Inspiring the young to save lives

December 2, 2009 by  
Filed under HEART AND STROKE

teenagersCardiopulmonary resuscitation (CPR) and using an automated external defibrillators (AED) are life-saving skills that everybody should learn. Including children. In a previous post, I described a study by Austrian researchers which indicated that school children as young as 9 years can be trained to perform these emergency procedures effectively.

The American Heart Association (AHA) has just launched a new online tool cardiac arrest awareness that teaches 12- to 15-year-olds the above-mentioned skills. However, this is no ordinary teaching tool. In order to inspire the youth to participate, the campaign uses fun and creative ways to learn the basics of CPR and AED use. The new online cardiac arrest awareness campaign is called Be the Beat and it includes video games, quizzes and songs that are appealing to this age group.

But why teach young people CPR and AED use? Because bystander helps increases the chances of a patient’s survival by two or three times during cardiac arrest. And young people are always around with others of their age at school, in sports, in leisure time. In this age group, they do not require 100% adult supervision anymore. In cases of emergency, they should be able to help each other.

Here’s what Beat the Beat has to offer:

In addition, the site also offers resources for educators and schools including downloadable lesson plans and templates for creating and sustaining an in-school emergency response plan.

According to Dr. Michael Sayre, chair of AHA’s Emergency Cardiovascular Care Committee.

“Be the Beat is helping to create the next generation of lifesavers by empowering teens and tweens to act when they see someone suddenly collapse. Sadly, far too many people are dying from cardiac arrest – we want this campaign to inspire people to help save lives.”

This campaign is supported by Medtronic Foundation. Schools can apply for a $1000 Be the Beat Mini Grant from the foundation.

Photo credit: stock.xchng

Lacrosse and commotio cordis

November 3, 2009 by  
Filed under HEART AND STROKE

Doing sports is a healthy pastime. For children and adolescents, sports can be the cure for obesity andLacrosse social problems.

Lacrosse is become a very popular sports In American schools. There are some concerns, whoever that the sports can be dangerous. A friend of mine didn’t allow her 14-year old son to play lacrosse because of these concerns.

In 2004, George Boiardi of Cornell University got hit with a lacrosse ball in the chest, causing his heart to stop. His was not an isolated case.

A recent report analysed the statistics of this popular game, as summarized below:

  • Since 1980, 23 lacrosse players in the US suffered from sports-related accident that led to cardiac arrest.
  • 19 of those players died; only 4 survived.

It is easily imaginable for athletes who play American football or rugby to sustain fatal injuries during a game. But lacrosse? How could a lacrosse ball kill a person? It is probably due to commotio cordis, “a condition in which an impact of blunt force arriving within a specific range of 15 thousandths of a second in the heart’s beating cycle sends an electrical impulse to the heart, stopping it.” Commotio cordis is a Latin terms which means “commotion of the heart”. A lacrosse ball hitting the chest at a precise moment can cause ventricular fibrillation,

a condition in which the heart’s electrical activity becomes disordered. The heart’s lower (pumping) chambers contract in a rapid, unsynchronized way and little or no blood is pumped from the heart. Collapse and sudden death follows unless medical help is provided immediately.

However, experts say it is a very rare event, a one-in-a-million shot. We shouldn’t let such rare occurrence discourage us and our kids from doing sports.

And because doctors, PE teachers and coaches are more aware of the risks, more preventive measures are in place, such:

  • Protective chest gears
  • Automated external defibrillators (AEDs)

The presence of AEDs during sports events has saved many lives. According to the report, two lacrosse players suffered from commotion cordis in 2008 and survived.

According to Dr. Jeff Mandak, a cardiologist in Harrisburg, Pa., and a member of U.S. Lacrosse’s safety board

“When there were two episodes of commotio cordis on the field a year, a year and a half ago … because these coaches recognized that this was a potential devastating injury … they called for a defibrillator and both kids survived”.

Photo credit: wikicommons

Michael Jackson’s death: Why it couldn’t have been a heart attack

October 5, 2009 by  
Filed under HEART AND STROKE

Michael_Jackson_1984When Michael Jackson suffered from cardiac arrest on June 25 this year, there were speculations that led to erroneous reports that Jackson suffered from a heart attack. It wasn’t clear whether the heart attack theories were based on medical evidence or the common mistake of equating cardiac arrest to heart attack. Once again, I have to put emphasis that heart attack (myocardial infarction in doctor speak) is not synonymous to (although it can cause) cardiac arrest, which is the sudden stopping of the heart.

Heart expert Dr. Melissa Walton-Shirley of Theheart.org wrote her blog heartfelt the many reasons why she is convinced that „Michael Jackson’s heart had nothing to do with his death [and] …was merely an innocent bystander.“ Dr. Walton-Shirley based her opinion on her analysis of Jackson’s risk factor profile which does not fit that of a young heart attack victim. These factors are listed and discussed below:

  • Family history. Heart disease seems to be not a part of the Jackson family medical history. Jackson’s parents are elderly (his mom is 79, his dad is 80) but are still fit. There has been no report of cardiovascular disease among his siblings.
  • Weight. Excess weight is a major risk factor for heart attack. Jackson was not overweight. On the contrary, he was underweight, looking „thin from the other side of the television screen but not emaciated.“ Excess weight is a strong indication of blocked arteries that lead to heart attack
  • Non-smoking. Smoking is another risk factor to consider and Jackson was a non-smoker.  
  • Diet. Jackson was rumored to be a vegetarian. Whether true or not, there is a strong indication due to his weight that he is not fond of animal fat.
  • Physical activity. The King of Pop can dance for extended periods, a feat that people with heart normally can do. Dr. Walton-Shirley, however, warns: Caution here on the exercise-tolerance issue, as 30% of all heart attacks may be asymptomatic.

In summary, Jackson did not have the most common risk factors that made him a likely victim of a heart attack.

Cardiac arrest, however, can be caused many things (including heart attack) and anybody can suffer from cardiac death that may or may not have to do with heart disease.

The latest autopsy reports reveal

Jackson was a fairly healthy 50-year-old before he died of an overdose. His 136 pounds were in the acceptable range for a 5-foot-9 man. His heart was strong with no sign of plaque build-up. And his kidneys and most other major organs were normal.

As to the real of cause of Jackson’s death, investigations are still ongoing. However, Dr. Walton-Shirley writes:

„His heart was merely an innocent bystander, a victim of the pop icon’s addiction and poor judgment, allegedly damned by a cardiologist’s stupidity, greed, and criminal negligence.“

Photo credit: wikicommons

“Cooling down”: therapeutic hypothermia for cardiac arrest patients

September 16, 2009 by  
Filed under HEART AND STROKE

ambulance__ecnalubmaIt has been recommended by the American Heart Association (AHA) since 2003. It was incorporated in the guidelines in 2005 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Yet, this clinical practice, which can save lives, are seldom used in hospitals and clinics.

The technique is called therapeutic hypothermia and is recommended for use in cardiac arrest survivors who are unconscious or in comma.

How does therapeutic cooling work?

Here is how “chilling out” works:

The patient’s body temperature is cooled down so that internal body temperature remains between 32° and 34°C (89.6° and 93.2°F) and the patient is monitored that the temperature remains stable for at least 12 to 24 hours. In doing so, damage is minimized and survival and neurological outcomes improved.

Is it effective?

A study by Australian researchers in 2002 showed that therapeutic hypothermia improved outcomes in patients with coma after resuscitation from cardiac arrest. 49% of patients who underwent hypothermia were discharged to go home to a rehab facility. Only 26% of those maintained at normal temperature were discharged. Other studies suggest similar results.

So why is therapeutic cooling not so popular in clinical practice?

Researchers at University of Pennsylvania School of Medicine, Philadelphia thought it might be due to the fact that therapy is not cost effective. Thus, they conducted a study to evaluate the cost-efficiency of this method. They balanced the cost to provide therapeutic hypothermia, which included treatment, posthospital discharge care, additional nursing care required during cooling treatment, and the extra time spent in the intensive care unit versus the efficacy and costs of no cooling therapy. Their analysis indicates that the therapy is effective in the long run. Specifically,

  • Patients who underwent therapeutic hypothermia gained more quality-adjusted life years than those treated with conventional therapies.
  • Cost effectiveness of hypothermia remained less than $100 000 per quality-adjusted life-year in 91% of the situations analyzed vs. conventional therapies.

According to study author Dr. Raina Merchant

“The cost of therapeutic hypothermia compares favorably with other medical treatments that are commonly used, such as kidney dialysis, estimated at $55 000 per quality-adjusted life-year, and public access defibrillation, at $44 000 per quality-adjusted life-year. Even when we controlled for care outside of the hospital, the cost of the therapy was still within the accepted range of cost-effectiveness.”

In some American cities, therapeutic cooling is becoming part of emergency procedures. Ambulances in New York City deliver cardiac arrest patients only to hospitals with cooling facilities. This is a bit controversial because smaller hospitals which don’t have and can’t afford cooling facilities may be at a disadvantage.

Dr. Merchant hopes that therapeutic hypothermia will soon become the standard of care everywhere.

“The American Heart Association recommends this therapy with very good data to show that it saves lives. People are able to return back home and to their regular jobs in many cases, without the permanent brain damage that would often ensue after a cardiac arrest. It’s not uncommon for studies to come out saying that something is effective, but hurdles remain in trying to figure out how to implement the therapy. Cost is often a part of that discussion, so we wanted to show that cost should not be an obstacle to cooling, a therapy we already know is effective.”

Photo credit: stock.xchng

Controversy about Michael Jackson’s CPR and emergency care

August 31, 2009 by  
Filed under HEART AND STROKE

michael_jackson_1984Last week, the LA coroner’s office announced that they are treating the death of Michael Jackson as a homicide.

Apparently, lethal amounts of the anesthetic-sedative drug propofol and other drugs were found in Jackson’s body during autopsy. And Jackson’s personal physician Dr. Conrad Murray is the focus of the investigation.

Murray was also criticized about his delivery of emergency care to his celebrity patient. Here are some of the questions that have come up:

Did Murray perform CPR properly?

CPR, short for cardiopulmonary resuscitation is performed when a person suffers from cardiopulmonary/cardiac arrest, e.g. the victim stops breathing and/or the heart stops beating. (Possible causes of the cardiac arrest have been discussed in a previous post). CPR, which consists of rescue breathing and chest compressions, is applied immediately after collapse to keep the blood circulating to the brain while waiting for emergency services to arrive. Murray reportedly found Jackson in his bed with a weak pulse and immediately started CPR. Many people questioned the effectiveness of performing CPR chest compressions on a bed/mattress. It is recommended that CPR works best when a patient is lying on a hard, flat surface such as the floor. Should the doctor have moved Jackson to the floor before starting CPR?

Was there an AED in the house?

cpr_training-04CPR alone cannot restart the heart. It needs an electric shock from a defibrillator to make beat again and this has to be done within 7 minutes of collapse, even with CPR before permanent brain damage and death occurs. Without CPR, this window of opportunity becomes shorter. Portable defibrillators, called automated external defibrillators (AEDs) are easily available and can be used even by laypersons. Could an AED have saved Jackson’s life?

Why did it take so long for the doctor to call 911?

The survival rate among cardiac arrest victims is very low. Every second counts if death is to be prevented. CPR alone cannot save a life. An AED within public access or by emergency medical services (EMS) is needed within the shortest time possible to restart the heart and the blood supply to the brain. CPR can minimize brain damage and extend the window of opportunity to save the victim’s life until professional emergency help comes. Unfortunately, it is unclear when the cardiac arrest happened and when the 911 call was made. It also reportedly took 25 to 30 minutes between the 911 call and the arrival of the paramedics. By then it was too late to save the King of Pop. So the next question is:

Why did it take so long for the EMS to arrive?

Photo credits: wikicommons

Cardiac arrest: what makes the heart stop?

June 29, 2009 by  
Filed under Featured, HEART AND STROKE

artificial-heartResource post for June

The King of Pop Michael Jackson was said to have suffered from cardiac arrest but the actual cause of death is unknown. This statement confused many people – why can’t cardiac arrest be the cause of death? To answer this question, we have to brush up a bit on what we know about cardiac arrest.

What is cardiac arrest?

According to the National Heart Lung and Blood Institute

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

If the heart does not start beating within a few minutes, death occurs.

There many things that can cause the heart to stop or “arrest” and sometimes it doesn’t even have anything to do with heart disease. The heart runs on an internal electrical system that regulates the rate and rhythm of the heart beat. From time to time, the electrical system can have problems, causing abnormal rhythms called arrhythmias. These abnormal heart rhythms can be too slow (bradycardia) or too fast (tachycardia) or it can complete stop. Some arrhythmias can cause the heart to stop pumping blood, causing sudden cardiac arrest.

Now, it is important for us to know that cardiac arrest is not synonymous to a heart attack or myocardial infarction in doctor speak. However, a cardiac arrest may be a complication of a heart attack. Although, people with heart problems have a high risk of SCA, most SCAs happen in completely healthy people with no history of heart disease.

Whatelectricity causes cardiac arrest?

So what can cause the heart to stop beating and lead to cardiac arrest? There are many things that can interfere with the heart’s electrical system and these are:

  • Coronary heart disease (CAD)/Heart attack. Blocked coronary arteries can lead to heart attacks but also interfere with the electrical system of the heart. A large number of SAC cases are due to CAD or heart attack.
  • Electric shock/electrocution. A strong electrical shock can stop the heart. Electrocution and lighting strikes can easily lead to SAC.
  • Respiratory arrest. This can happen when people choke, or drown or can’t breath, cutting off the oxygen supply to the heart.
  • Overdose on certain drugs. It is a know fact that certain drugs can interfere with heart rhythms. This is why new drugs are screened for pro-arrhythmic effects before approval. When taken in excessive amounts, certain drugs complete halt the heart, resulting in SAC.
  • Trauma. A strong sudden blow to the heart, or an injury that damages the heart can also lead to cardiac arrest.
  • Unknown causes. Some cases of SAC cannot be explained, unless an autopsy is conducted.

What are the signs of SAC?

According to the American Heart Association (AHA), the warning signs for SAC are

  • Loss of consciousness
  • Cessation of normal breathingheart-stethoscope
  • Absence of pulse
  • Absence of blood pressure

Death occurs within 4 to 6 minutes after cardiac arrest. It is estimated that 95% of SAC cases result in death.

How can cardiac arrest be reversed?

In SAC, every second counts. To save the patient, it is imperative that the heart be restarted as soon as possible. It can happen that heart function is restored but brain death has already set in due to interruption of blood and oxygen supply.

There are several ways to restore a normal heartbeat:

  • Electric shock using defibrillators, a scene that we often see in emergency rooms. In settings away from hospitals, the use of automated external defibrillators (AEDs) has saved many lives.
  • Cardiopulmonary resuscitation (CPR) is to manually restore the heart beat by applying pressure on the chest region.

According to the AHA

Cardiac arrest can be reversed if it’s treated within a few minutes with an electric shock to the heart to restore a normal heartbeat. This process is called defibrillation. A victim’s chances of survival are reduced by 7 to 10 percent with every minute that passes without CPR and defibrillation. Few attempts at resuscitation succeed after 10 minutes… It’s estimated that more than 95% of cardiac arrest victims die before reaching the hospital. In cities where defibrillation is provided within 5 to 7 minutes, the survival rate from sudden cardiac arrest is as high as 30-45 percent.

Because SAC is very time critical, waitdefibrillator1ing for emergency services to arrive may be too late. This is why AEDs are available in crowded public places, e.g. airports, sports stadiums, public events where people gather. In Zurich, Switzerland, AEDs are strategically located in telephone booths in the city center. Equally important is bystander awareness. AEDs are designed to be used by almost anybody, even without any medical training. Yet, many people are hesitant to “get involved.” Health groups, including the AHA are campaigning for more active bystander involvement in the prevention of SAC.

Photo credit: stock.xchng

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.