A modified cardiopulmonary resuscitation procedure increased survival three-fold when used for cardiac arrests due to a defibrillator-responsive arrhythmia, according to an article in the April issue of the American Journal of Medicine. The new approach, called Cardiocerebral Resuscitation, is dramatically different from existing, guideline-directed procedures.

“Cardiocerebral Resuscitation eliminates certain previously recommended procedures and reprioritizes the order of actions the emergency medical services deliver,” said Michael J. Kellum, MD, lead author of the report.

Under the new approach, first responders skipped the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. Instead, they simultaneously attached the victim to a defibrillator and began fast, forceful chest compressions.

“Intubating the patient and waiting for the defibrillator to do its analysis takes time ? time a cardiac arrest victim doesn’t have,” said Gordon A. Ewy, MD, a coauthor of the study. “In laboratory experiments, we found that the most important factor of survival is to keep the blood moving through the body by continuous chest compressions. Stopping chest compressions for ventilations was far more harmful than helpful. Excessive ventilations during chest compression turned out to be harmful, too.”

First responders applying the new protocol were able to resuscitate the 58 percent of out-of-hospital witnessed cardiac arrest victims if they had defibrillator-responsive initial rhythm. In contrast, the survival rate was only 20 percent in the three prior years, when the standard CPR protocol was used.

The current study, which involved 125 patients, reports the experiences after the revised protocol was implemented in two Wisconsin counties in collaboration between the CPR Research Group at the University of Arizona’s Sarver Heart Center and the Mercy Health System in Wisconsin.

“We think one of the reasons that CPR as directed by international guidelines has not worked well is because it is designed for two entirely different conditions: cardiac arrest and respiratory arrest,” said Ewy. “What is good for one may not be good for the other. Cardiocerebral Resuscitation is designed for cardiac arrest.

Sudden unexpected collapse in an adult is almost always due to cardiac arrest. The new approach is not recommended for respiratory arrest, a much less common situation following, for example, drowning or drug overdose.”

As a cause of death, out-of-hospital cardiac arrest is second only to all cancer deaths combined, taking the lives of 490,000 Americans every year. In spite of periodic updates of standardized international guidelines, survival rates have remained more or less unchanged over the last couple of decades. Survival rates are better only if an automated external defibrillator is available and is used soon after the cardiac arrest.