

Published in Journal Watch Emergency Medicine August 24, 2007

CITATION(S):

Schumacher HC et al. Use of thrombolysis in acute ischemic stroke: Analysis of the Nationwide Inpatient Sample 1999 to 2004. Ann Emerg Med 2007 Aug; 50:99-107.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mouth-To-Mouth CPR Not So Helpful?

Study: Chest Compression Best Resuscitation For Cardiac Arrest

 

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March 16, 2007

 (AP)

 
Quote


 

"This circulation you get from pushing on the chest is barely enough to keep the brain alive. If you stop for anything, like so-called 'rescue breathing,' which is an oxymoron, it is not good."
Gordon A. Ewy, M.D.
Director, Sarver Heart Center


 
 
(WebMD) For adults who suddenly collapse, CPR is more effective if rescuers focus on chest compression over mouth-to-mouth ventilation.

CPR stands for cardiopulmonary resuscitation. It's used on people whose hearts suddenly stop beating. Using this emergency technique, you can keep a person alive until professional help arrives.

Currently, CPR includes two techniques. The first is mouth-to-mouth resuscitation, the so-called breath of life. The other is chest compression: pushing down hard on a victim's chest, more than once a second, pressing it down at least an inch and a half before releasing.

A major reason why bystanders don't give CPR to people who suddenly collapse is reluctance to put their mouths on the mouth of a stricken person. That reason no longer exists.

Now, for adults who suddenly collapse, there's powerful evidence that chest compression alone is far better than doing nothing. In fact, the new evidence suggests that by interrupting lifesaving chest compressions, mouth-to-mouth resuscitation may do more harm than good.

The striking evidence comes from Ken Nagao, M.D., of Surugadai Nihon University Hospital in Tokyo, and colleagues. The researchers took a careful look at what happened to 4,068 adults who had an out-of-hospital cardiac arrest witnessed by bystanders.

More than 70 percent of the time, the bystanders did nothing when a person suddenly collapsed. Those victims were less likely to survive, and more likely to have brain damage if they did survive, than when bystanders tried to do something.

Bystanders bravely gave traditional CPR to 18 percent of victims. And those patients did much better than those who got no bystander aid.

But victims were 2.2 times less likely to suffer brain damage if they were among the 11 percent of patients who got chest compressions only — without mouth-to-mouth resuscitation.

Death of Mouth-to-Mouth Resuscitation?

"This study just confirms what has pretty much become common knowledge," CPR researcher Alfred Hallstrom, Ph.D., of the University of Washington in Seattle, tells WebMD. "We did a randomized trial of compressions vs. CPR, and the results indicated that the compression-only technique was better. Subsequently, labs have done animal studies suggesting the same thing."

"This does not surprise me one bit," CPR researcher Joseph W. Heidenreich, M.D., of Texas A&M Health Science Center, tells WebMD. "This is what all of us who have done CPR research have suspected for years. This is amazing data. Primarily, what people who suffer cardiac arrest need are chest compressions."

But not everyone is willing to give up on teaching people to give mouth-to-mouth resuscitation. One of them is Lance Becker, M.D., director of the center for resuscitation science at the University of Pennsylvania and past chair of the basic life support subcommittee of the American Heart Association(AHA).

"The real message from this study is that doing something is better for saving people's lives than doing nothing," Becker tells WebMD. "Good compressions are associated with good things. It does not mean that ventilation is not an excellent thing as well."

Becker says the AHA has always said that if people feel uncomfortable doing mouth-to-mouth resuscitation, they should simply focus on chest compression. And he says the new study validates this approach.

Charles Sea, M.D., an emergency-room physician at Ochsner Medical Center in New Orleans, teaches CPR to doctors. He says that new CPR techniques emphasize chest compressions over mouth-to-mouth ventilation.

"We are implementing new standards for faster, stronger chest compressions — 100 a minute, and only about six to eight breaths a minute," Sea tells WebMD. "Compared to the old CPR, just doing compressions would get better results. But I bet if they did the new CPR with the fast compression and minimal ventilation, they would get even higher survival rates than with compression alone."

But mouth-to-mouth resuscitation steals precious time from chest compression, argues Gordon A. Ewy, M.D. Ewy is director of the Sarver Heart Center and professor and chief of cardiology at the University of Arizona College of Medicine in Tucson.

"If you witness an adult collapse, it is most likely to be a cardiac arrest," Ewy says. "In cardiac arrest, the blood is fully oxygenated. What you need to do is press hard and fast on the chest to circulate the blood. This circulation you get from pushing on the chest is barely enough to keep the brain alive. If you stop for anything, like so-called 'rescue breathing,' which is an oxymoron, it is not good."

Reasons Remain for Mouth-to-Mouth

The main reason why the AHA teaches mouth-to-mouth resuscitation is that some people go into cardiac arrest because they have not been getting sufficient air. Such patients include drowning victims, for example, and victims of drug overdose. These patients do not have enough oxygen in their blood, and truly need mouth-to-mouth resuscitation.

But the vast majority of people who collapse have been breathing normally before their hearts stopped. That means that they have enough oxygen in their blood to survive until medical help arrives — if someone gives them continuous chest compressions, Heidenreich says.

Heidenreich notes that chest compression is not risk-free.

"With the type of force it takes to move the blood through the veins, if you do good CPR you probably are going to break someone's ribs," he says. "In this past week, I've done CPR several times in elderly patients in the ER, and probably every time I have cracked a rib. But if you talk to most people — and I have surveyed many — most are much more concerned about contracting a disease from giving mouth-to-mouth than about breaking a rib to save a life."

Regardless of what kind of CPR you give, the most important thing is to call for help right away. CPR is intended only to keep a patient alive until emergency help gets there.

And the compression-only technique applies only to adult patients. Children are far more likely to have stopped breathing than to have suffered a sudden cardiac arrest. This means they far more often need mouth-to-mouth resuscitation than adults do.



By Daniel DeNoon
Reviewed by Louise Chang
© 2005-2006 WebMD, Inc. All rights reserved.