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Dr. Gordon Ewy

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Gary Thompson

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

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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.
"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.
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?'"
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.
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.
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
Canadian Red Cross 'Baby Sitter's' First Aid
Majority of poisoning happens to children, rescue breathing essential.
Dr. Gordon Ewy
Dr. Gordon Ewy
Dr. Gordon Ewy

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Dr. Gordon Ewy

  • 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.