In America, technology is king. Perhaps it is the legacy of a pioneering “can do” spirit, or an open society that favors innovation and sharing of information, or perhaps it is related to the economic necessity to open new market opportunities for growth. For whatever reason, we Americans love our toys. And we are good at it—some of the best in the world. Although others may be more adept at perfecting our ideas, few societies in the history of the world have been so conducive to or productive of technological development as the United States.Most certainly the medical profession has been the beneficiary of this creative drive – advancing technological achievements adorn virtually every field of medical endeavor. Much of the seemingly irrepressible rise in medical expenditure which is currently challenging budgetary sobriety is due, quite ironically, to our productivity in expensive, albeit promising technological advance. Clearly financial concerns will obligate a paradigm shift from the “whatever we can do we should do” and “whatever is newer is better” boldness of the second half of the last century, to a more thoughtful approach which integrates promise with reality.
It is just in this area of deliberate integration that technology might have an increasingly important role to play in improving the outcomes from sudden cardiac arrest. Out of hospital sudden cardiac arrest afflicts approximately one third of a million Americans each year. Astonishingly, for all of our medical sophistication, overall survival is somewhere in the 7% range. The key challenge is to shorten the critical time period that the brain and other vital organs are deprived of blood supply. Someone who stops breathing and passes out from a failure of his/her heart to pump blood, depending on the underlying reason, has a very high probability of meaningful survival if attended to within four minutes. Four minutes is a preciously short amount of time. Even if someone observed the event, which is frequently not the case, the observer must recognize what has occurred and must act upon his observation. In such a situation, an untrained observer might well spend much of the first four minutes just trying to figure out what is going on and what, if anything, he wants to do about it. On the other hand, if he were to call 911 and begin PUSHCPR™, pressing on the center of the chest 100 times/minute sufficient to compress the breast bone 2 inches with complete release between pumps, he would have a very high chance of saving a life.
These are human decisions, not technological ones. And, should there be no observer, or should the observer not respond, or not respond in a timely or appropriate fashion, the result will be almost certain death. But now enters the role of technology. Should the call go out to 911, advanced communication systems can summon prompt trained response teams. PUSHCPR™ instruction can be given over the phone (or even downloaded as an “app” on smart phones). Defibrillators, which can sense the rhythm of the heart, can be brought to the victim’s side that provide audible instructions to even the uninitiated on whether to apply an electrical shock which might well restore the heart to a stable rhythm and permit the restoration of blood flow throughout the body. If the 911 system were informed with a registry of defibrillators, it would not only be able to notify the appropriate response teams, but would also be able to inform the observers on site where the nearest defibrillator could be found. Once the 911 team arrives on the scene, they can actually make advanced assessments in the field and potentially begin hypothermic therapy, and/or activate the hospital cardiac catheterization laboratory to receive a patient in the throes of a heart attack. Should the patient survive to hospitalization, obviously the most advanced and sophisticated intensive care would be available.
Technology, as we can see, has a key role to play in the treatment of sudden cardiac arrest, as it does in all medical conditions. However, it is the human decisions which hold the key to its success. For more information, please go to www.pushcpr.org and join the “push” to save a life!
