Aortic Valve Replacement (MIS)

Mouth-to-Mouth May Not Save More Lives During CPR, Two Studies Conclude

Mouth-to-Mouth May Not Save More Lives During CPR, Two Studies Conclude
By Arielle Fridson - Jul 28, 2010 2:06 PM PDT Wed Jul 28 21:06:34 UTC 2010

CPR is performed on a dummy. Source: American Heart Association

Hollywood heroics aside, mouth-to- mouth resuscitation does nothing to improve the outcome of CPR, two studies showed. It doesn’t provide any benefit over the chest-pumping procedure, U.S. and Swedish scientists said.

In the research, there was no significant difference in survival for patients who received just chest-compression CPR from bystanders after heart stoppages compared with those who got both that treatment and mouth-to-mouth breathing, according to two papers published today in the New England Journal of Medicine.

While cardiopulmonary resuscitation can double or even triple a patient’s rate of survival, two-thirds of people in cardiac arrest outside a hospital don’t receive CPR, according to the American Heart Association. Bystanders might refrain from acting because they can’t identify cardiac arrest, are afraid of hurting the person, or are averse to mouth-to mouth contact, said Thomas D. Rea, an associate professor of medicine at the University of Washington in Seattle.

“Eliminating mouth-to-mouth from CPR may make a layperson less reticent to act and if they act, they can save a life,” said Rea, the lead author of the U.S. study. “Chest compression alone is simpler and intuitively easier.”

The U.S. researchers considered 1,941 people in cardiac arrest who needed bystanders to perform CPR until an ambulance arrived. The scientists reported finding no significant difference between the 981 patients who received chest compression alone and the 960 who received both that procedure and mouth-to-mouth breathing.

Survival Rates

The first group survived to hospital discharge at a rate of 12.5 percent and the second had an 11 percent survival rate, the scientists wrote. The trials were carried out in two counties in Washington state and in London in 2009. The Laerdal Foundation for Acute Medicine, based in Stavanger, Norway, funded the research.

For the other study, Swedish researchers collected data on 1,276 patients from 2005 to 2009. Of the 620 patients who received chest pumping only, the rate of 30-day survival was 8.7 percent. Of the 656 patients who received both chest pumping and mouth-to-mouth breathing, 7 percent survived the 30-day period. The study was funded by the Swedish Heart-Lung Foundation, based in Stockholm.

Emergency medical services each year treat about 300,000 people in the U.S., according to the Dallas-based heart association. These patients have a less than 8 percent chance of survival. Sudden cardiac arrest is the loss of heart function, breathing and consciousness, according to the Mayo Clinic, based in Rochester, Minnesota. It can be caused by diverse conditions, including heart attack, drowning, choking, and electrocution, or it can happen without any known cause, according to the heart association.

CPR Guidelines

The group, in guidelines published jointly with the Antwerp, Belgium-based International Liaison Committee on Resuscitation, has recommended hands-only CPR since April 2008, said Junaid Khan, president of the association’s East Bay Division and a cardiothoracic surgeon at Alta Bates Summit Medical Center in Oakland.

“These two studies are the first randomized control trial in this area, which constitutes the highest level of evidence that physicians trust,” Khan said in a telephone interview. “This will enable the strongest level of recommendation.”

Association officials now are “probably going to modify their statements in a more forceful way based on this study and other similar ones,” most likely by the end of this year, said Myron L. Weisfeldt, director of the Department of Medicine at John Hopkins Hospital in Baltimore.

Weisfeldt wrote an editorial on CPR, urging more research, that was published in the medical journal along with the studies.

Rescue Training

While the studies may cause instructors to place less emphasis on mouth-to-mouth techniques, it would be a mistake to eliminate them from CPR courses, Weisfeldt wrote in the editorial. The technique is effective against respiratory failure, the most common cause of cardiac arrest in children, he wrote. Each year, about 5,800 children under 18 suffer cardiac arrest in the U.S., according to the heart association.

MIS Surgery w/ Edwards IMRand MC3 Rings Videos

Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures

Aortic Stenosis Still Goes Under-treated Despite Lower Risk Surgical Procedures — Junaid Khan, M.D.

In the United States, up to four percent of the population over the age of 65 is affected by aortic stenosis. Yet, for every one patient treated for this condition, it is estimated that there is one patient who goes untreated. The consequences of not treating aortic stenosis are dire. The average survival of patients with the condition who are experiencing symptoms and do not receive treatment is only two years, and the five-year survival rate is less than 20 percent. Unfortunately many of these patients are not referred for surgical consultation because severity of the disease is underestimated or the operative risk is overestimated by nonsurgeons (Surgeons use the STS national database to calculate predicted risk of mortality). To better understand the prevalence of unoperated severe aortic stenosis within the Oakland community, two local cardiology groups participated with the Alta Bates Summit Research and Education Institute analyzing 101 patients with clinically severe aortic stenosis. The results were surprising: 73% of the patient cohort was not referred for surgical intervention, despite half of them reporting symptoms related to AS. Eleven of these patients died within 11 months following their last echocardiogram.

Outcomes
Aortic valve replacement surgery has advanced over the past decade. Cutting-edge procedural techniques and innovations have led to an average mortality below 5% nationwide and at the Summit Campus, even patients in their eighties with comorbidities have a lower than expected surgical risk and typically gain an additional 6 to 8 years of quality life. Age is not a contraindication for surgery and more of these patients should be considered for surgical intervention. In addition, minimally invasive techniques like port access can result in faster recovery for patients. As surgical techniques continue to improve and risk declines, efforts must continue to reduce the number of untreated patients with severe valve disease.

Routine EKG testing of young athletes' hearts could save lives, Stanford study says

Routine EKG testing of young athletes' hearts could save lives, Stanford study says

By Sandy Kleffman

Contra Costa Times

Posted: 03/01/2010 04:30:31 PM PST

Updated: 03/01/2010 05:32:57 PM PST

Using electrocardiograms to test the hearts of young athletes before they participate in sports could be a cost-effective way to reduce sudden deaths, a Stanford University study concludes.

Questions about what type of pre-screening to require have drawn heightened interest since two seemingly healthy East Bay high school students suddenly collapsed during basketball games earlier this year.

One student died. The other was hospitalized and later released with a diagnosis of an electrical abnormality in his heart.

The California Interscholastic Federation, which oversees high school sports, requires all students to have a physical exam, including providing a family health history, before participating. That is the extent of screening for most students.

EKGs can detect signs of hypertrophic cardiomyopathy, a genetic defect that causes thickening of the heart muscle and can lead to dangerous heart rhythms that can stop the organ. Nationally, it is estimated that one in 500 people have this condition, a common cause of sudden deaths in young athletes.

But many experts consider routine EKG screening too expensive, especially since sudden deaths remain rare, involving fewer than 100 young athletes each year in the United States. A panel of the American Heart Association estimated mandatory EKG screening for all middle school and high school athletes would cost $2 billion annually.

The Stanford study, published today in the Annals of Internal Medicine, challenges such opinions and encourages people to re-examine the issues.

Combining routine EKG screening with a family health history and physical exam "would save the most lives at a cost that is generally acceptable for the U.S. health care system," said Dr. Matthew Wheeler, a fellow in cardiovascular medicine at Stanford and a lead author of the study.

EKG screening would cost about $88 per athlete, including follow-up tests, the study estimates. The test takes about 10 minutes, with five minutes more for a physician to examine the results.

For every 1,000 athletes screened, it would save the equivalent of two years of life, the study concludes. The expense for saving one year of life would be $42,900. Anything under $50,000 is generally considered cost-effective in health care, the study notes.

In Italy, where routine EKG screening of young athletes has been mandatory since 1982, sudden deaths during competitions have plunged nearly 90 percent since testing began, Wheeler said.

Yet many experts continue to have reservations about routine EKG screening.

EKGs do not pick up all heart problems, notes Dr. Junaid Khan, director of cardiac services at Alta Bates Summit Medical Center in Oakland. He worries that after getting a clean bill of health, students may no longer be concerned if they start to feel faint, have shortness of breath or develop chest pain.

"They could ignore symptoms," said Khan, president of the East Bay division of the American Heart Association. "That's a real issue."

Khan added that there would be an emotional toll on students who have false positives. They might become unduly worried and might be denied participation in sports until additional tests rule out heart problems.

The best way to save lives, Khan argues, would be to have more defibrillators at schools and to ensure that adults know how to use the equipment and to do CPR.

Pat Middendorf, athletic director at Clayton Valley High School in Concord, which will soon receive defibrillators, said the $88 expense for an EKG could be a "huge burden" for many families and prevent some students from participating.

"I don't see the state or federal government picking up the cost of it," she said. "Would it be covered by insurance? Now that's a different story."

In an editorial accompanying the study in the Annals of Internal Medicine, Dr. Barry Maron of the Minneapolis Heart Institute Foundation calls mandatory EKG screening impractical at this time. He questioned whether there would be enough doctors to perform the tests, whether students would argue that their liberties had been infringed upon if they are denied the ability to play sports, and whether nonathletes could argue that they should also receive screening.

Wheeler counters that a massive, nationwide program is not necessary and that local school districts could consider requiring EKGs for their students.

Contact Sandy Kleffman at 925-943-8249.

Warriors’ Ronny Turiaf donates defibrillators to prevent deaths among high school athletes

Warriors’ Ronny Turiaf donates defibrillators to prevent deaths among high school athletes

By: Elise Craig February 23, 2010 – 3:38 pm

Ronny Turiaf poses with school children at the kickoff of his charity foundation.

After an enlarged aortic root nearly kept him from his dream of playing NBA basketball, Warriors’ center Ronny Turiaf learned how dangerous heart problems could be. Now, in the wake of three recent cardiac emergencies on East Bay high school basketball courts, Turiaf is donating automatic electronic defibrillators (AEDs) and CPR training to four local high schools. “As someone who has been affected directly by a heart health issue, it is important for me to assist others in their efforts to prepare for a heart trauma incident,” Turiaf said.

Since October, two Bay Area student athletes have died while playing basketball, and one survived a near-lethal cardiac arrest. Joshua Ellison, the 17 year-old co-captain of El Sobrante Calvary Christian Academy, collapsed on the court and died on January 29. De La Salle freshman Darius Jones, 14, died during a preseason basketball camp at Diablo Valley College on October 11. A third student, El Cerrito High School sophomore David Gurganious, went into cardiac arrest on February 2 while sitting on the bench, but was saved by CPR administered by his basketball coach, who is a Richmond police officer, and parents in the stands.

The three schools, along with Oakland’s Life Academy High School, will each receive defibrillators, as well as AED and CPR training for ten staff members and CPR training for 30 students. The donation, which was announced Tuesday on the basketball court of Oakland’s Leonard J. Meltzer Boys and Girls Club, comes from the Ronny Turiaf Heart to Heart Foundation, which Turiaf established in 2009 to help provide medical care for children without health insurance. Through the foundation, Turiaf hopes to provide EKGs, heart surgeries and defibrillators to kids in need.

About 100 students attended Tuesday’s event, along with representatives from the schools, the American Heart Association and Cardiac Science, the company that manufactures the defibrillators and provides training. Some members of the audience also wore black armbands with “Josh #1” in white writing in honor of Ellison.

“I don’t get nervous very often,” Turiaf said. “I play in front of 20,000 people.” But he said that talking about things that matter to him, in front of a crowd that was mostly composed of high school students, as well as some parents, coaches and younger kids in Warriors apparel, was a little more nerve-wracking.

Kent Mercer, head athletic trainer De La Salle, a private Catholic school in Concord, is glad to have the defibrillator, particularly after the death of Jones, whose “dream was to play basketball at La Salle,” he said.

“It’s a great thing that they’re doing to have something in place to save somebody—not only students at the school, but anyone who comes to the school,” Mercer said. “Hopefully, it continues to spread.”

El Cerrito High School Assistant principal Marcos Garcia said he will be relieved to have a defibrillator on campus, even though coaches at El Cerrito have already been trained in CPR. “The health and safety of our students is our utmost concern,” he said. “We’re very grateful.”
As for Gurganious, the sophomore who survived cardiac arrest thanks to quick action by coach Michael Booker, he was released from the hospital last week, and is expected to make a full recovery. “We want to bring him back slowly,” Garcia said.

“It’s a whole transition between collapsing on the basketball court and going back to a full academic load,” said Kenny Kahn, head football coach at El Cerrito High and Gurganious’s creative writing teacher. “I’m looking forward to his poems and creative writing—he’s quite the poet.”

Dr. Junaid Khan, a heart surgeon at Alta Bates Summit Medical Center in Oakland and president of the East Bay division of the American Heart Association, addressed the students directly, telling them not to be too scared about sudden cardiac arrest: it’s highly unusual in teens, he said, and very rare to see three cases at the same time in the same area. Chances are better that a young person would die in a car accident, or of cancer, Khan said. “It’s like lightening striking the same place twice,” he said. “It’s that rare. In a 26 year period, there were only 30 events around the country.”

But, when it does happen, CPR and defibrillators increase survival rates significantly. Only five percent of people survive sudden cardiac arrest without CPR or defibrillation. With CPR, the odds go up to 30 percent. If a defibrillator is present, they go up to 50 percent. “Automatic defibrillators really are the key to saving lives,” Khan said. “These things are so easy to use. Just put them on and they do the rest of the work. But the devices alone, not including the training to use them, can cost between $1,500 and $2,500.

Brett Reisner, a representative from Cardiac Science who lost his own brother to sudden cardiac death, applauded Turiaf for his donation, and advocated for a new State Assembly bill that would require schools to have defibrillators available at sports contests and practices. The bill is co-sponsored by State Assembly Members Mary Hayashi (D-Hayward) and Jerry Hill (D-Castro Valley). “Fourteen states in the US have laws requiring AEDs in schools,” he said. “California is not one of them. We need to support bill 1647.”

Turiaf started his charity, the Ronny Turiaf Heart to Heart Foundation, in 2009, but he had been thinking about starting a charity for a long time. “I played basketball my whole life to make a living for my family,” said Turiaf. “In 2005, I finally signed a contract. I thought everything was perfect.”

Two days after he signed with the Los Angeles Lakers in 2005, Turiaf, now 27, was diagnosed with an enlarged aortic root during a physical exam. His doctor, Stanford surgeon Craig Miller, told him had two options: quit basketball, or have surgery. Turiaf told the crowd of students that Miller told him to have the surgery, and that he had “confidence in my ability to get you back on track.”

Turiaf believed him. “If the guy that’s going to open me up like a lobster tells me I’m going to be able to play basketball again, I have confidence in myself to do the rest,” he said.

The open-heart surgery lasted six hours, and Turiaf was back on the court in less than six months. “After I went through my surgery,” he said, “I told myself that if one day I was financially stable enough, I would do whatever I could to give back to the community.”

How to live your heart-healthiest life

Click here to check out Dr. Khan in this article by the American Heart Association...