A form of cardiopulmonary resuscitation (CPR) administered in some hospitals may also prove to be effective when preformed on the scene of emergency calls, said a local team of researchers.
The College of Nursing at ETSU, Mountain States Health Alliance and the Washington County/ Johnson City EMS are teaming to study the benefits of cough CPR (cCPR) when used in the community by paramedics assisting patients who display an abnormal heart rhythm (dysrhythmia).
Cough CPR was initially described by Dr. J.M. Criley in 1976 and has proven to be safe and effective in maintaining blood flow particularly to the brain and heart. Previous studies have reported that cough CPR has been associated with the restarting of a heartbeat, an increase in heart rate in patients experiencing low blood pressure initiated by a slow heart rhythm, a spontaneous conversion of an abnormal heart rhythm to a stable one, and sustained consciousness during ventricular fibrillation up to 93 seconds prior to emergency defibrillation.
Phyllis Eorgan, a critical care nurse at the Johnson City Medical Center and one of the lead study investigators, said cough CPR has been successfully used in the hospital cardiac catherization lab and adult critical care units.
When presenting with an abnormal heart rhythm, a patient will be asked by the attending medical personnel to perform a deep cough vigorously and repetitively until the heartbeat returns to normal.
“Coughing has been shown to help keep the patient conscious because it facilitates blood flow to the brain, ” Eorgan said. “When blood flow to the brain is halted, this increases the individual’s risk of sustaining possible neurological deficits. As long as we can keep the patient coughing, we have a good chance of maintaining consciousness.”
“Because of the promising results we’ve seen in hospitals, we know how well cough CPR will work when administered by paramedics in the community, ” said Dr. Priscilla Ramsey, associate professor of adult nursing.
Ramsey and Eorgan are working with Washington County/ Johnson City EMS paramedics, who will soon begin administering cough CPR when responding to emergency calls.
EMS operations director Steve Croley said paramedics use an EKG to determine if a patient has an abnormal heartbeat. If an abnormal rhythm is discovered, cough CPR can be used as an immediate first-line cardiac maneuver.
“During these emergency situations, every second counts, and the sooner we can convert a bad rhythm, the better,” Croley said. “In certain situations, we can use cough CPR immediately to help control the problem while we prepare other things like Ivs, medication injections, and oxygen supply which might be needed. It is likely in some situations that we can stabilize the patient without having to use more invasive therapeutic measures.
“Cough CPR does not delay treatment. In fact, it allows us to assist the patient quicker.”
And that can make a big difference, according to Eorgan, who cited life-threatening abnormal heart rhythms as a leading cause of sudden cardiac death among patients in non-hospital settings.
Ramsey added, “It is extremely important the public understand that cough CPR has proven to be effective, and under no circumstances will it replace or compromise care.”
“Currently, there us no research clearly indicating that cough CPR can prevent a heart attack, but we do know it has been successful in controlling an abnormal heart rhythm,” Eorgan said.
“And that is why anyone who suspects they are in cardiac distress should call 9-1-1 immediately,” Croley said.
Training sessions are being offered to paramedic crews who will be involved in the study. Patients eligible to receive cough CPR will be between the ages of 30-0 and must be conscious and able to perform deep coughs. They must also not have any medical conditions, such as chronic obstructive pulmonary disorder (COPD) or chest trauma, which have caused their lung capabilities to be compromised.
The researchers will compare data from patients administered cough CPR versus those receiving standard methods to measure changes in heart rhythms, oxygen levels and consciousness.
For information, call 439-4518 or 431-6600.

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