Rehearsal, Rehearsal, Rehersal

Rehearsal, Rehearsal, Rehersal

Aurora medics perfecting the back-to-life cycleBy SARA CASTELLANOSThe Aurora SentinelPublished: Thursday, September 16, 2010 8:00 AM MDT
Ale Kerekes, RN and clinical educator, performs chest compressions on a dummy, Nathan Daly operates a bag valve mask and Gilbert Pineda, MD, and EMS medical director, oversees the Resuscitaion Choreogaphy drill Sept. 9 at The Medical Center of Aurora. (Gabriel Christus/The Aurora Sentinel)

The protagonist is a person whose heart has stopped beating.

The secondary characters are firefighters, physicians and nurses.

The Aurora Fire Department’s Resuscitation Choreography program is like a play. It’s scripted and choreographed, with each movement calculated and meticulous.

The secondary characters work to circulate blood from the heart to the brain by rhythmically pumping on the chest of the cardiac arrest patient, mindful to miss as few beats as possible.

If it’s done right, the patient is brought back to life at the denouement.

Resuscitation Choreography was put into practice in January 2009. It’s the only resuscitation technique in the metro area that focuses on significantly limiting the pauses between chest compressions for patients undergoing cardiac arrest.

If the pauses are reduced between chest compressions, the cardiac arrest patient has a greater chance of surviving without brain damage, according to the American Heart Association.

“Everybody is responsible for their own task, but their task is done to support quality compressions,” said Kevin Waters, manager of the Aurora Fire Department’s Emergency Medical Services Bureau. “We concentrate on how we can do all the other things that are really important to managing a cardiac arrest, without interrupting CPR.”

Emphasis is placed on timing the compressions and continuing them throughout the entire time spent with the patient, with pauses of only a few seconds in between two-minute-long compression cycles. [Blogger comment: note that this is not 30:2 timing. It's 200:2]

Because of Resuscitation Choreography, 90 percent of the time spent with a cardiac arrest patient is now dedicated to chest compressions.

That’s up from 30 percent of the time that was dedicated to chest compressions prior to 2009.

“Historically, we’d respond to a cardiac arrest and we’d know there’s a very low likelihood that we are going to be able to resuscitate these people,” Waters said. “Now, we respond to a cardiac arrest and we know that it’s very likely that we are going to be resuscitating them.”

Last year, with the help of doctors and nurses at the Medical Center of Aurora, the Aurora Fire Department successfully revived 24 patients who were able to walk out of the hospital without brain damage — more people than they were able to resuscitate in the previous three years combined, Waters said.

The program is now a finalist for the 2010 Municipal Excellence award, sponsored by the National League of Cities and given annually in November.

Arthur Ceccato, 46, says he owes his life to the “complete strangers” that performed the resuscitation technique on him after he suffered a cardiac arrest while driving home from his son’s baseball game in February.

“Hopefully nobody ever has to experience that to understand what it is they do, and how it comes together,” said Parker-resident Ceccato. “But they do make a difference. They really do. It’s touching — it’s overwhelming.”

It was the difference between an endless sleep, and watching his 7-year-old daughter’s dance performances and coaching his 13-year-old son’s baseball team.

It was a beautiful, sunny day, Ceccato remembers, when his family was driving home one afternoon in late February.

At a stoplight at the intersection of South Parker Road and East Quincy Avenue, Ceccato looked over at his son, who was sitting in the passenger seat. He playfully tipped his son’s baseball hat.

When the light turned green, he stepped on the gas.

“Then it was just like taking a nap,” Ceccato said. “That’s the last thing I remember.”

He was driving about 30 miles per hour when his heart stopped. The car drifted off the side of the road and smashed through a fence.

His son rotated the steering wheel to avoid hitting a tree, and the car landed in a ditch, wrecked.

A man driving the opposite way was watching Ceccato’s car drift off the road.

He made a U-turn to try and help the family, although he was on his way to the funeral of a friend who had died from heart failure, Ceccato said.

The man performed chest compressions for a few minutes until an ambulance arrived at the scene.

Ceccato awoke from an induced coma at the south campus of the Medical Center of Aurora about three days later.

“I didn’t know what happened,” he said. “It was like trying to recall a dream.”

There is no doubt in Ceccato’s mind that the bystander, CPR and Resuscitation Choreography saved his life.

The memory of the traumatic experience lingers in the minds of his family, though.

“Once I did start driving again, my daughter, for the longest time, would ask, ‘you’re not going to fall asleep again, are you?’ … It helps keep things in perspective,” Ceccato said. “Things could always be worse. Every day is a gift.”

Aurora’s medical professionals consider Ceccato’s case to be a prime example of the importance of reacting quickly and efficiently when trying to revive a cardiac arrest victim.

If several minutes pass without chest compressions, the chances of reviving a patient are slim.

“Your heart is not pumping any blood, there’s no blood circulating to the brain, so the brain is going to die,” said Gilbert Pineda, a doctor at the Medical Center of Aurora and the medical director of Emergency Medical Services.

To put it more candidly, a person who has suffered a cardiac arrest is virtually dead when the Resuscitation Choreography process begins, Waters said.

“This thing we are doing here, without being too blunt, we do this on people that are dead,” he said. “They don’t have a pulse, they’re not breathing, they’re dead. That’s why what we’re doing here is so amazing.”

Educating people about the significance of bystander CPR is one of the most helpful ways to save more lives, Waters said.

“If the bystanders have started CPR before any of us get here, it dramatically increases the likelihood that we’re going to be able to resuscitate them,” Waters said.

Aurora’s Resuscitation Choreography program was adopted after research by the American Heart Association in 2005 showed that cardiac arrest victims have a better chance of surviving when doctors and bystanders spend more time doing chest compressions.

It’s a simple concept, but one that can mean the difference between life and death.

“When we do chest compressions, it helps the patient,” Pineda said. “Every time you stop, you take about five steps backward.”

There are striking differences between the choreography method and the way the city’s firefighters and paramedics used to manage cardiac arrest victims.

A team of medical professionals and fire department officials simulated the two versions for The Aurora Sentinel on Sept. 9 at the south campus of the Medical Center of Aurora.

There was no synthesized approach before 2009.

Paramedics didn’t keep track of how long they were doing chest compressions from the time they arrived at the scene to the time they arrived at the hospital. The hospital room was buzzing with chatter. The doctor was barking orders at people, while everyone was talking over one another. Chest compressions were infrequent, especially before and after the dummy was “shocked” with the defibrillator.

“When you’re in this adrenaline-pumped environment, you don’t realize how quickly a minute can go by,” said Mark Mayes, interim director of Emergency Services for the Medical Center of Aurora. “We would be off the chest for a minute, doing many other things that were necessary to be done. Nobody wanted to be a minute off the chest, but we just didn’t realize it.”

The clock starts as soon as the paramedics arrive on the scene, with the new method.

Chest compressions are done at two-minute intervals, because that’s how long it takes for blood to circulate to the brain, Pineda said.

During the ambulance ride, a hockey puck-shaped device is placed on the dummy’s chest, which is attached to a machine that tells paramedics whether they are doing the chest compressions effectively.

Paramedics take turns with chest compressions. When the dummy is in the emergency room, the elements of quiet and calmness are the starkest changes from the old version.

Everyone has a specific assignment, and the doctor oversees the process with very little discourse.

The machine is left with the hospital until they no longer need it.

The final step in the sequence of choreographed moves is the heart that starts to beat on its own.

“This is what we work for, what we live for, what we train for,” Pineda said. “It’s the ultimate save.”

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