There’s a story Dr. Sheldon Cheskes likes to tell:
You’ve been riding with the same friends for 20 years, going out bike riding on trails. One day, 10 minutes into the ride, one of your friends collapses, falling off his bike. He’s unresponsive, not breathing, in cardiac arrest.
You’re in the middle of a park, far from any emergency services. You begin CPR. You call for an ambulance. You do CPR for 30 minutes in the middle of a massive park, no one around but you and your riding group, before an ambulance can get there.
Ambulance comes; they apply a defibrillator and shock your friend. The paramedics continue CPR, continue resuscitation and get him to the hospital 60 minutes after the cardiac arrest occurred.
On Thanksgiving Day, weeks later, your friend is walking out of hospital to his loved ones.
This is a true story. It happened a few months ago to a group of riders and paramedics Dr. Cheskes knows in Hamilton. He tells it to stress the importance of CPR (cardiopulmonary resuscitation), and to underline the potential of CanROC, a massive new research initiative aimed at improving survival rates from cardiac arrest.
Dr. Cheskes, medical director at Sunnybrook Centre for Prehospital Medicine in Toronto and a scientist at Li Ka Shing Research Institute at St. Michael’s Hospital, has devoted his research career to improving survival from cardiac arrest.
He answered our questions about CanROC, cardiac arrest and what every Canadian should know about CPR.
Why do you like that story?
Those men and women did bystander CPR – as opposed to standing there waiting for help and doing nothing. Without bystander CPR their friend would have died, not a question in the world.
How important is bystander CPR?
It’s the single most important factor in surviving cardiac arrest. Plus it is an easy intervention. As researchers we get a lot of funding to do research on new interventions, new drugs. But what people don’t understand is that the greatest chance of surviving cardiac arrest is when a bystander performs CPR.
Why do you research cardiac arrest?
Cardiac arrest can occur at any time. It can occur at any age. It can happen at schools. It can happen at a recreation centre. It happens 40,000 times every year in Canada. That’s once every 13 minutes.
As an emergency physician, I consider cardiac arrest the ultimate emergency. You’re actually bringing patients from death to life and allowing them to survive, to live with their children, with their family. To me, it’s an area where I can make the most difference.
What is CanROC?
It’s the Canadian Resuscitation Outcomes Consortium, an all-Canadian extension of a previous 10-year research network involving 10 large EMS systems across North America, including the Greater Toronto Area, Ottawa and Vancouver. That one, the Resuscitation Outcomes Consortium (ROC),was the largest out-of-hospital research network exploring strategies to improve outcomes from traumatic injury as well as cardiac arrest.
Now we’re expanding that concept across Canada with new funding from Canadian Institutes of Health Research (CIHR) and the Heart & Stroke (which also supported ROC). We’re going to create an extensive cardiac arrest registry so we can see which interventions performed by individual EMS systems actually improve patient outcomes, then work to apply them across Canada.
Watch Dr. Cheskes describe the impact of the CanROC initiative.
How could this research help Canadians?
The research we did under ROC helped double and triple cardiac arrest survival rates in the sites that took part. We hope that we can spread that impact across Canada.
We want to see every patient get excellent care for sudden cardiac arrest, including bystander CPR and the application of an automated external defibrillator (AED), so that we can maximize survival. And we don’t want to just see excellence in little pockets, but right across Canada. That would be my aim for 2020.
What needs to happen for that vision to become reality?
We need to increase bystander CPR rates. Here in Canada, fewer than half of cardiac arrest victims get CPR prior to the arrival of paramedics and first responders. There are other countries with much higher rates of bystander CPR. It’s my hope that we can increase the rates in Canada so we can improve survival.
I think it’s that fear of doing something wrong, of causing harm, that prevents many Canadians from acting. There should be no fear of doing harm. You can’t do harm to someone who is already, theoretically, dead.
How has CPR changed?
Research has shown that compression-only CPR will improve survival. So don’t worry about the airway; just compress the chest, compress it hard and fast. Whether you do it perfectly or imperfectly, the action of doing something will make a huge difference.
Where do AEDs fit in this picture?
Learning to use an AED is extremely important. It’s the second phase – first bystander CPR, and then apply a defibrillator. An AED is an extremely simple device; it’s not something just a doctor can use. You just open it up, turn it on and a voice prompt gives you easy-to-follow instructions.
If you go to an airport you’ll see a defibrillator every hundred metres. It’s the hope of Heart & Stroke that we see them as commonly as fire extinguishers in public places across Canada.
How is research contributing to improved survival from cardiac arrest?
Prior to the research we did under ROC, no one knew about the quality of CPR, no one knew about pushing fast, pushing deep, minimizing pauses in cardiac arrest resuscitation. It’s through that funded research that we were able to understand that the quality of CPR made a huge difference in the outcomes from cardiac arrest.
And now you see these findings all over the 2015 Guidelines for CPR and Emergency Care (launched by Heart &Stroke in October 2015) – terms such as compression rate, compression depth, minimize interruptions, chest recoil. These are all finer nuances of high quality CPR. And without Heart & Stroke funding we wouldn’t have been able to do the research that we performed in CPR quality.
Is there one CPR message you’d like Canadians to remember?
Doing something is better than doing nothing at all.