Toilet plunger improved cardiac resuscitation – 06/22/2023 – Science

In 1988, a 65-year-old man’s heart suddenly stopped in his home. His wife and son didn’t know CPR (cardiopulmonary resuscitation), so in desperation they grabbed a toilet plunger to get his heart pumping until an ambulance arrived.

Later, after the man recovered at San Francisco General Hospital, his son gave the doctors there some advice: Put toilet plungers near every bed in the coronary care unit.

The hospital didn’t do this, but the idea got doctors thinking about better ways to do CPR, the conventional method of chest compressions after cardiac arrest. More than three decades later, at a meeting of directors of emergency medical services this week in Hollywood, Fla., researchers presented data showing that using a plunger-like configuration leads to markedly better results for resuscitating patients.

Traditional CPR doesn’t have a great track record: On average, only 7% of people who receive it before reaching the hospital are discharged with full brain function, according to a national registry of cardiac arrests treated by emergency medical teams in communities of all over the United States.

“It’s sad,” said Keith Lurie, a cardiologist at the University of Minnesota School of Medicine who treated the patient with an embolus in 1988.

The new procedure, known as neuroprotective CPR, has three components. First, a silicone plunger forces the chest up and down, not only pushing blood into the body, but pulling it back to refill the heart. A plastic valve fits over a face mask or breathing tube to control pressure in the lungs.

The third piece is a body positioning device sold by AdvancedCPR Solutions, a company founded by Lurie in Edina, Minnesota. A hinged support slowly elevates the patient from a supine position to a partially seated position. This allows oxygen-depleted blood in the brain to drain more effectively and replenish more quickly with oxygenated blood.

The three pieces of equipment, which fit in a backpack, cost around US$ 20,000 (R$ 95,600) and can be used for several years. The devices have been separately approved by the US Food and Drug Administration.

About four years ago, researchers began to study the combination of the three devices used together. At this week’s meeting, Dr. Paul Pepe, a former CPR researcher and director of Dallas County (Texas) emergency medical services, reported results from 380 patients who could not be revived by defibrillation, making their chances of survival particularly difficult. Among those who received the new method of CPR 11 minutes after cardiac arrest, 6.1% survived with intact brain function, compared with just 0.6% who received traditional CPR.

He also reported significantly better odds for a subgroup of patients who didn’t have a heartbeat but had random electrical activity in their heart muscles. Typical chances of survival for people in these circumstances are about 3%. But patients in Pepe’s study who received neuroprotective CPR had a 10% chance of leaving the hospital neurologically intact.

Last year, a study in four states found similar results. Patients who received neuroprotective CPR within 11 minutes of a 911 call were about three times more likely to survive with good brain function than those who received conventional CPR.

“This is the right thing to do,” said Pepe.

A few years ago, Jason Benjamin went into cardiac arrest after a workout at a gym in St. Augustine, Florida. A friend took him to a nearby fire station, where trained workers put on neuroprotective CPR equipment. It took 24 minutes and several defibrillations to revive him.

After recovering, Benjamin, a former emergency medical technician himself, was stunned to learn of the new approach that saved his life. He read the studies and interviewed Lurie. The three-part procedure had a lot of complicated names at the time. It was Benjamin who coined the term neuroprotective CPR, “because that’s what it does,” Benjamin recalled, adding that “the focus was on protecting my brain.”

Karen Hirsch, a Stanford University neurologist and member of the American Heart Association’s CPR standards committee, said the new approach is interesting and makes physiological sense, but the committee needs to see more research in patients before it can recommend it. formally as a treatment option.

“We are limited by the available data,” she said, adding that the committee would like to see a clinical trial in which people who have experienced cardiac arrest are randomly assigned to either conventional CPR or neuroprotective CPR. None of these assessments are happening in the United States.

Joe Holley, medical director of the emergency service that serves Memphis, Tennessee, and several surrounding communities, is not waiting for a bigger test. Two of his teams, he said, are getting neurologically intact survival rates of about 7% with conventional CPR. With neuroprotective CPR, rates rose to about 23%.

Their teams are coming back from emergency calls much happier these days, and patients are even showing up at firehouses to thank the firefighters for their help.

“That was a rare thing,” Holley said. “Now it’s almost normal.”

^{Translated by Luiz Roberto M. Gonçalves}