Ewy's Mission: Saving Lives Using Continuous Chest Compressions

International resuscitation experts to consider recommending this protocol during meeting next week in Dallas

TUCSON, Ariz.–For more than two decades, Dr. Gordon Ewy
has been on a crusade to change the way people are treated for sudden cardiac
arrest, a leading cause of death in the nation.

The 76-year-old cardiologist and director of the University of
Arizona's Sarver Heart Center has challenged what for years was a kind of
sacred cow in the medical profession and a prescription for good Samaritan
behavior worldwide: the mouth-to-mouth rule of cardiopulmonary resuscitation,
or CPR.

Ewy (pronounced AY-vee) has pioneered the use of chest
compression-only CPR on adults whose hearts suddenly stop pumping.
Mouth-to-mouth only detracts from the more effective compressions, he insists.

Since the mid-1990s, Ewy's advocacy has often been a thorn in
the side of venerable medical establishments such as the American Heart
Association. Ewy has written letters in medical journals demanding change and
accused the association, whose influence is strong, of not moving quickly
enough.

In the past five years, though, there has been a gradual
realization that the outspoken Tucson doctor is on to something.

In a major shift in 2008, the American Heart Association issued
an advisory that said compression-only CPR can be used to save lives and is an
option for people who aren't trained in CPR or who are unsure of their CPR
abilities. People who are trained can do either, it says. The advisory applies
only to cases of adults in cardiac arrest, not children, and excludes drowning
and drug-overdose cases.

Now, the compression-only version may be on the verge of going
worldwide, as an international health group considers whether to revise its
guidelines to make it the preferred method.

Not everyone has bought into Ewy's approach. Evidence is mixed.
Research in the U.S., Netherlands and Japan has found that
chest-compression-only yields similar or better survival rates than standard
CPR. Some European studies report better results with mouth-to-mouth. Still,
Ewy is convinced it's only a matter of time before compression-only CPR becomes
the standard for cardiac arrest.

Every year, cardiac arrest kills about 325,000 people in the
U.S. Its main underlying cause is heart disease, and the majority of cardiac
arrests happen outside the hospital.

As bad as that is, prospects were worse for victims before
modern CPR emerged about five decades ago.

Two American doctors, Peter Safar and James Elam, are credited
with inventing CPR, and the technique spread rapidly after the American Heart
Association endorsed the idea in 1963.

CPR works under the premise that pressing on the chest moves
blood to the vital organs while mouth-to-mouth breathing gets oxygen into the
lungs.

When a person's heart stops beating, the first few minutes are
critical. If nothing is done, the chance of survival drops 7 to 10 percent
every minute.

Ewy says the compression-only method is better than standard CPR
for a simple reason: In standard CPR, when a rescuer stops after 30
compressions to give two breaths, the blood stops moving through the patient's
body, essentially starving the organs. Continuous compressions keep the blood
flowing. Doing only those also is simpler and easier to remember than standard
CPR.

Next week, Ewy will fly to Dallas for a meeting of the world's
major resuscitation groups. No one knows whether the International Liaison
Committee on Resuscitation (ILCOR) will endorse compression-only CPR as the preferred
method. It's fair to say the discussion will be controversial and Ewy again
could face an uphill battle.

What is ILCOR?

The International Liaison Committee on Resuscitation (ILCOR) includes eight international resuscitation organizations: the American Heart Association (AHA), European Resuscitation Council (ERC), Heart and Stroke Foundation of Canada (HSFC), Resuscitation Council of Asia (RCA), Resuscitation Council of Southern Africa (RCSA), the Australian and New Zealand Council on Resuscitation (ANZCOR), and the InterAmerican Heart Foundation (IAHF). To follow developments, visit www.americanheart.org/ilcor.

What is Hands-Only CPR? Visit http://handsonlycpr.org.

SOURCES: Associated Press, Information from: Arizona Daily Star, http://www.azstarnet.com