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Thu January 26, 2012
You're part of a cardiac arrest experiment in King, like it or not
If your heart stops beating and you’re treated by paramedics in the next few years, which treatment you get may depend on a coin flip. Once again, King County residents are part of a national study of how best to resuscitate someone from cardiac arrest.
A coin flip sounds pretty random – and that’s actually on purpose.
Researchers are trying to test two different ways emergency responders perform CPR, and two different drugs used to revive someone whose heart stops beating. There’s genuine uncertainty about what works best.
“If you are using a treatment that’s not effective, you are potentially robbing a patient of an alternate treatment that might have been used in its place," says Dr. Peter Kudenchuk, a cardiac specialist at the University of Washington.
"And for that reason, even a treatment that's found to not be effective is very important information.”
Debate over pausing for 'rescue breathing'
One experiment focuses on how best to combine chest compressions and "rescue breathing" during CPR. In some organizations, such as the Seattle Fire Department, one technician will keep pumping the chest without pausing, while another EMT will intermittently pump air into the victim. Elsewhere, the EMT's will pause after 30 chest compressions (while two breaths are given).
For average citizens, the American Heart Association recommends chest compressions only, but for professionals, it's not clear yet if one approach is better than the other.
A parallel experiment compares two popular drugs used to revive people -- Amiodarone and Lidocaine. Capt. Jonathan Larsen, of the Seattle Fire Department's Medic One unit, says, "We really truly don’t know how safe the two drugs are compared to each other, or compared to no treatment at all."
Knowing what works and what doesn’t should help more people survive cardiac arrest, which is the third leading cause of death in America. Most victims never recover. Cardiac arrest often follows a heart attack, but sometimes strikes suddenly, including younger people who seem otherwise healthy.
Ten cities involved
Kudenchuk is one of the leaders of a national group, coordinated through the UW, studying cardiac arrest. They've been at it since 2005, and earlier studies also randomized which treatment people get when they call 911.
They say the only way to compare two types of resuscitation is to have a whole community – in this case Seattle and King County – try different versions, randomly. Overall, ten cities are involved, including Dallas, Pittsburgh and Toronto.
King County residents were "informed" of the experiment through advertisements that ran inside Metro buses since last summer.
A telephone survey found the vast majority of residents support such an experiment, says Kudenchuk and fellow investigator Dr. Graham Nichol of the U.W. and Harborview Hospital.
The experiment is good for you
Kudenchuk argues that being part of an experiment is actually in your favor, because it tends to make all the emergency responders extra attentive to everything they do.
King County has been a pioneer in emergency treatments for decades, through Harborview and Medic One.
The two current experiments run for about two years. If you want to opt-out, you can request a bright red rubber bracelet that says, “No study.”
(Note this story has been corrected to better reflect how Seattle first responders combine chest compressions and rescue breathing.)