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The work of Dr. Michael Kellum is crucial to improving and simplifying CPR

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STANLEY B. MILAM
March 27, 2012
— Forget about traditional CPR.

Forget about breathing into the patient's mouth.


A person in cardiac arrest doesn't need air. The person needs blood flow. Call 911, start chest compressions and keep applying compressions until help arrives.


That's the advice of Dr. Michael Kellum, the EMS medical director for Mercy Health System.


Decades of research brought about a major change from traditional CPR that taught us to breathe into the mouth.


"Our EMTs were at the point where the expectation was that the patient would die, not live," Kellum said.


Dr. Gordon Ewy at the Sarver Heart Center in Tucson, Ariz., pioneered a path to greater outcomes. An alternative program was developed at Sarver in 2003.


"We were the first rural area (Rock and Walworth counties) in the world to institute this new approach to cardiac arrest patients," Kellum said.


The new approach is often inaccurately described as "chest compression only" CPR.


Kellum said he is teaching "delayed positive pressure ventilation continuous chest compression recessitation."


It's a mouthful, but it's the medically accurate description of the technique.


"All you have to know is continuous chest compression, and don't try to remember the technical name," he said.


The technical description aside, the change in cardiac management in Rock and Walworth counties resulted in a survival rate that's twice the national average.


"You can argue all you want about whether you should ventilate or not, but the bottom line is we are double the national survival rate," Kellum said.


The science involved is remarkably simple, Kellum said. A patient in cardiac arrest can still breathe. The problem is the lack of blood to the heart and brain.


A soft-spoken and matter-of-fact physician, Kellum becomes emotional when he discusses paramedics' expectations.


"Imagine the feeling if the last 20 people you worked on all died."


The low expectation is why Kellum became a leader in CPR training.


"My job as medical director was to review all these cardiac arrest victims. I would go through them and see a dead one, another dead one and another dead one. It was just dead and dead and dead and dead and dead."


After six months of the grim statistics, Kellum concluded that "either the disease is so bad that nobody can make them better, or there's something we are not doing right.


"You can get all the oxygen into the lungs you want, but if there's no blood going to the lungs to carry that oxygen up to the brain and into the heart, it's useless," he said.


As Kellum put it, "this is not rocket science. Apply continuous optimal compression at the right rate, somewhere around 100 compressions per minute."


The compressions need to be deep enough and include a release to create a pumping action.


Ewy of the Sarver Heart Center praised Kellum.


"His work has been critical to the advances we've been making. He's been a major contributor over the years," Ewy said.


Dr. Sanjay Gupta, the chief medical correspondent for CNN, also recognized Kellum for his CPR work. In his book "Cheating Death," Gupta noted Kellum's success rates.


"In the previous three years, of 92 people in Rock and Walworth counties who suffered out-of-hospital cardiac arrest, only 15 percent had survived with intact brain function," Gupta wrote. "After the new (Kellum) protocol was implemented, that rate more than tripled. In 33 cases of sudden cardiac arrest, 19 people survived, and 16 of themó48 percentówalked out of the hospital, more or less, as good as new."


The bottom line for Kellum is lives saved. It's his motivation.


"We have improved our survival rate from 17 percent to 44 percent, twice the national average," he said. "In Rock and Walworth counties, that means we save 10 to 15 more lives per year."



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