Cardiovascular Disease: Catching Up

By Mary Jane Dittmar

Chest-Compression-Only CPR
According to a statewide study conducted in Arizona, more patients with out-of-hospital cardiac arrest survived when lay individuals administered chest compressions only than when given conventional cardiopulmonary resuscitation (CPR) that included chest compressions interrupted by mouth-to-mouth “rescue breaths.” The overall survival rate for patients that did not receive any bystander CPR was 5.2 percent; those who received conventional CPR with rescue breaths from bystanders, 7.8 percent; and those that received chest-compression-only CPR from bystanders, 13.3 percent. The study was reported in the October 6, 2010 issue of the Journal of the American Medical Association (JAMA).
 
According to Bentley Bobros, MD, lead author and medical director of emergency medical services at the Arizona Department of Health Services and member of the University of Arizona Sarver Heart Center Resuscitation Research Group, the study identified three major findings:
 
1. The rate of bystanders who administered CPR for patients with out-of-hospital cardiac arrest grew from 28 percent in 2005, when the statewide study began, to 40 percent at the end of 2009.
 
2. The rate of chest-compression-only CPR increased from 20 percent in 2005 to 76 percent in 2009.
 
3. As noted above, a higher percentage of cardiac arrest victims survived in the chest-compression-only CPR group (13.3 percent) vs. 7.8 percent in the conventional CPR group.
 
“In 2004, fire departments, EMS ambulance companies, and hospitals across Arizona all said, ‘We cannot accept the current dismal survival rates from cardiac arrest in our state,’” explains Bobrow. “They made an enormous collective effort to teach chest-compression-only CPR to their communities for free,” he notes. These efforts have resulted in hundreds of lives saved in Arizona, Bobrow reports.
 
Gordon A Ewy, MD, senior author and UA Sarver Heart Center director, points to another significant result: The survival rate for individuals who had the greatest chance of surviving (those who collapsed in the presence of witnesses and who had a heart rhythm that could be restored by a defibrillator shock) was 18 percent when conventional CPR was performed and 34 percent when chest-compression-only CPR was administered.
 
Dr. Ewy adds that if chest-compression-only CPR and other protocols of cardiocerebral resuscitation were implemented nationally by emergency responders and cardio-resuscitation centers, an estimated 58,000 lives could be saved each year in the United States.
 
To view a six-minute instructional video produce by the UA Sarver Heart Center, go to www.medicine.arizona.edu/sarver-cpr.
 
STUDY FINDS AIR POLLUTION LINK WITH SUDDEN CARDIAC ARREST
“Exposure to ultrafine particles during fire suppression should be considered a potential contributing factor for coronary heart disease in firefighters. Of major significance is their predominance during overhaul, where firefighters frequently remove respiratory protection,” states the Conclusions section of the “Ultrafine Particle Exposure During Fire Suppression—Is It an Important Contributory Factor for Coronary Heart Disease in Firefighters? study, published in the Journal of Occupational and Environmental Medicine, Vol. 52, No. 8, Aug 2010.
 
Study Scenarios. The study included seven fire tests conducted in the large-scale fire test laboratory at Underwriters Laboratories. The tests represented typical residential building and automobile fire scenarios to which firefighters routinely respond. Six scenarios included a living room, a bedroom, a kitchen, an attic structure, and composite and traditional wood deck structures. The automobile scenario involved a passenger compartment fire.
 
Findings. Among the findings of the study, conducted by the University of Cincinnati; Underwriters Laboratories, Inc.; and the Chicago Fire Department, are the following:
 
  • During fire suppression, followed by overhaul, U.S. firefighter deaths from acute cardiovascular events occur at a rate of 10 to 100 times higher than during nonemergency duties. The overhaul phase is the most critical when considering firefighter particle exposure, however, because respiratory protection is commonly not worn during this period.
  • Risk factors for cardiac heart disease in firefighters may be personal, work related, or both. Personal risk factors include hypertension, obesity, increased serum cholesterol and triglyceride levels, and smoking.
  • Potential work-related risk factors include excessive noise levels; physical, heat, and psychological stress; dehydration; extended work shifts; and exposure to chemical asphyxiants, such as carbon monoxide, hydrogen cyanide, and hydrogen sulfide. Any of these factors could precipitate an acute cardiovascular event, particularly in individuals with underlying cardiovascular disease.
  • An additional occupational cardiovascular risk factor receiving increasing attention is exposure to respirable particles, including those in the ultrafine range (diameters <0.1 µm); indications are that they may be capable of inducing remote cardiovascular events after respiratory deposition by several mechanisms.
  • Independent of study scenarios, ultrafine particles were the most prevalent type of particulate matter generated. Ultrafine particles are not observable to the human eye, which may create a false sense of safety that leads firefighters to remove their SCBA protective equipment during overhaul to ease the physical burden and potential heat stress associated with use of personal protective equipment.
 

Helping Yourself. There is a need for additional research to determine whether exposure to ultrafine particles is a coronary event risk factor in firefighters. As a precautionary principle in the meantime, wear respiratory protection during overhaul to decrease the potential for exposure to ultrafine particulates. For additional information on the study, e-mail c.stuart.baxer@uc.edu.

Photo by Sam Mugraby, Photos8.com

SODIUM UPS RISK OF HEART ATTACK AND STROKE
From Harvard Men’s Health Watch (Oct. 2010): The sodium in salt is responsible for more than 100,000 American deaths a year. Most of the salt we eat is in processed foods. Salt’s major health effect is a rise in blood pressure, a risk factor for heart attack and stroke. Even a slight reduction in intake can improve blood vessels, flexibility, and reduce the loss of albumin in urine, thereby protecting the heart and the kidneys. According to current guidelines, sodium intake should be restricted to 2,300 milligrams (mg) a day—1,500 mg if you have high blood pressure, are middle-aged, an older adult, or an African American (who tends to be especially sensitive to salt’s effects).
 
HIGHLIGHT ON FOOD: WATERCRESS
This antioxidant-rich member of the cabbage family contains iron, calcium, and vitamins A and C. It has been sought for its nutritional properties since the days of the ancient Persians, Greeks, and Romans. Recent research in the United Kingdom suggests that it has anti-cancer potential, especially for breast cancer survivors. Antioxidants decrease cancer-causing free radicals in the body. Antioxidants are gender-neutral: They are beneficial for males and females. Try watercress in a salad; on a sandwich; or in omelets, quiches, soups, sauces, and dips, or try some of the recipes at www.watercress.com.

Allan Spreen, MD, NorthStar Nutritionals’ Guide to Good Health, Oct. 7, 2020.

 
DID YOU KNOW?Taking the prescription drug Avandia (rosiglitazone) for Type 2 diabetes may pose a risk for heart attack and stroke? The U.S. Food and Drug Administration recently announced that it will “significantly restrict” the use of the drug to Type 2 diabetes patients who cannot control their diabetes on other medications. Rosiglitazone is available also in combination with the diabetes medications, metformin under the brand name Avandamet, and glimepiride under the brand name Avandaryl.

If your medical provider has prescribed any of the above drugs for you, consult with him about this matter. Do not stop the medication on your own.

 

Mary Jane Dittmar is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.

 

 

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