MORE ON CPR

Here’s what I have learned in the field recently; Milwaukee Counties EMS system has consistently been rated #2 in the country second only to Seattle who has automatic public defibrillators all over the place and aggressively promotes public CPR. In Milwaukee county 3 years ago CPR breath to compression rates went from 2:15 to 2:30 (it is thought that every time you press up and down on a chest you create small negative and positive pressures in the lungs mini-breathing???)

Also,we started testing a "rescue valve" on the bag valve mask that improved CPR systolic blood pressure from 40 to 80 by creating a negative preload pressure in the lungs and therefore the right side of the heart. Also I have personally seen an increase in Cardiac Arrest saves from around 5% to 20%, a four-fold increase. CPR is getting better because for the first time AHA (American Heart Association) numbers are not being changed arbitrarily by a bunch of doctors with educated guesses but by doctors with studies that are showing direct empirical results.

I also teach CPR for the AHA. Arterial blood gases are finding better oxygenation of the blood stream and other tools are being developed to help us do better CPR. We just started using defibrillator pads with a built-in accelerometer. It measures depth and rate of compression. What we have found is even the strongest most fit person when doing "good CPR" gets tired quickly and starts doing crappy CPR. Slower rate or shallower compressions or not allowing the chest to recoil after compression. (leaning on patients chest,) allowing for chest to heart to refill or preload is very important. The solution is to switch out people often and use fresher people...(4 cycles or 2 minutes max.) or automate with thumper-type devices. Also some departments are using a suction type compression cup that resembles a toilet plunger and actually pull on the chest for better refill in between compressions.

End result; people -- with no measurable electrical rhythm (asystole) -- are even coming back. The use of epinephrine and atropine is routinely administered to cardiac arrest patients to not only jump start the heart (and sympathetic system) and to take off the breaks (parasympathetic system) but to improve CPR by constricting blood vessels and to drive pressure upward. We incubate people to gain control over the airway and one way of verifying endotracheal tube placement is with a end title CO2 meter that connects the tube and the bag valve mask.

No reading means you’re in the esophagus or stomach hole and reading of 4mm Hg to 12mm Hg means you’re in the trachea or lungs. A normal live person averages between 35 to 45. Why so low at 4 to 12? Because people with no heart beats don't off gas CO2 very well and this creates a lot of acid in the blood.

When I get a person with a reading of 10 or so I tell my crew to speed up compressions and to slow down breathing a little. This drives the readings up to around 50 or 60 sometimes...too alkaline so we might have to adjust back down with slightly slower CPR....the goal is to get right in the 35 to 45 range and low and behold if the person if not down for too long they regain a heart rhythm and pulses.....what’s going on here???? This is not CPR by the book numbers but tailor made CPR for the patient based on the patients own blood chemistry.

I am not a scientist by any stretch of the imagination, however, I do know that all this stuff is working and people are coming out ahead of the game by a factor of 3 to 4. And that's just my experience in the last 3 years. I hope some of this stuff, both equipment and new techniques, can be applied to Cryonics for better perfusion or circulation just prior to administration of cryoprotectants.