Pre-hospital cardiac care “is like an orphan,” Stiell says; it slips through the bureaucratic cracks. Municipalities, for instance, control firefighter units, but provinces set ambulance guidelines. And while the feds direct funding, independent groups like HSF generate CPR guidelines. Morrison notes that when she’s hunting for grant money, she’s often forced to team up with specialists in other fields. Vaillancourt swears that the huge scale of cardiac arrest research trials—which often involve hundreds of patients—makes grant boards nervous, and more inclined to fund “basic science projects.” Research on “the effect of such and such a protein on muscle contractivity” sells better than a social science project trying to improve CPR rates, he argues.
Recently, though, there has been a resurgence of interest in CPR. “For a long time,” says Stiell, “we’ve [focused on] drugs and gadgets. But CPR is back.” This interest is largely fuelled by the Resuscitation Outcomes Consortium (ROC), a coalition of Canadian and U.S. research teams conducting the first large-scale clinical trials in the cardiac arrest field. Part of the issue, says Stiell, is that modern CPR was designed in the 1960s. Since then, we’ve basically accepted that formula.
One city that hasn’t accepted the norm is Vancouver. Several years ago, Vancouver EMS threw standard CPR guidelines to the wind. Now, its paramedics do “continuous-compression” CPR; in other words, they don’t stop compressions for breaths. The same applies to Seattle paramedics. Stiell cautiously agrees that the departure could help explain Vancouver’s cardiac success. Indeed, a growing body of evidence suggests that interrupting the flow of blood provided by compressions reduces a patient’s chances of survival. But continuous-compression CPR has not been scientifically analyzed. That will soon change; a forthcoming ROC study will examine the role of breathing in CPR’s efficacy. (For Vancouver, to Stiell’s dismay, the evidence already available may be compelling enough; B.C. Ambulance has not decided if it will take part in the study.)
Today, the most active Canadian research sites are those involved in ROC: Toronto, Vancouver, and a group of cities under Ottawa’s leadership. Piazza admits their research is very dependent on our southern neighbour. If it weren’t for the U.S. National Institute of Health, she says, “there’s no way we would have the money to do this.” The amount dedicated to cardiac arrest research is “a drop in bucket compared to something like oncology,” adds Morrison. As a result, “there is very little resuscitation research ongoing in Canada.” In fact, for ROC’s next funding cycle, beginning in 2010, the Canadian Institutes of Health Research will actually decrease its contribution from almost $3 million to $2 million. HSF will make up the difference.
A 2008 report in the Journal of the American Medical Association claims that if all North American cities could match Seattle’s success rate, we would save 15,000 more lives a year. Most cities still trail behind, though. “I think with some diseases,” says Piazza, “everyone knows somebody who has them, whereas it’s almost hidden when somebody collapses from a cardiac arrest and is resuscitated.” Stiell agrees: “Cardiac arrest goes sort of under the radar. It’s not like a plane crash or a pandemic.” But how can the nation’s number one cause of death—a disease that affects 35,000 to 45,000 Canadians each year—be a silent killer?
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