Article here http://archive.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html Don't do as Ontario Public Health does chest compressions only for respiratory emergencies https://www.linkedin.com/pulse/college-pharmacists-june-7-2016-gary-thompson More info @GaryCPR

1. Tucson doctor a crusader for CPR change
Urges 'chest compression only' to be medical standard Email from Dr. Ewy bottom
this article
by Anne Ryman - Jan. 19, 2010 12:00 AM
The ArizonaRepublic
Readmore:
http://archive.azcentral.com/news/articles/2010/01/19/20100119cardiacdoc0119.html#ixzz4F9tLzN2u
Charlie Leight/The Arizona Republic
Dr. Gordon Ewy, director of the University of Arizona's Sarver Heart Center in Tucson, has
conducted numerous studies that support his theory that compression-onlyCPR increases
the chances ofsurvival after sudden cardiac arrest. [Acute respiratory
failure is not a sudden witnessed cardiac arrest. One in six
presented to hospitals are respiratory emergencies. Over a
million per year in Ontario, Canada. Less than 10 thousand
out of hospital cardiac arrest per year Ontario, how many
sudden witness cardiac arrests the only time CC only is of
value?]
TUCSON - Dr. Gordon Ewy strolls into a conference room at the University of Arizona's Sarver
Heart Center and sets a book on the glass table.
"Look at Chapter 2," he says, opening the newly released "Cheating Death" by Dr. Sanjay Gupta,
CNN's chief medical correspondent. Chapter 2 is about resuscitation.
"Sanjay Gupta calls me cantankerous and opinionated," says the 76-year-old cardiologist and
director of the Sarver Heart Center.

2. "It's OK to be cantankerous and opinionated if you're right," he says. "And we're right."
For more than two decades, Ewy (pronounced AY-vee) has been on a crusade to change the way
people are treated for sudden cardiac arrest, a leading cause of death in the United States.
He has challenged what for years was a kind of sacred cow in the medical profession and a
prescription for good Samaritan behavior worldwide: the mouth-to-mouth rule of
cardiopulmonary resuscitation, or CPR.
Ewy has pioneered the use of chest compression-only CPR on adults whose hearts suddenly stop
pumping. Mouth-to-mouth only detracts from the more effective compressions, he insists.
Since the mid-1990s, Ewy's advocacy has often been a thorn in the side of venerable medical
establishments such as the American Heart Association. Ewy has written letters in medical
journals demanding change and accused the association, whose influence is strong, of not
moving quickly enough.
In the past five years, though, there has been a gradual realization that the outspoken Tucson
doctor is on to something.
In a major shift in 2008, the American Heart Association issued an advisory that said
compression-only CPR can be used to save lives and is an option for people who aren't trained in
CPR or who are unsure of their CPR abilities. People who are trained can do either, it says. The
advisory applies only to cases of adults in cardiac arrest, not children, and excludes
drowning and drug-overdose cases. [Excludes and cardiac arrest secondary to respiratory
arrest]
Now, the compression-only version may be on the verge of going worldwide, as an international
health group considers whether to revise its guidelines to make it the preferred method.
Not everyone has bought into Ewy's approach. Evidence is mixed. Research in the U.S.,
Netherlands and Japan has found that chest-compression-only yields similar or better survival
rates than standard CPR. Some European studies report better results with mouth-to-mouth. Still,
Ewy is convinced it's only a matter of time before compression-only CPR becomes the standard
for cardiac arrest.
Why CPRis important
Every year, cardiac arrest kills about 325,000 people in the U.S. Its main underlying cause is
heart disease, and the majority of cardiac arrests happen outside the hospital.
As bad as that is, prospects were worse for victims before modern CPR emerged about five
decades ago.
Two American doctors, Peter Safar and James Elam, are credited with inventing CPR, and the
technique spread rapidly after the American Heart Association endorsed the idea in 1963.

3. CPR works under the premise that pressing on the chest moves blood to the vital organs while
mouth-to-mouth breathing gets oxygeninto the lungs.
When a person's heart stops beating, the first few minutes are critical. If nothing is done, the
chance of survival drops 7 to 10 percent every minute.
Yet studies show most people are averse to performing CPR for a variety of reasons, including a
fear that they will hurt the victim or an inability to get beyond the "yuck" factor of mouth-to-
mouth contact. Instead, they call 911, as CPR courses teach, but then just wait for paramedics to
arrive. Bystanders attempt CPR in less than a third of cardiac arrests. That's one reason so few
people survive: More than 95 percent of people who suffer sudden cardiac arrest die.
Ewy says the compression-only method is better than standard CPR for a simple reason: In
standard CPR, when a rescuer stops after 30 compressions to give two breaths, the blood stops
moving through the patient's body, essentially starving the organs. Continuous compressions
keep the blood flowing. Doing only those also is simpler and easier to remember than standard
CPR.
Ewy'sstory
Ewy grew up in a small western Kansas town, knowing as a boy that he wanted to be a doctor.
He got interested in cardiology while working at a Washington, D.C., hospital, where he
successfully pushed for heart defibrillators to be standardized so they put out the same electrical
output. That led him into cardiac-related research, which he continued when he moved to Tucson
in 1969.
Over the next two decades, he and his colleagues did research, including studies using pigs, that
touched on nearly every aspect of CPR. At first, he believed in standard CPR. But he also
believed that compression-only CPR was better than nothing. Surveys conducted by the Sarver
Heart Center showed people were four times as likely to perform compression-only CPR than
standard CPR. Ewy and his team decided to research whether one was more effective than the
other. Their findings favored compression-only CPR.
In the early 1990s, Ewy heard something that really convinced him. He was in his office
listening to a recording of a 911 call that someone had sent him. A Seattle woman was giving her
husband CPR while she waited for paramedics to arrive.
After several minutes, the woman got back on the phone and said, frustrated, "Why is it every
time I press on his chest he opens his eyes? And every time I stop and breath for him he goes
back to sleep?"
Ewy was amazed. The woman had summed up in two sentences what he had spent 20 years
researching.
"What she was actually saying was this: 'Why is it every time I press on his chest, he's not in a
coma? And every time I stop and breathe for him, he's in a coma?'"

4. Struggleforacceptance
Since the mid-1990s, Ewy's goal has been to convince the medical community that he is right.
Along the way, he and his research team have made other breakthroughs, including pioneering
new protocols for paramedics and a treatment that involves cooling body temperatures to
minimize brain damage.
Critics have raised several objections about the CPR findings. One is Ewy's use of pigs in his
studies. Unlike people, pigs gasp during cardiac arrest, making them more likely to survive,
critics say. Ewy went back and looked at Arizona data and found that many people gasp during
cardiac arrests.
Some doctors worry that bystanders can get confused and do only chest compressions in
drug-overdose and drowning cases. [Any cardiac arrest secondary to respiratory emergency]
Some critics wonder if the research has been sufficient.
"We weren't outcasts, but people really vehemently disagreed with us," Dr. Karl Kern, Sarver's
associate head of cardiology, says of the Tucson group.
In 2000, Ewy pressed the American Heart Association to change its guidelines to compression-
only in cases of cardiac arrest, but the group was reluctant.
Ewy and his colleagues took their campaign locally, first in the Tucson area and then statewide.
The Arizona Department of Health Services got on board in 2005, launching a statewide
campaign to promote compression-only CPR.
In 2007, Ewy wrote an editorial for a leading medical journal, advocating for the American Heart
Association to change its guidelines, which weren't up for review until 2010. The following year,
the association issued the advisory endorsing compression-only CPR as an option.
Colleagues say it would have been easy for Ewy to back off his campaign in the face of criticism
over the years.
"He really has forged ahead. I think what it's showing, now that we have more and more human
data, is that Dr. Ewy was right," says Dr. Ben Bobrow, a medical director for the DHS.
Goingforward
Next month, Ewy will fly to Dallas for a meeting of the world's major resuscitation groups. No
one knows whether the International Liaison Committee on Resuscitation will endorse
compression-only CPR as the preferred method. It's fair to say the discussion will be
controversial and Ewy again could face an uphill battle. But he is not giving up.

5. Sitting in the Sarver Heart Center's conference room on a recent day, he is optimistic that change
will come soon. "Yes, it's frustrating, but there is this book called 'The Tipping Point,' " he says,
referring to a best-seller about forces that make change unstoppable.
Ewy raises his right arm at the elbow, then drops it halfway down to his left. "I think we're about
there," he says.

6. 2015 AHA GuidelinesPart10.3: 'Cardiac or Respiratory Arrest Associatedwith OpioidOverdose' page
506 http://circ.ahajournals.org/content/132/18_suppl_2/S501.full.pdf+html
Response:Physiciansworst nightmare patientin cardiac arrest secondary to respiratory arrest. No
antidote has a role inthe managementof cardiac arrest.
2015 European Resuscitation Council Guidelines for Resuscitation
Section 4. 'Cardiac arrest in special circumstances' TOXINS p165 CORRECT
http://www.cprguidelines.eu/assets/downloads/guidelines/S0300-9572(15)00329-
9_main.pdf
In opioid-Associated Life-Threatening Emergency (Adult) Algorithm—New 2015
*CPR technique based on rescuer’s level of training.
Figure 2. Opioid-Associated Life-Threatening Emergency (Adult) Algorithm

7. Canadian Red Cross 'Baby Sitter's' First Aid

8. Majority of poisoning happens to
children, rescue breathing
essential.