A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works
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As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.
Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.
Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.
But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.
Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.
Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.
Using two defibrillators
During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.
Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.
DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.
A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.
The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.
Evidence of success
New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.
Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.
The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.
Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.
From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.
The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.
The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.
Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.
Training and implementation
Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.
There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.
Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.
Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.
Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.
Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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HRT & Your Heart
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝So the reason that someone on estrogen has a slightly higher chance of a heart attack is…what? Is it just because there’s a higher body fat?❞
There shouldn’t be higher chance of a heart attack once everything’s been taken into account, and indeed estrogen has some cardioprotective benefits, along with competing properties, e.g:
❝The cardiovascular effects of estrogen require a careful balancing act between possible advantages, such as enhanced lipid profiles and vascular function, and possible concerns, like increased thrombotic risk.
Estrogen has cardioprotective properties in premenopausal women❞
Source: The Relationship Between Myocardial Infarction and Estrogen Use: A Literature Review
The risks and benefits of HRT are numerous, and/but a lot of the risks are associated only with animal-derived HRT rather bioidentitical, so you might want to check out our previous article:
HRT: A Tale Of Two Approaches (Bioidentical vs Animal)
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Uric Acid’s Extensive Health Impact (And How To Lower It)
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Uric Acid’s Extensive Health Impact (And How To Lower It)
This is Dr. David Perlmutter. He’s a medical doctor, and a Fellow of the American College of Nutrition. He’s a member of the Editorial Board for the Journal of Alzheimer’s Disease, and has been widely published in many other peer-reviewed journals.
What does he want us to know?
He wants us to know about the health risks of uric acid (not something popularly talked about so much!), and how to reduce it.
First: what is it? Uric acid is a substance we make in our own body. However, unlike most substances we make in our body, we have negligible use for it—it’s largely a waste product, usually excreted in urine.
However, if we get too much, it can build up (and crystallize), becoming such things as kidney stones, or causing painful inflammation if it shows up in the joints, as in gout.
More seriously (unpleasant as kidney stones and gout may be), this inflammation can have a knock-on effect triggering (or worsening) other inflammatory conditions, ranging from non-alcoholic fatty liver disease, to arthritis, to dementia, and even heart problems. See for example:
- David Perlmutter | Uric Acid and Cognitive Decline
- American Heart Association | Uric acid linked to later risk for irregular heart rhythm
- World Journal of Gastroenterology | The role of uric acid in non-alcoholic steatohepatitis development
How can we reduce our uric acid levels?
Uric acid is produced when we metabolize purine nucleotides, which are found in many kinds of food. We can therefore reduce our uric acid levels by reducing our purine intake, as well as things that mess up our liver’s ability to detoxify things. Offsetting the values for confounding variables (such as fiber content, or phytochemicals that mitigate the harm), the worst offenders include…
Liver-debilitating things:
- Alcohol (especially beer)
- High-fructose corn syrup (and other fructose-containing things that aren’t actual fruit)
- Other refined sugars
- Wheat / white flour products (this is why beer is worse than wine, for example; it’s a double-vector hit)
Purine-rich things:
- Red meats and game
- Organ meats
- Oily fish, and seafood (great for some things; not great for this)
Some beans and legumes are also high in purines, but much like real fruit has a neutral or positive effect on blood sugar health despite its fructose content, the beans and legumes that are high in purines, also contain phytochemicals that help lower uric acid levels, so have a beneficial effect.
Eggs (consumed in moderation) and tart cherries have a uric-acid lowering effect.
Water is important for all aspects of health, and doubly important for this.
Hydrate well!
Lifestyle matters beyond diet
The main key here is metabolic health, so Dr. Perlmutter advises the uncontroversial lifestyle choices of moderate exercise and good sleep, as well as (more critically) intermittent fasting. We wrote previously on other things that can benefit liver health:
…in this case, that means the liver gets a break to recuperate (something it’s very good at, but does need to get a chance to do), which means that while you’re not giving it something new to do, it can quickly catch up on any backlog, and then tackle any new things fresh, next time you start eating.
Want to know more about this from Dr. Perlmutter?
You might like his article:
An Integrated Plan for Lowering Uric Acid ← more than we had room for here; he also talks about extra things to include in your diet/supplementation regime for beneficial effects!
And/or his book:
…on which much of today’s main feature was based.
Take care!
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Hack Your Hunger
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When it comes to dealing with hunger, a common-sense way of dealing with it is “eat something”. However, many people find that they then eat the wrong things, in the wrong quantities, and end up in a cycle of overeating and being hungry.
If this gets to the extreme, it can turn into a full-blown eating disorder:
Eating Disorders: More Varied (And Prevalent) Than People Think
…and even in more moderate presentations, the cycle of hunger and overeating is not great for the health. So, how to avoid that?
Listen to your body (but: actually listen)
Your body says: we’re running a little low on glycogen reserves so our energy’s going to start suffering in a few hours if we don’t eat some fruit, kill something and eat its fatty organs, or perhaps find some oily nuts.
You hear: eat something bright and sugary, shout at the dog, eat some fried food, got it!
Your body says: our water balance is a little off, we could do with some sodium, potassium, and perhaps some phosphorus to correct it.
You hear: eat something salty, got it, potato chips coming right up!
…and so on. Now, we know 10almonds readers are quite a health-conscious readership, so perhaps your responses are not quite like that. But the take-away point is still important: we need to listen to the whole message, and give the body what it actually needs, not what will just shut the message off the most quickly.
Here’s how: Intuitive Eating Might Not Be What You Think
Bonus: Interoception: Improving Our Awareness Of Body Cues
About those cravings…
As illustrated a little above, a lot of cravings might not be what they first appear, and in evolutionary terms, our body is centuries behind industrialization, in terms of adaptations, which means that even if we try to take the above into account, our responses can sometimes be inappropriate in the age of supermarkets.
See also: The Science of Hunger, And How To Sate Cravings
Natural appetite suppressants
Eating more is not always the answer, not even if it’s more healthy food. And hunger pangs can be especially inconvenient if, for example, we are fasting at present, which is by the way a very healthful thing for most people:
Learn more: Intermittent Fasting: What’s the truth?
One way to suppress hunger is simply to trigger the stomach into sending “full” signals, which involves filling it. Since you do not want to overeat, the trick here is imply to use high-volume food.
Consider for example: 30 grapes and 30 raisins have approximately the same calorie count (what with raisins being dried grapes, and the calories didn’t evaporate), but the bowl of fresh fruit is going to physically fill your stomach a lot more quickly than the tiny amount of dried fruit.
More on this: Some Surprising Truths About Hunger And Satiety
Protein is of course also an appetite suppressant, but it takes about 20 minutes for the signal to kick in. So a “hack” here is to snack on something proteinous at least 15 minutes before your main meal (for example, a portion of nuts while cooking, unless you’re allergic, or some dried fish unless you’re vegetarian/vegan; you get it, pick something high in protein and good for snacking, and have a small portion before your main meal).
Nor is protein the only option!
See also: 3 Natural Appetite Suppressants Better Than Ozempic
Scale it down
Related to the above, there is a feedback loop that occurs here. The more you eat, the more your stomach slowly grows to accommodate it; the less you eat, the more your stomach slowly shrinks because the body tries hard to be an efficient organism, and will not maintain something that isn’t being used.
So, there’s a bit of a catch-22; sate your hunger by filling your stomach with high volume foods, but filling it will cause it to grow?
The trick is: do the “eat until 80% full” thing. That’s full enough that you have had a nice meal and are not suffering, without stretching the stomach.
Enjoy your food
Seriously! Actually enjoy it. Which means paying full attention to it. Eating can and should be a wonderful experience, so it’s best savored rather than inhaling a bowl of something in 30 seconds.
Have you seen those dog bowls that have obstructions to slow down how quickly a dog eats? We can leverage that kind of trick too! While you might not want to eat from a dog bowl, how about having a little bowl of pistachio nuts rather than ready-to-eat peanuts? Or any shelled nuts that we must shell as we go. If you’re allergic to nuts, there are plenty of other foods with a high work-to-food ratio. Take some time and enjoy that pomegranate, for instance!
Not that we necessarily have to make things difficult for ourselves either; we can just take appropriate care to ensure a good dining experience. Life is for living, so why not enjoy it?
See also: Mindful Eating: How To Get More Out Of What’s On Your Plate
Enjoy!
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Visceral Belly Fat & How To Lose It
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Visceral Belly Fat & How To Lose It
We’ve talked before about how waist circumference is a much more useful indicator of metabolic health than BMI.
So, let’s say you’ve a bit more around the middle than you’d like, but it stubbornly stays there. What’s going on underneath what you can see, why is it going on, and how can you get it to change?
What is visceral fat?
First, let’s talk about subcutaneous fat. That’s the fat directly under your skin. Women usually have more than men, and that’s perfectly healthy (up to a point); it’s supposed to be that way. We (women) will tend to accumulate this mostly in places such as our breasts, hips, and butt, and work outwards from there. Men will tend to put it on more to the belly and face.
Side-note: if you’re undergoing (untreated) menopause, the changes in your hormone levels will tend to result in more subcutaneous fat to the belly and face too. That’s normal, and/but normal is not always good, and treatment options are great (with hormone replacement therapy, HRT, topping the list).
Visceral fat (also called visceral adipose tissue), on the other hand, is the fat of the viscera—the internal organs of the abdomen.
So, this is fat that goes under your abdominal muscles—you can’t squeeze this (directly).
So what can we do?
Famously “you can’t do spot reduction” (lose fat from a particular part of your body by focusing exercises on that area), but that’s about subcutaneous fat. There are things you can do that will reduce your visceral fat in particular.
Some of these advices you may think “that’s just good advice for losing fat in general” and it is, yes. But these are things that have the biggest impact on visceral fat.
Cut alcohol use
This is the biggie. By numerous mechanisms, some of which we’ve talked about before, alcohol causes weight gain in general yes, but especially for visceral fat.
Get better sleep
You might think that hitting the gym is most important, but this one ranks higher. Yes, you can trim visceral fat without leaving your bed (and even without getting athletic in bed, for that matter). Not convinced?
- Here’s a study of 101 people looking at sleep quality and abdominal adiposity
- Oh, and here’s a meta-analysis with 56,000 people (finding the same thing), in case that one study didn’t convince you.
So, the verdict is clear: you snooze, you lose (visceral fat)!
Tweak your diet
You don’t have to do a complete overhaul (unless you want to), but a few changes can make a big difference, especially:
- Getting more fiber (this is the biggie when it comes to diet)
- Eating less sugar (not really a surprise, but relevant to mention)
- Eat whole foods (skip the highly processed stuff)
If you’d like to learn more and enjoy videos, here’s an informative one to get you going!
Click Here If The Embedded Video Doesn’t Load Automatically! Don’t Forget…
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PTSD, But, Well…. Complex.
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PTSD is typically associated with military veterans, for example, or sexual assault survivors. There was a clear, indisputable, Bad Thing™ that was experienced, and it left a psychological scar. When something happens to remind us of that—say, there are fireworks, or somebody touches us a certain way—it’ll trigger an immediate strong response of some kind.
These days the word “triggered” has been popularly misappropriated to mean any adverse emotional reaction, often to something trivial.
But, not all trauma is so clear. If PTSD refers to the result of that one time you were smashed with a sledgehammer, C-PTSD (Complex PTSD) refers to the result of having been hit with a rolled-up newspaper every few days for fifteen years, say.
This might have been…
- childhood emotional neglect
- a parent with a hair-trigger temper
- bullying at school
- extended financial hardship as a young adult
- “just” being told or shown all too often that your best was never good enough
- the persistent threat (real or imagined) of doom of some kind
- the often-reinforced idea that you might lose everything at any moment
If you’re reading this list and thinking “that’s just life though”, you might be in the estimated 1 in 5 people with (often undiagnosed) C-PTSD.
How About You? Take The (5mins) Test Here
Now, we at 10almonds are not doctors or therapists and even if we were, we certainly wouldn’t try to diagnose from afar. But, even if there’s only a partial match, sometimes the same advice can help.
So what are the symptoms of C-PTSD?
- A feeling that nothing is safe; we might suddenly lose what we have gained
- The body keeps the score… And it shows. We may have trouble relaxing, an aversion to exercise for reasons that don’t really add up, or an aversion to being touched.
- Trouble sleeping, born of nagging sense that to sleep is to be vulnerable to attack, and/or lazy, and/or negligent of our duties
- Poor self-image, about our body and/or about ourself as a person.
- We’re often drawn to highly unavailable people—or we are the highly unavailable person to which our complementary C-PTSD sufferers are attracted.
- We are prone to feelings of rage. Whether we keep a calm lid on it or lose our temper, we know it’s there. We’re angry at the world and at ourselves.
- We are not quick to trust—we may go through the motions of showing trust, but we’re already half-expecting that trust to have been misplaced.
- “Hell is other people” has become such a rule of life that we may tend to cloister ourselves away from company.
- We may try to order our environment around us as a matter of safety, and be easily perturbed by sudden changes being imposed on us, even if ostensibly quite minor or harmless.
- In a bid to try to find safety, we may throw ourselves into work—whatever that is for us. It could be literally our job, or passion projects, or our family, or community, and in and of itself that’s great! But the motivation is more of an attempt to distract ourselves from The Horrors™.
“Alright, I scored more of those than I care to admit. What now?”
A lot of the answer lies in first acknowledging to yourself what happened, to make you feel the way you do now. If you, for example, have an abject hatred of Christmas, what were your childhood Christmases like? If you fear losing money that you’ve accumulated, what underpins that fear? It could be something that directly happened to you, but it also could just be repeated messages you received from your parents, for example.
It could even be that you had superficially an idyllic perfect childhood. Health, wealth, security, a loving family… and simply a chemical imbalance in your brain made it a special kind of Hell for you that nobody understood, and perhaps you didn’t either.
Unfortunately, a difficult task now lies ahead: giving love, understanding, compassion, and reassurance to the person for whom you may have the most contempt in the world: yourself.
If you’d like some help with that, here are some resources:
ComplexTrauma.org (a lot of very good free resources, with no need for interaction)
CPTSD Foundation (mostly paid courses and the like)
Some final words about healing…
- You are in fact amazing,
- You can do it, and
- You deserve it.
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Why We’re Called “10almonds”, And Other Questions
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Avid coffee drinker so very interested in the results Also question Is there something that you could take or eat that would prevent the caffeine from stimulating the kidneys? I tried to drink decaf from morning to night not a good result! Thanks❞
That is a good question! The simple answer is “no” (but keep reading, because all is not lost)
There’s no way (that we yet know of) to proof the kidneys against the stimulating effect of caffeine. This is especially relevant because part of caffeine’s stimulating effect is noradrenergic, and that “ren” in the middle there? It’s about the kidneys. This is just because the adrenal gland is situated next to them (actually, it’s pretty much sitting on top of them), hence the name, but it does mean that the kidneys are about the hardest thing in the body to have not effected by caffeine.
However! The effects of caffeine in general can be softened a little with l-theanine (found in tea, or it can be taken as a supplement). It doesn’t stop it from working, but it makes the curve of the effect a little gentler, and so it can reduce some unwanted side effects.
You can read more about l-theanine here:
❝How to jump start a inactive metabolism and keep it going? THANKYOU❞
The good news is, if you’re alive, your metabolism is active (it never stops!). So, it may just need perking up a little.
As for keeping it going, well, that’s what we’re here for! We’re all in favor of healthy longevity.
We’ll do a main feature soon on what we can do to influence our metabolism in either direction, but to give some quick notes here:
- A lot of our metabolism is influenced by genes and is unalterable (without modifying our genes, anyway)
- Metabolism isn’t just one thing—it’s many. And sometimes, parts of our metabolism can be much quicker or slower than others.
- When people talk about wanting a “faster metabolism”, they’re usually referring to fat-burning, and that’s just a small part of the picture, but we understand that it’s a focal point for many.
There really is enough material for a whole main feature on metabolic tweaks, though, so watch this space!
❝Why the name “10 Almonds?” Is this recommended by the Doctor? A daily dosage? And, if so, why? Thanks! Please answer me…I truly want to know!❞
Almonds are very nutritionally dense, and for example 20g of almonds (so, about 20 almonds) would give a 100% daily dose of zinc, amongst other nutrients.
We also do like to think that we give our readers an easily digestible dose of condensed “nutrition” in the form of health information.
However! That’s not actually the reason at all. It’s a reference to a viral Facebook hoax! There was a post going around that claimed:
❝HEADACHE REMEDY. Eat 10–12 almonds, the equivalent of two aspirins, next time you have a headache❞ ← not true!
It made us think about how much health-related disinformation there was circulating online! So, calling ourselves 10almonds was a bit of a nod to that story, but also a reminder to ourselves:
We must always publish information with good scientific evidence behind it!
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