A New Order for CPR, Spelled C-A-B: American Heart Association

Guidelines

ScienceDaily (Oct. 18, 2010) — The American Heart Association is re-arranging the
ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association
Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care,
published in Circulation: Journal of the American Heart Association.
Recommending that chest compressions be the first step for lay and professional
rescuers to revive victims of sudden cardiac arrest, the association said the A-B-Cs
(Airway-Breathing-Compressions) of CPR should now be changed to C-A-B
(Compressions-Airway-Breathing).
"For more than 40 years, CPR training has emphasized the ABCs of CPR, which
instructed people to open a victim's airway by tilting their head back, pinching the nose
and breathing into the victim's mouth, and only then giving chest compressions," said
Michael Sayre, M.D., co-author of the guidelines and chairman of the American Heart
Association's Emergency Cardiovascular Care (ECC) Committee. "This approach was
causing significant delays in starting chest compressions, which are essential for
keeping oxygen-rich blood circulating through the body. Changing the sequence from A-
B-C to C-A-B for adults and children allows all rescuers to begin chest compressions
right away."
In previous guidelines, the association recommended looking, listening and feeling for
normal breathing before starting CPR. Now, compressions should be started
immediately on anyone who is unresponsive and not breathing normally.
All victims in cardiac arrest need chest compressions. In the first few minutes of a
cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so
starting CPR with chest compressions can pump that blood to the victim's brain and
heart sooner. Research shows that rescuers who started CPR with opening the airway
took 30 critical seconds longer to begin chest compressions than rescuers who began
CPR with chest compressions.
The change in the CPR sequence applies to adults, children and infants, but excludes
newborns.
Other recommendations, based mainly on research published since the last AHA
resuscitation guidelines in 2005:

 During CPR, rescuers should give chest compressions a little faster, at a rate of
at least 100 times a minute.
 Rescuers should push deeper on the chest, compressing at least two inches in
adults and children and 1.5 inches in infants.
 Between each compression, rescuers should avoid leaning on the chest to allow
it to return to its starting position.
 Rescuers should avoid stopping chest compressions and avoid excessive
ventilation.
 All 9-1-1 centers should assertively provide instructions over the telephone to get
chest compressions started when cardiac arrest is suspected.

"Sudden cardiac arrest claims hundreds of thousands of lives every year in the United
States, and the American Heart Association's guidelines have been used to train
millions of people in lifesaving techniques," said Ralph Sacco, M.D., president of the
American Heart Association. "Despite our success, the research behind the guidelines
is telling us that more people need to do CPR to treat victims of sudden cardiac arrest,
and that the quality of CPR matters, whether it's given by a professional or non-
professional rescuer."
Since 2008, the American Heart Association has recommended that untrained
bystanders use Hands-Only CPR -- CPR without breaths -- for an adult victim who
suddenly collapses. The steps to Hands-Only CPR are simple: call 9-1-1 and push hard
and fast on the center of the chest until professional help or an AED arrives.
Key guidelines recommendations for healthcare professionals:

 Effective teamwork techniques should be learned and practiced regularly.

 Professional rescuers should use quantitative waveform capnography -- the
monitoring and measuring of carbon dioxide output -- to confirm intubation and
monitor CPR quality.
 Therapeutic hypothermia, or cooling, should be part of an overall interdisciplinary
system of care after resuscitation from cardiac arrest.
 Atropine is no longer recommended for routine use in managing and treating
pulseless electrical activity (PEA) or asystole.

Reference:

http://www.sciencedaily.com/releases/2010/10/101018074028.htm
Additional Cardiac Testing Vital for Patients With Anxiety and
Depression

ScienceDaily (Nov. 11, 2010) — People affected by anxiety and depression should
receive an additional cardiac test when undergoing diagnosis for potential heart
problems, according to a new study from Concordia University, the Université du
Québec à Montréal and the Montreal Heart Institute.
As part of this study, published in the Journal of Cardiopulmonary Rehabilitation and
Prevention, a large sample of patients received a traditional electrocardiogram (ECG),
where they were connected to electrodes as they exercised on a treadmill. Patients also
received a more complex tomography imaging test, which required the injection of a
radioactive dye into the bloodstream followed by a nuclear scan to assess whether
blood flow to the heart was normal during exercise.
"An ECG is usually reliable for most people, but our study found that people with a
history of cardiac illness and affected by anxiety or depression may be falling under the
radar," says study co-author Simon Bacon, a professor in the Concordia Department of
Exercise Science and a researcher at the Montreal Heart Institute. "Although it is a more
costly test, undergoing an additional nuclear scan seems to be more effective at
identifying heart disease."
The discovery is significant, because 20 percent of people with cardiac illness also
suffer from anxiety or depression. "When prescribing and performing cardiac tests,
doctors should be aware of the psychological status of their patients, since it may affect
the accuracy of ECG test alone," warns senior researcher Kim Lavoie, a psychology
professor at the Université du Québec à Montréal and a researcher at the Montreal
Heart Institute.
"ECG tests are not detecting as many heart problems as nuclear tests among many of
these patients, particularly those that are depressed, and physicians may be under
diagnosing people at risk," adds Professor Lavoie.
Some 2,271 people took part in the study and about half of participants had previously
suffered from major heart attacks, bypass surgery or angioplasty. The other half were
people exposed to heart disease because of high cholesterol levels, high blood
pressure or other risk factors.
The study found that patients with anxiety disorders were younger and more likely to be
smokers than patients without anxiety disorders. Participants with anxiety disorders
were also less likely to be taking Aspirin or lipid-lowering medication, which can protect
against some cardiac events. What's more, 44 percent of participants with anxiety
disorders were found to also suffer from major depressive disorders.
"Patients with higher depression scores reported higher fatigue and exertion levels --
effects that may be attributed to depression," says Professor Lavoie.
To ensure heart disease doesn't go undetected, physicians should consider
administering a brief questionnaire before conducting ECGs to determine whether
patients are highly anxious or depressed. If so, their exercise performance should be
carefully monitored. In the event of a negative (i.e., normal) ECG result, doctors may
want to refer patients for nuclear testing.
"Our study indicates that detection of heart irregularities during ECGs may be influenced
by the presence of mood or anxiety disorders," concludes lead investigator Roxanne
Pelletier of the Université du Québec à Montréal and Montreal Heart Institute. "Greater
efforts should be made to include routine mood or anxiety disorder screening as part of
exercise stress-testing protocols."
The study was funded by the Fonds de la recherche en santé du Québec, the Canadian
Institutes of Health Research, the Heart and Stroke Foundation of Canada and the
Social Sciences and Humanities Research Council of Canada.

Reference:

http://www.sciencedaily.com/releases/2010/11/101111133215.htm
Molecular Evolution Proves Source of HIV Infection in Criminal Cases
ScienceDaily (Nov. 15, 2010) — In 2009, a Collins County, Texas, jury sentenced
Philippe Padieu to 45 years in prison for aggravated assault with a deadly weapon --
having sex with a series of women and not telling them he had HIV. An important part of
the evidence that identified him as the source of the women's infection came from
experts at Baylor College of Medicine and The University of Texas at Austin.
In a report in the Proceedings of the National Academy of Sciences, Dr. Michael
Metzker, associate professor in the BCM Human Genome Sequencing Center, Dr.
David Hillis of UT Austin and their colleagues, describe how they identified Padieu and
a man in Washington State in two different cases as the sources of HIV infection to
multiple female partners.
"We were blinded in the study," said Metzker. That means they did not know which
sample came from the men accused in the crimes and which came from the women
who had become infected with HIV.
In determining the source of the infection, they relied on the "bottleneck" that occurs
during HIV transmission.
"Within a given person, there is not just one strain but a population of strains because
HIV mutates all the time when it makes new virions (viral particles)," said Metzker.
"During transmission, however, there is a genetic bottleneck in which only one or two
viruses get transmitted to the recipient."
"As many as 75 percent of HIV infections results from a single virus," said Metzker. That
means that even though HIV changes in the body, there is a single virus that is the
"ancestor" or progenitor of all those viruses.
"Phylogenetic analysis allows us to reconstruct the history of the infection events," said
Hillis, professor at UT Austin. "We can identify the source in a cluster of infections
because some isolates of HIV from the source will be related to HIV isolates in each of
the recipients."
In comparing DNA sequences, Metzker and his colleagues looked at two gene regions
of the virus. They are known as env and pol. Comparing these sequences in the
different case samples and using mathematics to model evolutionary change, they were
able to identify in each case that the viral sequences from case samples were related.
More important, they could identify which case sample was the source of the infection.
Only after the scientist had done all the sequencing and analysis did the District
Attorneys' offices break the code. In each case, the sample that they thought was the
source of the infection came from the man accused of transmitting the virus to the
unsuspecting women.
"This is the first case study to establish the direction of transmission," said Metzker.
The other case involved Anthony Eugene Whitfield in Washington State, who was also
convicted and sentenced.
Others who took part in this research included Diane L. Scaduto and Wade C. Haaland
of BCM and Jeremy M. Brown and Derrick J. Zwickl of UT Austin.
Funding for this work came from the Donald D. Harrington Fellowship from UT Austin
and the National Science Foundation.

Reference:

http://www.sciencedaily.com/releases/2010/11/101115161146.htm
Operation Unified Response: Three Phases of Disaster Care in Haiti

ScienceDaily (Oct. 3, 2010) — A pediatric medical response to a major disaster should

focus on three consecutive missions: protection of life and limb, continuing care, and
finally, humanitarian aid, according to research presented Sunday, Oct. 3, at the
American Academy of Pediatrics (AAP) National Conference and Exhibition in San
Francisco.
In January, within 24 hours of the worst earthquake in more than 200 years, the United
States Naval Ship (USNS) Comfort was deployed to Haiti. With a staff of more than 800
physicians, nurses and ancillary staff, the ship was transformed into a full-fledged
floating hospital treating over 931 critically injured patients, of whom 35 percent were
children.
The operation was the largest and most rapid triage and treatment effort since the
inception of hospital ships. As a result, the six-week experience "provided the
framework from which future disaster responses can be based," said lead study author
Shawn Safford, MD.
Children "represented a group that posed a significant challenge," during the disaster,
said Dr. Safford. Most pediatric patients required orthopedic care including extremity
injuries (72 percent) and pelvic fractures (4 percent). On average, patients returned to
the operating room up to eight times for wound care (debridement) and wash outs.
Amputations reflected 6.5 percent of cases, with 40 percent arriving with limbs already
amputated. Eight babies were born on the ship, including two premature infants.
Pediatric admissions surged during the first five days, with an average of 21.3 per day,
and then decreased to 5.2 per day.
As a result of the data compiled during the Operation Unified Response -- the largest
collection of information, to date, on the pediatric surgical care of children in an
earthquake disaster -- researchers recommend a three-phase response to disaster
medicine that has not been previously described. The first phase focuses on triaging
patients who require life- and limb-saving care. The second phase involves caring for
patients who were able to survive the first days without medical care. At this juncture,
plastic and general surgeons can aid in the management of complex wounds and
attempting limb salvage. Finally, phase three represents the transition from a disaster
response to a humanitarian response, whereby all medical specialties and personnel
can help to develop current and future health care for the population.

Reference:

http://www.sciencedaily.com/releases/2010/10/101003081443.htm