New device part of ‘bundle of care’ saving lives during cardiac arrest in Minnesota, across country
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It’s been about a month since Edina paramedics rushed to the home of Richfield Fire Chief Wayne Kewitsch after he suffered cardiac arrest on July 1. Six days later, the Chief walked into the Edina Fire Station to thank the team for saving his life.
5 EYEWITNESS NEWS sat down with the Chief two weeks ago.
“The whole cascade of events went perfectly for me,” said Kewitsch. “I am one very, very lucky and fortunate individual.”
The Edina team was using the latest technology, including a device that just became available in 2019. It’s called the EleGARD and it’s used for device-assisted head up CPR.
“It was designed to help improve blood flow to the brain,” said Dr. Keith Lurie, the co-founder and chief medical officer at AdvancedCPR Solutions. “Help remove venous blood from the brain so that during CPR we have a greater likelihood to save brain function, which has been a major problem for decades.”
In a simulation, paramedics showed us how they rush to a patient with two bags of equipment, expertly packed. A team member immediately starts compressions as others get the equipment out, including the EleGARD.
Lurie narrated the demonstration for our 5 EYEWITNESS NEWS crew.
He explained a tube with an impedance threshold device would be inserted into the patient’s throat to secure an airway. The impedance threshold device is used to improve circulation, regulating air pressure going in and out of the lungs.
The EleGARD is then positioned under the patient’s head and a mechanical compression device is attached to it, taking over CPR.
“Now they have the entire system in place,” explained Lurie.
Compressions are performed for two minutes while the EleGARD is on its lowest level. Then, paramedics push a button on the EleGARD, which slowly raises the patient’s head and torso to the highest level. After two minutes, it stops at 22 cm of head elevation, according to Lurie.
“If you optimize the entire system, you nearly normalize blood flow to the brain then you have a much greater likelihood of waking up,” he said.
It’s all part of a “bundle of care” that paramedics used to resuscitate Chief Kewitsch.
“Because they had implemented everything so rapidly and so efficiently they were able to get him back within, less than 15 minutes,” said Lurie.
He said he debriefed with the Edina paramedics after the event, learning that they pack their bags so their equipment is easy to transport quickly. It’s a lesson he plans to pass on to the other first responders who use the same bundle of care.
“What we learned collectively is translation from the research lab to the patient requires an implementation step that has to be super-efficient,” said Lurie.
Lurie is professor of Emergency Medicine at the University of Minnesota and has a research lab at HCMC. He developed the device after spending years analyzing how animals respond to different CPR positions.
“It’s become clear to us one of the reasons why so few patients wake up is when you push down with conventional manual CPR on the chest on somebody who is flat, you do push blood out of the heart to the brain,” he said. “But you also push venous blood from the thorax up to the brain.”
“Each time you push down on the chest the brain gets both the arterial wavefront and the venous wavefront and that’s not good, it’s almost like giving a concussion with every compression.”
The EleGARD, he said, reduces that pressure on the brain.
“We’ve had some incredible saves,” said Lurie.
It was used to save a man’s life after he collapsed at the Minneapolis-St. Paul International Airport in August 2019. In another case that year, a 15-year-old was resuscitated after being pulled unresponsive from a pool.
“They rescued him and used this whole bundle and he’s back playing basketball which he is passionate about,” said Lurie.
He also flew to Arkansas to meet a woman who survived cardiac arrest with the help of this technology.
“She went down one night at work and she got bystander CPR and the Little Rock, Arkansas EMS team arrived and they worked her for 30 minutes, 22 shocks with the defibrillator, this entire bundle of care,” said Lurie. “It turned out her main coronary artery had dissected and normally that’s a lethal event in that setting. She was discharged from the hospital four days later completely intact.”
It’s used across 30 communities in nine states: Minnesota, Florida, Texas, California, Ohio, Arkansas, Louisiana, Tennessee and Illinois.
Edina and Richfield Fire crews are just two of many cities using it in Minnesota. Andover, Bloomington, Coon Rapids, Columbia Heights, Fridley, MAC, Vadnais Heights, Roseville and Lake Johanna Fire crews, plus New Brighton Public Safety have all implemented the bundle of care.
Edina was the first to successfully use it to save a life in April 2019, according to Lurie.
“We’ve learned that we can see more signs of life sooner, we’ve learned that people otherwise thought to be given up for dead, survive, we’ve learned that if you put this on too late, it’s worthless,” he said. “So those are some important lessons.”
Minnesota has one of the highest rates of survival for cardiac arrests. The Cardiac Arrest Registry to Enhance Survival (CARES) tracks cases among communities that choose to provide information.
It includes 28 state-based registries, the District of Columbia, and more than 45 communities in 14 additional states. Each reports non-traumatic cardiac arrest cases that happen outside of the hospital, where 911 is called.
The data does not include cardiac arrests where EMS personnel immediately determine the patient cannot be resuscitated.
According to the 2019 report, in Minnesota, only 13.5 percent of patients survived and were discharged from the hospital. Only Alaska, Oregon and Washington had a higher rate. Nationally, only 10.5 percent of patients survived to hospital discharge.
While the EleGARD is still new, Lurie hopes the device and bundle of care will improve outcomes.
“I want people to know there is a better alternative than just a pair of hands,” he said. “We have extraordinary results in other places where they have adopted this as well.”
He told us, “There is no single silver bullet, when you put it all together it’s quite extraordinary.”
Bystanders should not attempt elevated CPR but instead immediately start conventional compressions while waiting for trained first responders to arrive.
CARES data also shows among Minnesota cases last year, only 37.5 percent of patients received bystander CPR, which is below the national rate of about 41 percent.
“We know that when a person suddenly collapses with cardiac arrest, bystander CPR is a critical step to survival,” said Kim Harkins, the program manager for Center for Resuscitation Medicine at the University of Minnesota.
It can double or even triple the chances of survival, according to the American Heart Association.
Harkins and her team are providing virtual hands-only CPR classes, where they also explain how to respond during the pandemic.
“If it’s a family member or somebody you live with go ahead and start the CPR, you’re not going to be any more exposed than you already were living with that person,” she said.
“If you should witness somebody in a public setting collapse, you do want to take some extra precautions. Don’t take your mask off, don’t take their mask off. If you need to, cover their mask or their nose or mouth with another cloth, pull up their shirt, something to help protect you while you’re doing it.”
Instead of leaning down to listen if someone is breathing, Harkins said you can feel their chest for movement instead.