Holiday season always brings with it both joy and reflection – what have we accomplished in this past year and what are our goals for the coming year? The Florida Heart Research Institute remains steadfast in its dedication to the elimination of heart disease through research, education and prevention. Because of the breadth of scope, the depth of commitment and the importance of the mission, the Institute always has a full menu of activities and accomplishments to report, as well as an ambitious agenda for the coming year. This year is certainly no exception. However, this past year FHRI has become involved in a project which in and of itself challenges all of our combined research and educational resources—the prevention of sudden cardiac death.

 

As numerous previous articles in this journal have highlighted, sudden cardiac arrest afflicts between one quarter and one third of a million people every year in this country. Despite dramatic advances in the science and treatment of cardiovascular disease, and despite the fact that death from heart disease in general has been declining for the past twenty years, the mortality rate nationwide for sudden cardiac arrest remains an abysmal 93%. A hopeless situation? Not at all. This rate varies as much as tenfold depending upon which community one happens to live in. For those patients with a recognizable heart rhythm at the time of discovery, some communities have even achieved a 50% survival.

 

So what is needed? In Miami Dade County we are fortunate to have many fine resources available – educated and energetic fire rescue teams, hospitals that perform hypothermia for victims who are unconscious after resuscitation, protocols for rapid transport of heart attack victims, etc. And yet, our survival statistics do not appear to be much better than the national average. What are we lacking? Simply put, education, empowerment and research. Since the heart provides the vital supply of oxygen and other nutrients to every part of the body, and since the human brain cannot tolerate the lack of oxygen at normal temperature for more than a few minutes, every minute that a person’s heart is not effectively pumping oxygen to the brain, the chance of ultimate survival decreases approximately 10%. After four minutes without oxygen, the heart becomes increasingly resistant to resuscitation. Therefore, the challenge of this disease is to respond IMMEDIATELY – even before the fire rescue team arrives, long before the patient has access to a hospital or doctor. For this to happen, each and every one of our fellow citizens must have the knowledge to 1) recognize the problem when someone stops breathing and loses consciousness, and 2) to know exactly how to respond. After the event happens it may be too late (although 911 operators are trained to coach people on the proper method of CPR over the phone). For this reason, FHRI this year initiated a campaign of PUSHCPR® which instructs people how to respond to sudden cardiac arrest: 1) Call 911, immediately; 2) start PUSHCPR® (compression only), immediately; 3) employ a defibrillator if one is available. The technique is simple—applying the palms of one’s hands to the middle of the chest with the victim on his back, compressing 2 inches and releasing 100 times per minute (approximately the rhythm of the popular song “Staying Alive”). No mouth to mouth, minimal concern for causing injury (without doing anything the person is essentially dead), and full legal protection under Good Samaritan statutes.

 

In addition to education and empowerment, we need data – an organized system for tracking our results and making improvement. For this effort FHRI is working closely with Fire Rescue and local area hospitals to institute a data collection system that will enable us to track our results as a community and initiate improvements.

 

So as the year draws to a close, FHRI is proud of our accomplishments in research – advances in bone marrow stem cell therapy, application of molecular genetics to the treatment of congestive heart failure, novel techniques to reduce brain and heart injury from stroke and heart attack, long term results of optimal surgical techniques, deeper understanding our the unique cardiovascular risk of our local Hispanic population. We are likewise inspired by our advances in education – development of a community awareness campaign that includes the launching of our website www.pushcpr.org, an instructional video that can be seen on our website, educational pamphlets on PUSHCPR® in English, Spanish and Creole, and community education of over 2,000 South Florida residents on PUSHCPR® since we started in February. But we have no illusion that we still have a long way to go and much to accomplish in combining our educational and research efforts in the prevention of sudden cardiac death.