Nonshockable Rhythms and CPR

The benefits of cardiopulmonary resuscitation (CPR) have been well recorded in Sudden Cardiac Arrest victims

When applied early, correctly and followed up with a defibrillator, chances of survival can increase to 75 percent or more.

What about non-shockable rhythms; will CPR still increase the chances of survival?

University of Washington professor, Dr. Peter Kudenchuk and his team from Seattle analyzed thousands of patients who suffered a cardiac arrest with non-shockable rhythms and found a strong correlation between high-quality chest compressions and survival rates for people in cardiac arrest, even if they do not response to defibrillator shocks. 

Types of Rhythms

Click for a larger view

Dr. Kudenchuk discovered patients had a 50 percent better chance of regaining spontaneous circulation, a 56 percent better chance of a favorable neurological outcome, and an 85 percent better chance of living one year. 

“Why the study is important is that a huge emphasis has been placed on treating patients with shockable arrhythmias. That’s why these public-access defibrillators and rapid shock methods have evolved and been promoted and rightly so, but shockable rhythms account for only a small proportion of cardiac arrests,” says Kudenchuk.

Non-shockable cardiac arrest, including asystole and so-called pulseless electrical activity, represent a large portion of sudden cardiac-arrest cases, up to 75 percent, but this is the first study to rigorously check whether CPR could improve survival in for people with non-shockable rhymes.

All of the patients in the study were determined to have a nonshockable arrhythmia after the responders tried to defibrillate their hearts. “These patients do very poorly, because the only real therapies we have to throw at them are CPR and drugs and trying to find something reversible that may have caused the rhythm,” Kudenchuk says.

All of the patients in this study were in Washington State from 2000 to 2010, so the study was able to compare outcomes of patients before and after the release of the 2005 American Heart Association CPR guidelines that encourage uninterrupted chest compressions. Kudenchuk was then able to compare historical methods to up-to-date methods focusing on uninterrupted chest compressions. 

Kudenchuk explained that the current CPR guidelines “provide a stronger emphasis on ongoing minimally interrupted CPR and to reduce the time that a patient is in cardiac arrest and the hands are not actively pumping the chest. In simply deploying those guidelines–there is nothing magical about it–you can almost double survival from a non-survivable disease, and that is nonshockable cardiac arrest.”

Going Global! National and International Public Access to Defibrillation (PAD) Programs

Global Medical Services is a proud partner of the Heart and Stroke Foundation’s PAD program. Over the past decade and a half many countries have worked to develop programs that facilitate the public’s access to Automatic External Defibrillators (AEDs). In order to develop an innovative public access to defibrillation program for BC, the Heart and Stroke Foundation surveyed a variety of national and international PAD programs. We are excited to be part of this exceptional project that will ultimately save the lives of countless British Columbians. To celebrate BC’s PAD Program, we decided to take a look around the globe to see how different Public Access to Defibrillation programs were able to create positive impacts in their communities.

Canada

Canada has a few provincial PAD programs. The Ontario PAD program has been active since 2007, and they have installed around 3000 publically accessible AEDs. Over the next few years, and with the help of additional provincial funding Ontario is planning on installing another 2500 Public AEDs. Today, over 40 lives have been saved by publically accessible AED’s in Ontario.

United States

In the United States, many cities have developed their own PAD programs. San Diego started “Project Heartbeat” in 2001. The initial goal of their program was to place 250 AEDs in public places throughout the city in time for the 2003 Superbowl. San Diego managed to exceed their goal by placing 550 publically accessible AED units in that time frame. San Diego is working to make AEDs prevalent in public places as Fire Extinguishers currently are. San Diego’s AED of choice is the Powerheart AED G3 Automatic; an AED that Global Medical Services is also proud to carry in our product line. Today, Project Heartbeat has saved 107 lives in the Greater San Diego area.

In Florida, the City of Miami/DADE fire-rescue department developed the “Team for Life” program in an effort to promote public access to defibrillators in the region. The fire-rescue department provides funding, training, equipment and program management for the public AED program. Miami/DADE has also worked to create one of the largest public access to Defibrillator initiatives in the world by equipping 1900 Police vehicles with Lifepak 500 AEDs.

Spain

In 2011, Spain became the first country in the European Union to start a PAD Program. The Territory of Girona, Spain intends to install 500 fixed AEDs and 150 portable AED units throughout the region. Spain has chosen to install the Powerheart G3 Plus Automatic AED on busy street corners and in public buildings. 

Australia

Meanwhile in the Southern hemisphere, Saint John’s Ambulance Australia started the community based “Heart Start” program. This program was begun in 2004 and provides guidance for public institutions seeking to incorporate an AED into their facilities. To date, this program has saved 19 lives. In 2012, Saint Johns Ambulance began offering subsidized AED’s to the public. They have received an overwhelming amount of public support for their program and they are hoping to see it grow dramatically in the future.

Hong Kong

Moving into Asia, on March 11th 2007, the Hong Kong College of Cardiology in conjunction with the Lan Kwai Fong Association installed their first AED in a public place, as part of their “Heart-Safe Place” program. In the program’s first year, over 100 AEDs were installed in places ranging from community centers and sports arenas to amusement parks.

Japan

Since 2004, Japan has been working to incorporate AED’s into their communities. When the program began there were approximately 9906 publicly accessed defibrillators in Japan. Due to a number of public and private initiatives, by 2007 the number of community based AEDs had risen to about 88,265. A study conducted on the Japanese PAD initiative found that the increase in public access to defibrillators was shown to dramatically improve an individual’s chances of surviving a cardiac event .

Global Medical Services is very proud to be part of the BC-PAD program and we are very excited to be joining these other locations in an effort to bring accessible AEDs to the public.

[1] Kitamura, T., et.al. “ nationwide Public-Access to Defibrillators in Japan” New England Journal of Medicine, (March 18, 2010) http://www.nejm.org/doi/full/10.1056/NEJMoa0906644

An Automated External Defibrillator (AED) Saves Another Life

With the recent launch of the province-wide Public Access Defibrillation (PAD) Program in BC, news of an AED save in Toronto couldn’t have come at a better time. Since 2006, the public defibrillator program in Ontario, funded by the Heart and Stroke Foundation has saved 48 lives.

Now it is our turn here in BC. With the PAD program underway, we can expect the same impact, as articulated by Health Minister Margaret MacDiarmid, we will be to “save hundreds of lives”. Indeed, with increased access to AEDS, each of the 2000 SCA deaths reported annually in BC has the potential to be avoided.

The team here at Global Medical Services is excited to play an ongoing role with the HSFBC and PAD program, we hope to see many lives saved.

Toronto AED Save

TORONTO, Feb. 13, 2013 /CNW/ – Once again, AEDs and CPR have proven their worth as a Toronto man is alive today thanks to the quick actions of bystanders. 

On Sunday, January 13, a 51-year-old Toronto-area resident Paul Poce was playing hockey at the Malvern Recreation Centre when he collapsed to the ice after suffering a cardiac arrest. His son Ben Poce, who also works as a paramedic for Peel Regional Paramedic Services, immediately rushed to his father’s side. Recognizing the signs and symptoms of cardiac arrest, Poce called out to his teammates to dial 9-1-1, instructed his friend Shawn Nichols to start chest compressions, while he retrieved the on-site AED. 

Read the full story

About the Heart and Stroke Foundation:

The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke, reducing their impact through the advancement of research and its application, the promotion of healthy living and advocacy.

Global to supply British Columbia with 450 AEDs

Michael, Julie, Vern, Allan and Tom at the PAD Program Launch presentation

In 1997, a British Columbia mill suffered a heart-wrenching loss when one of its staff members collapsed and died of Sudden Cardiac Arrest (SCA).    The only remedy for an SCA is the delivery of an electric shock that acts to reset the heart’s electrical rhythms – a shock deliverable by an Automated External Defibrillator (AED).   Unfortunately, that shock must come quickly.   For every minute that passes without shock delivery, a person’s chance of survival is reduced by 10%.   In 1997, only ambulance attendants and fire rescue personnel had access to AEDs, and on that day, neither could get to the mill in time with the life-saving AED.

This event, while tragic, led to the formation of Global Medical Services (Global), a BC-based company passionate about broader access to AEDs.  Founded by Dr. Allan Holmes, an emergency-trained physician, Global has worked in the intervening years to implement comprehensive AED programs for hundreds of workplaces across the province and throughout Canada.

And then came February 6^th, 2013, a particularly special day in our company’s history.

Gathered alongside representatives of the Ministry of Health, the Heart and Stroke Foundation of BC & Yukon (HSFBCY), and the British Columbia Ambulance Service (BCAS), our team helped bring forward the announcement that a province-wide Public Access Defibrillation Program initiative was launching.

Kicked off with a highly effective Public Service Announcement and an awareness campaign, the initiative, funded by the HSFBCY and the Ministry of Health, will see 450 AED units and associated training delivered to communities throughout BC.   The expected impact, as articulated by Health Minister Margaret MacDiarmid, will be to “save hundreds of lives”.   Indeed, with increased access to AEDS, each of the 2000 SCA deaths reported annually in BC has the potential to be avoided.   This was exactly the case for Anna Shanh, an SCA survivor, who shared her survival story with those at the launch.  It was a stark reminder for us all that SCA doesn’t discriminate; even the young, fit, non-smoking and non-drinking among us are at risk.

In participating in the launch and seeing the efforts invested to bring it to life, we could not be more proud to be the PAD initiative’s exclusive AED provider.   We look forward to working with communities throughout the province as well as with the exceptional teams at both the HSFBCY and BCAS.    We share CEO Diego Marchese’s view that this has the potential to be one of the best programs in Canada, and we look forward to playing our role in ensuring that it is.

For more information and video, visit the BC Government newsroom: http://www.newsroom.gov.bc.ca/2013/02/bc-increases-access-to-defibrillators.html

What is an AED Program?

Issue

In Canada, 35,000 to 45,000 people die of sudden cardiac arrest (SCA) each year. Unlike a heart attack, which is caused by a blockage in an artery, SCA results from an electrical malfunction of the heart. The only effective treatment for this condition is the early delivery of an electric shock by an automated external defibrillator (AED). Response time is critical; for every minute of delay in delivering the shock, survival rates for SCA victims decrease by 7-10 percent.

Solution

Recognizing the link between increased survival rates in SCA victims and the prompt use of a defibrillator, the Heart and Stroke Foundation of Canada (HSFC) has recommended that all Canadians:

• Have widespread access to automated external defibrillators.
• Be trained and encouraged to apply cardiopulmonary resuscitation (CPR) and AED skills when needed.

When applied to the workplace, these recommendations entail implementing a program that makes AEDs readily available and ensures that staff are well prepared to use them when needed.

Process

Global Medical Services (Global) provides an AED Program that includes three indispensable components:

1) The AED device, associated accessories, and servicing

Global is British Columbia’s sole distributor of LIFEPAK AEDs and we are a regional distributor of Powerheart G3 Plus AED. Both manufacturers are renown for their use of leading-edge technology, the reliability of their units, and after purchase service provided.

2) Initial and ongoing training

Managing a cardiac arrest involves more than merely “pushing the button” on an AED. Respondents must be able to recognize an arrest, perform CPR, and use a defibrillator properly. Our AED training workshops ensure that participants are able to respond effectively when the time comes.

3) Medical direction (a WorkSafeBC recommendation)

Global provides a medical direction package, consisting of the following components:

• Emergency medical response procedures
• Emergency Health Services liaison
• Operational debriefing
• Post incident call review
• Physician consultation
• Critical incident stress referrals

Our medical direction package is designed to maximize the value of your AED, and exceeds the recommendations from WorkSafeBC, the HSFC, and Health Canada.

Our Company

Since 1998, Global has overseen the training and certification of over 10,000 lay rescuers in the use of AEDs. Dr. Allan Holmes, a fellowship-trained Emergency Physician, is an expert in pre-hospital care and has worked extensively with Occupational First Aid Attendants, fire rescue personnel and the BC Ambulance Service. We currently provide medical direction to over 300 clients including 140 fire departments throughout the province.

Study Looks to Predict Sudden Cardiac Arrest Risk

A promising new way to predict sudden cardiac arrest risk has been identified by medical researchers at the University of Buffalo.

For patients who are at the highest risk of sudden cardiac arrest, this is exciting news, as this research may give cardiologists an advanced screening tool to help those in the high-risk category and those most likely to benefit from receiving an implantable cardiac defibrillator (ICD).

ICDs are mainly used to prevent sudden cardiac arrest in patients with advanced heart disease, but many patients’ devices are never triggered.

New research suggests that imaging the degradation of nerve function in the heart may identify those patients at greatest risk of developing a life-threatening heart rhythm.

Using Positron Emission Tomography (PET), in the largest PET imaging study ever done on sudden cardiac arrest, researchers were able to measure the amount of nerve damage within the muscular tissue of the heart.

PET imaging is also able to show where nerves have died or become damaged due to inadequate blood flow.

“The principal question we posed with this study was whether the amount of nerve damage in the heart could predict sudden cardiac arrest,” says James A. Fallavollita, author on the study. “We found that when at least 38 percent of the heart was showed signs of nerve damage, there was a significant increase in the risk of sudden cardiac arrest.”

At this time, to determine whether an ICD is needed, doctors take a measurement of heart function called the ejection fraction; the percentage of blood pumped by the heart with each beat. An ejection fraction of 35 percent or less is a strong indicator of sudden cardiac arrest risk; these patients usually require an ICD.

This research is a prime example of translational medicine (the emerging field which focuses on using what is learned in pre-clinical studies to do smarter things in the clinic). In this case, the pre-clinical studies demonstrated that the risk of developing ventricular fibrillation (a deadly heart rhythm) was related to regional nerve damage.

“Ultimately, we wanted to develop an approach that could tackle the problem of identifying a larger portion of the patients with coronary artery disease who are at risk of developing sudden cardiac arrest,” explains John M. Canty, a principal investigator of the research. “Since many patients who suffer a cardiac arrest do not have severely depressed heart function, PET imaging may be able to identify high risk individuals who, in the future, could be considered candidates for an ICD.”

Stepping Up to the Plate for AED Training

In March, we announced the winners of our 2012 AED Giveaway – the Kopytko family. Their son, Mitchell, was diagnosed with Hypertrophic Cardiomyopathy, a disease of the heart. 

Hypertrophic Cardiomyopathy can increase the likelihood of Sudden Cardiac Arrest (SCA). The only treatment for SCA is though defibrillation. Without immediate access to a defibrillator, SCA is almost always fatal.

For the Kopytko family, having an Automated External Defibrillator (AED) means they now have the right tool to fight SCA.

“We are so grateful to have the peace of mind that the AED offers our family, we will always worry about the ‘what if’s’ where Mitchell is concerned, but this gives us a piece of equipment that could make all the difference in a worst case scenario” said Melanie Kopytko.

But as important as the defibrillator is, there is one other key component involved – training.

It is true many could pick up a defibrillator and use it without training, but will they be performing high-quality CPR? How do you apply an AED to a child? When should you call 911? These are important questions that training will answer.

Now that the Kopytko family has an AED, the next step was to get them certified. We spoke with FACTs First Aid (located in Vernon, BC), who were so touched by the Kopytko story they generously donated their time to provide AED and CPR certification.

Here’s what Melanie Kopytko (Mitchell’s mother) had to say:

“I just wanted to let you know how well our training went with Jules from FACTs first aid. She was wonderful; she really took her time with Mitchell (10) and Jorja (7) as we thought it was important that they take the training with us.

She was so on task and dialed in to our dynamic that everyone felt very comfortable asking questions, some of them tough and personal because we are thinking it may be this 10 year old child who is our patient one day, and everyone had lots of hands on time with the machine and Annie dolls, as well as a very good understanding of the basic CPR that accompanies using the AED.

I had no doubt the adults would gain from the training, but what touched me most was, like I said, her attention to Jorja, making sure she felt comfortable and sure of herself with what she was learning. They are at that age where sometimes Jorja and Mitchell are home alone together for short periods of time, so it was important she have the knowledge.  

Also with us were Mitchell’s Grandmothers, his aunt, his classroom teacher and his principal, as well as Chad and I of course :)

We cannot thank Global Medical Services enough, we feel so fortunate, and now so knowledgeable. I didn’t realize how empowering it would feel to know that I have the tools of CPR if I should need them.”

At Global, we are thrilled to hear the training went well; it’s great to have made such a huge impact. We feel very fortunate to be in a position to help others through the promotion of AEDs and life-saving CPR training.

We wish the Kopytko family all the best. – The Global Team

 

AED Maintenance is Key for Life-Saving Defibrillators

As a distributor of AEDs, Global Medical Services would like to take this opportunity to comment on the recent CBC media reports regarding AEDs not operating correctly or failing.  As indicated in the article, a reason for the failure of an AED to function properly has been the lack of routine maintenance.  It is important for individuals or organizations who have purchased an AED to frequently check their device to ensure it will be ready when needed.  To ensure readiness, a routine check would involve inspecting the following:

• Expiration dates on the battery and electrode pads.  If either items are about to expire or have expired, immediately order and replace the soon to expire/or expired supplies.
• AED examined for visible damage. 
• Electrode cable is securely connected to AED
• Spare set of electrodes is present with AED
• Rescue Kit is present with AED

To help organizations manage their AED program, GMS provides an AED Medical Direction Program. As part of this program, we track the battery and electrode expiration dates, placing a call to your organization in advance of expiration to ensure the AED is always ready to be used.

In addition to helping track expiration dates, the AEDs we distribute are equipped with safety features to help ensure the AEDs will work when needed. The following are some of the features:

Physio-Control LIFEPAK CR Plus AED:

• Performs weekly and monthly automatic self- tests for functionality
• 4 Readiness indicators
• SafeGuard Power System – a dual layer of security inside the CR Plus as the internal battery is kept to its optimal power level via the CHARGE-PAK™ battery charger.

Cardiac Science Powerheart G3 Plus AED:

• Rescue Ready Technology
  • a daily, weekly and monthly check for functionality of all main components (battery  and electrodes for presence and capacity, software and hardware)
  • visual alarm (Rescue Ready Status Indicator turns from green to red)
  • an audible alarm (prompting the user to service the unit)

The media reports also state that some defibrillators did not deliver a shock.  It is important to understand that in some sudden cardiac arrest situations, the defibrillators may not deliver a shock because it is not needed.  When the electrode pads are placed on the patient’s chest, the device analyzes for 2 shockable rhythms:  Ventricular fibrillation (VF) or Ventricular tachycardia (VT).  If these shockable rhythms are detected, a shock will be delivered.  If they are not detected, a shock will not be delivered and the rescuer will continue with CPR.  If a device does not deliver a shock, it does not mean the unit has failed.

Like all safety equipment, AEDs should be maintained according to the manufacturer’s recommendations.  Having a regular maintenance plan in place can help ensure your AED will be ready to use when needed.