Resuscitation Research: Cardiocerebral Resuscitation

The University of Arizona Sarver Heart Center Resuscitation Research Group is world-renowned for decades of research that led to new CPR guidelines that advocate chest-compression-only CPR, a method that doubles a person’s chance of survival from sudden cardiac arrest. Equally important are their life-saving protocols for emergency responders and hospitals.

“Sudden cardiac arrest is responsible for an estimated 300,000 deaths each year in the United States—about one every minute. It is a major public health issue,” says Gordon A. Ewy, MD, professor emeritus of medicine and director emeritus of the UA Sarver Heart Center. “The survival rates were abysmal and essentially unchanged for 30 years, in spite of recurrent updates of the national CPR guidelines. Our group has focused not only on how to save lives, but also to improve the quality of life for survivors of cardiac arrest. If the protocols initiated in Arizona in 2004 were implemented nationally, we project that an additional 11,000 lives would be saved each year.”

Strengthening Skills of Participants at All Levels

Arizona’s cardiocerebral resuscitation protocols changed the near-half-century-old approach to resuscitation and encompasses participants at all levels including encouraging people to follow the 3 Cs:

Check: Teaching people to recognize cardiac arrest—seeing or hearing someone unexpectedly collapse who is not responsive. (Note: it is not necessary to check for pulse or breath, as gasping or agonal respiration can be mistaken for breathing, when in fact these are signs of cardiac arrest.)

Call 911 for emergency medical services.

Compress: Starting chest-compression-only CPR without removing clothing.

If available, using an automated external defibrillator, to shock the heart back to a normal rhythm. The AED pads must be attached to the patient's bare chest.

Pre-hospital Protocols

For arrests due to a "schockable rhythm," emergency responders do not place a breathing tube, but provide passive ventilation and continue chest compressions before and after a single shock from a defibrillator. The patient is transported to a designated cardiac receiving center.

Hospital Protocols

The cardiac receiving centers throughout Arizona provide immediate access, if indicated, to a catheterization lab to open up blocked arteries 24 hours a day, seven days a week and provide therapeutic mild hypothermia to cardiac arrest survivors who initially are in a coma. Cooling a patient to 32° has been shown to limit brain damage. Patterned after the trauma center designation, ambulance crews in Arizona have the opportunity to bypass hospitals in order to take a patient directly to the closest cardiac receiving center.

What is The PEARL Study?

A Pilot Randomized Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography for Post-Cardiac Arrest Patients Without ECG ST Segment Elevation, called The PEARL Study for short, is evaluating the safety and effectiveness of coronary angiography (also known as heart catheterization) performed within 90 minutes of hospital arrival in a population of post-cardiac arrest patients without ST Segment elevation on their electrocardiograms (ECGs). This study will help answer the question: “Does an early heart catheterization improve cardiac arrest survival, regardless of what the ECG shows?”

Learn more on the PEARL Study webpage.

Timeline for Cardiocerebral Resuscitation Research for Primary Cardiac Arrest:

2011-present – Sarver Heart Center Resuscitation Research Group and SHARE continue to work with researchers nationally and internationally to prevent sudden cardiac arrest and to improve survival of patients with cardiac arrest.  In Arizona alone the number of lives saved continues every day (http://www.AZSHARE.gov)  We estimate that if all of the United States would implement the changes made in Arizona, that nearly 11,000 additional patients would be saved every year.  This is why the Sarver Heart Center and SHARE are so passionate about their work.

2010 – Arizona Statewide published data showed a survival rate of patients with ventricular fibrillation arrest of 38% with chest compression only CPR compared to 18% with chest compression plus rescue breathing, based on a five-year program advocating chest compression-only CPR for bystanders of patients with out-of-hospital cardiac arrest (JAMA 2010:304;1447)

2008 – Cardiocerebral Resuscitation therapy for three years (2004 to 2007) resulted in sustained improvement in survival of patients with ventricular fibrillation arrest: 38% compared to published national average of 18% (Ann Emerg Med 2008:52;244) (Resuscitation 2004:63;17)

2005 – Sarver Heart Center Resuscitation Research Group and SHARE (Save Heart in Arizona Registry & Education) network, headed by Bentley J. Bobrow, MD, advocated and taught new protocols to several greater-Phoenix-area fire departments while advocating bystander chest-compression-only CPR for primary cardiac arrest.

2005 – Rational for Cardiocerebral Resuscitation published (Circulation 2005:111;2134 & Resuscitation 2005:64;261)

2004 – Michael Kellum MD, an emergency physician from Janesville, Wisc., collaborated with Sarver Heart Center and introduced Cardiocerebral Resuscitation to fire and rescue departments in two rural counties in Wisconsin—resulting in improved survival of patients with primary cardiac arrest. (Am J Medicine 2006:119;335).

2003 – Drs. Ewy, Kern and other members of the Sarver Heart Center Resuscitation Research Group announced their intention, and instituted Cardiocerebral Resuscitation, a non-guidelines alternative to the therapy of patients with out-of-hospital cardiac arrest (Resuscitation 2003:58;271).

1985 - 2002 – Physiological laboratory research by the UA Sarver Heart Center Resuscitation Research Group reported that survival in primary ventricular fibrillation cardiac arrest was improved with chest compressions alone (references in Circulation 2005:111:2134).

1984-1985 – Physiological laboratory research (Sanders, Kern, and Ewy) on the importance of the coronary perfusion pressure during resuscitation efforts and survival form ventricular fibrillation arrest.

1980s – Researchers at Arizona and Duke published on the importance of faster chest compression rates to survival from ventricular fibrillation cardiac arrest (Circulation 1988; 77:240).

1970s-1980s – Charles W. Otto, MD, Arthur B. Sanders, MD and Karl B. Kern, MD, joined the resuscitation research group in the physiological laboratory. They reported on the role of medications in resuscitation success.

1970s – Research by Gordon A. Ewy, MD, determined that defibrillator energy output was variable. His research elucidated the determinants of defibrillation success, including the role of electrode size and electrode chest wall interface. He found that the major determinant of defibrillation success was the delivered current density.