Peel first to launch North American CPR study: Chest compressions key to survival

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Peel Regional Paramedics have enrolled the first case in a North American study intended to determine the impact of an alternate method of cardiopulmonary resuscitation (CPR) compared to standard CPR.

“Previous research has shown that minimizing interruptions in chest compressions may impact survival from cardiac arrest,” says Dr. Sheldon Cheskes, Peel Regional Paramedic Services’ Medical Director and Co-Principal Investigator of the Toronto site of the Resuscitation Outcomes Consortium. “This research will compare two methods of CPR in hopes of providing some insight as to the optimal method of CPR.”

The study, known as Continuous Cardiac Compressions (CCC) and led by the Resuscitation Outcome Consortium (ROC), will compare standard CPR, (30 compressions followed by two ventilations during a CPR interval) to a technique providing “continuous compressions,” (10 compressions followed by one ventilation). The key difference between the two techniques is not just the different compression ventilation ratio, but the techniques by which ventilations are provided. In the intervention or continuous compression arm providers will not stop CPR to provide ventilations, but rather provide ventilations while CPR is ongoing. This technique, currently used by some EMS services in North America, minimizes interruptions in chest compressions, which are known to be deleterious to cardiac arrest survival.

According to Cheskes, “When it comes to cardiac arrest survival we now know that there is not one drug or device that will make the difference between life and death, but rather a system of care that optimizes a rapid response by EMS, as well as high quality CPR by all providers, that can be critical to survival. Research has shown us that geographic areas in which bystanders perform CPR have significantly higher rates of survival than those with lower rates of bystander CPR.”

This study comes on the heels of another recently published ROC study showing that survival rates from cardiac arrest decreased when more time passed between chest compressions and defibrillation. Perishock Pause: An Independent Predictor of Survival from Out-of-Hospital Shockable Cardiac Arrest is authored by Dr. Cheskes and ROC investigators. It can be found in the July 5, 2011 version of t he American Heart Association’s journal Circulation, as well as online at circ.ahajournals.org.

Cheskes also pointed out that bystander CPR in Peel Region sat at 15 per cent in 1992. “We now can boast a bystander CPR rate of 34 per cent. This is much improved but we still have a long way to go. Convincing the public to act when one witnesses a cardiac arrest remains a challenge, but we are really happy with the progress we have made so far.”

“It is our hope that the new recommendations for bystanders to perform compression-only CPR before paramedics get to the scene is an extremely important factor in the success of a cardiac resuscitation,” continues Cheskes. “Anything we can do to get bystanders to act will save lives.”

Members of the public can look into CPR training from organizations such as the Peel Paramedic Association, St. John Ambulance, the Heart and Stroke Foundation of Ontario and the Canadian Red Cross.

The Resuscitation Outcomes Consortium (ROC) consists of 11 regional clinical centers across North America. The goal of these centers is to promote pre-hospital research in the areas of cardiac resuscitation and life-threatening trauma. Almost 125 fire and EMS organizations, involving more than 20,000 fire and emergency medical service providers who serve a combined population of nearly 15 million people from diverse urban, suburban and rural regions will participate in the study. To learn more about ROC, visit roc.uwctc.org.

Peel paramedics and Brampton and Mississauga firefighters were trained for the CCC study, which launched first in Peel on June 6.

“Peel’s paramedics are dedicated to ongoing training and education that delivers better patient outcomes,” says Peter Dundas, Peel Regional Paramedic Services Chief. “We’re excited to participate in another groundbreaking study with the ROC research group.”

Peel paramedics respond to more than 84,000 emergency medical calls every year. For more information about Peel Regional Paramedic Services, visit peelems.ca.