Data: High-performance CPR works

By Dee Riggs
The Wenatchee World

WENATCHEE, Wash. — Longtime firefighter Mike Soltwisch says he is a lot more tired after doing CPR today than he was several years ago.

He is not complaining.

Soltwisch is now doing high-performance CPR, which, experts say, is saving more lives than the CPR protocols of the past.

"It's more labor intensive," Soltwisch said. "It's faster and you're really concentrating on depth and rhythm."

Soltwisch, a captain with Douglas County Fire District 2, is one of dozens of first-reponders in Chelan and Douglas counties who began doing high-performance CPR about five years ago. It calls for more chest compressions per minute and fewer pauses than CPR that had been the standard in the two counties for decades.

"We want to make sure we are doing almost perfect CPR," said Dr. Lance Jobe, medical director for emergency medical services in Chelan and Douglas counties and an emergency room doctor at Central Washington Hospital. "In the past, there have been a lot of pauses between compressions, with people looking at monitors and not realizing how much time they were off of chest compressions."

He is pleased with survival rates for out-of-hospital cardiac arrests since he started measuring them in 2011. Before that, no one was charting success rates in the two counties.

In 2015, 10 out of 15 patients in the two counties survived after being revived by CPR, for a 67 percent success rate, he said. So far in 2016, the survival rate (4 per 6 patients) has also been 67 percent.

That, he said, compares with about 62 percent in 2015 in the Seattle area, where first-responders have been doing high performance CPR for 10 years. Jobe noted that Seattle's percentages may be more representative of overall success rates because they have more cases annually to evaluate.

Jobe said that the success rate for Chelan and Douglas counties in 2013 and 2014 were lower than in 2011, 2012, 2015 and 2016 because some of the cardiac arrests were in rural areas, far from quick medical help. He also noted that local medical experts estimated success rates at 20 percent in 2010 and earlier years.

The percentages in Seattle and in Chelan and Douglas counties are based on cardiac arrests that are witnessed. That means the start time of the arrest is known.

The cases that Jobe tracks for success rates are cardiac arrests that are determined to be ventricular fibrillation, an electrical malfunction in which the heart "is quivering but there is no coordinated activity to bring any blood flow to the body," Jobe said.

Of the 65 to 70 out-of-hospital cardiac arrests in Chelan and Douglas counties each year, about one third are ventricular fibrillation, he estimated. Of those ventricular fibrillation cases, 12 to 14 are witnessed.

"That subset is the international definition of success," Jobe said. "We feel we should be able to save most of those patients."

He noted that ventricular fibrillation is "100 percent fatal unless someone intervenes. The likelihood of survival goes down 10 percent per minute.

"What CPR does is buy more time," he said.

Since first responders have been emphasizing continuous compressions, the five-year survival rate has been 46 percent, he said. That compares with a national average of 30 percent.

Also contributing to the local survival rates, Jobe said, is a new protocol at the RiverCom dispatch center in which dispatchers work with 911 callers to help those callers perform CPR. Dispatchers now eliminate breathing instructions and ask fewer questions before helping the caller start CPR. If a person is unconscious and breathing abnormally or not at all, CPR should be started.

Jobe also credited automatic external defibrillators, being used by Douglas County sheriff's deputies, and said the local emergency medical services council hopes money can be found to outfit patrol cars with the units in Chelan County.

Jobe said there is not money in the emergency services budget to chart survival rates in other out-of-hospital emergencies, such as car accidents and other traumas. He wishes there was a local EMS levy that would supply those funds.

"If our emergency services system trains for the most difficult task, which cardiac arrest requires, it trickles down to how we treat patients with less time-sensitive problems," he said.


(c)2016 The Wenatchee World (Wenatchee, Wash.)

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