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.The Conversation

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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  • Alpha, beta, theta: what are brain states and brain waves? And can we control them?

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    There’s no shortage of apps and technology that claim to shift the brain into a “theta” state – said to help with relaxation, inward focus and sleep.

    But what exactly does it mean to change one’s “mental state”? And is that even possible? For now, the evidence remains murky. But our understanding of the brain is growing exponentially as our methods of investigation improve.

    Brain-measuring tech is evolving

    Currently, no single approach to imaging or measuring brain activity gives us the whole picture. What we “see” in the brain depends on which tool we use to “look”. There are myriad ways to do this, but each one comes with trade-offs.

    We learnt a lot about brain activity in the 1980s thanks to the advent of magnetic resonance imaging (MRI).

    Eventually we invented “functional MRI”, which allows us to link brain activity with certain functions or behaviours in real time by measuring the brain’s use of oxygenated blood during a task.

    We can also measure electrical activity using EEG (electroencephalography). This can accurately measure the timing of brain waves as they occur, but isn’t very accurate at identifying which specific areas of the brain they occur in.

    Alternatively, we can measure the brain’s response to magnetic stimulation. This is very accurate in terms of area and timing, but only as long as it’s close to the surface.

    What are brain states?

    All of our simple and complex behaviours, as well as our cognition (thoughts) have a foundation in brain activity, or “neural activity”. Neurons – the brain’s nerve cells – communicate by a sequence of electrical impulses and chemical signals called “neurotransmitters”.

    Neurons are very greedy for fuel from the blood and require a lot of support from companion cells. Hence, a lot of measurement of the site, amount and timing of brain activity is done via measuring electrical activity, neurotransmitter levels or blood flow.

    We can consider this activity at three levels. The first is a single-cell level, wherein individual neurons communicate. But measurement at this level is difficult (laboratory-based) and provides a limited picture.

    As such, we rely more on measurements done on a network level, where a series of neurons or networks are activated. Or, we measure whole-of-brain activity patterns which can incorporate one or more so-called “brain states”.

    According to a recent definition, brain states are “recurring activity patterns distributed across the brain that emerge from physiological or cognitive processes”. These states are functionally relevant, which means they are related to behaviour.

    Brain states involve the synchronisation of different brain regions, something that’s been most readily observed in animal models, usually rodents. Only now are we starting to see some evidence in human studies.

    Various kinds of states

    The most commonly-studied brain states in both rodents and humans are states of “arousal” and “resting”. You can picture these as various levels of alertness.

    Studies show environmental factors and activity influence our brain states. Activities or environments with high cognitive demands drive “attentional” brain states (so-called task-induced brain states) with increased connectivity. Examples of task-induced brain states include complex behaviours such as reward anticipation, mood, hunger and so on.

    In contrast, a brain state such as “mind-wandering” seems to be divorced from one’s environment and tasks. Dropping into daydreaming is, by definition, without connection to the real world.

    We can’t currently disentangle multiple “states” that exist in the brain at any given time and place. As mentioned earlier, this is because of the trade-offs that come with recording spatial (brain region) versus temporal (timing) brain activity.

    Brain states vs brain waves

    Brain state work can be couched in terms such as alpha, delta and so forth. However, this is actually referring to brain waves which specifically come from measuring brain activity using EEG.

    EEG picks up on changing electrical activity in the brain, which can be sorted into different frequencies (based on wavelength). Classically, these frequencies have had specific associations:

    • gamma is linked with states or tasks that require more focused concentration
    • beta is linked with higher anxiety and more active states, with attention often directed externally
    • alpha is linked with being very relaxed, and passive attention (such as listening quietly but not engaging)
    • theta is linked with deep relaxation and inward focus
    • and delta is linked with deep sleep.

    Brain wave patterns are used a lot to monitor sleep stages. When we fall asleep we go from drowsy, light attention that’s easily roused (alpha), to being relaxed and no longer alert (theta), to being deeply asleep (delta).

    Can we control our brain states?

    The question on many people’s minds is: can we judiciously and intentionally influence our brain states?

    For now, it’s likely too simplistic to suggest we can do this, as the actual mechanisms that influence brain states remain hard to detangle. Nonetheless, researchers are investigating everything from the use of drugs, to environmental cues, to practising mindfulness, meditation and sensory manipulation.

    Controversially, brain wave patterns are used in something called “neurofeedback” therapy. In these treatments, people are given feedback (such as visual or auditory) based on their brain wave activity and are then tasked with trying to maintain or change it. To stay in a required state they may be encouraged to control their thoughts, relax, or breathe in certain ways.

    The applications of this work are predominantly around mental health, including for individuals who have experienced trauma, or who have difficulty self-regulating – which may manifest as poor attention or emotional turbulence.

    However, although these techniques have intuitive appeal, they don’t account for the issue of multiple brain states being present at any given time. Overall, clinical studies have been largely inconclusive, and proponents of neurofeedback therapy remain frustrated by a lack of orthodox support.

    Other forms of neurofeedback are delivered by MRI-generated data. Participants engaging in mental tasks are given signals based on their neural activity, which they use to try and “up-regulate” (activate) regions of the brain involved in positive emotions. This could, for instance, be useful for helping people with depression.

    Another potential method claimed to purportedly change brain states involves different sensory inputs. Binaural beats are perhaps the most popular example, wherein two different wavelengths of sound are played in each ear. But the evidence for such techniques is similarly mixed.

    Treatments such as neurofeedback therapy are often very costly, and their success likely relies as much on the therapeutic relationship than the actual therapy.

    On the bright side, there’s no evidence these treatment do any harm – other than potentially delaying treatments which have been proven to be beneficial.The Conversation

    Susan Hillier, Professor: Neuroscience and Rehabilitation, University of South Australia

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • What does it mean to be immunocompromised?

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    Our immune systems help us fight off disease, but certain health conditions and medications can weaken our immune systems. People whose immune systems don’t work as well as they should are considered immunocompromised.

    Read on to learn more about how the immune system works, what causes people to be immunocompromised, and how we can protect ourselves and the immunocompromised people around us from illness.

    What is the immune system?

    The immune system is a network of cells, organs, and chemicals that helps our bodies fight off infections caused by invaders, such as bacteria, viruses, fungi, and parasites.

    Some important parts of the immune system include: 

    • White blood cells, which attack and kill germs that don’t belong inside our bodies. 
    • Lymph nodes, which help our bodies filter out germs. 
    • Antibodies, which help our bodies recognize invaders.
    • Cytokines, which tell our immune cells what to do.

    What causes people to be immunocompromised?

    Some health conditions and medications can prevent our immune systems from functioning optimally, which makes us more vulnerable to infection. Health conditions that compromise the immune system fall into two categories: primary immunodeficiency and secondary immunodeficiency.

    Primary immunodeficiency

    People with primary immunodeficiency are born with genetic mutations that prevent their immune systems from functioning as they should. There are hundreds of types of primary immunodeficiencies. Since these mutations affect the immune system to varying degrees, some people may experience symptoms and get diagnosed early in life, while others may not know they’re immunocompromised until adulthood.

    Secondary immunodeficiency

    Secondary immunodeficiency happens later in life due to an infection like HIV, which weakens the immune system over time, or certain types of cancer, which prevent the body from producing enough white blood cells to adequately fight off infection. Studies have also shown that getting infected with COVID-19 may cause immunodeficiency by reducing our production of “killer T-cells,” which help fight off infections.

    Sometimes necessary treatments for certain medical conditions can also cause secondary immunodeficiency. For example, people with autoimmune disorders—which cause the immune system to become overactive and attack healthy cells—may need to take immunosuppressant drugs to manage their symptoms. However, the drugs can make them more vulnerable to infection. 

    People who receive organ transplants may also need to take immunosuppressant medications for life to prevent their body from rejecting the new organ. (Given the risk of infection, scientists continue to research alternative ways for the immune system to tolerate transplantation.)

    Chemotherapy for cancer patients can also cause secondary immunodeficiency because it kills the immune system’s white blood cells as it’s trying to kill cancer cells.

    What are the symptoms of a compromised immune system?

    People who are immunocompromised may become sick more frequently than others or may experience more severe or longer-term symptoms than others who contract the same disease.

    Other symptoms of a compromised immune system may include fatigue; digestive problems like cramping, nausea, and diarrhea; and slow wound healing.

    How can I find out if I’m immunocompromised?

    If you think you may be immunocompromised, talk to your health care provider about your medical history, your symptoms, and any medications you take. Blood tests can determine whether your immune system is producing adequate proteins and cells to fight off infection.

    I’m immunocompromised—how can I protect myself from infection?

    If you’re immunocompromised, take precautions to protect yourself from illness.

    Wash your hands regularly, wear a well-fitting mask around others to protect against respiratory viruses, and ensure that you’re up to date on recommended vaccines.

    Immunocompromised people may need more doses of vaccines than people who are not immunocompromised—including COVID-19 vaccines. Talk to your health care provider about which vaccines you need.

    How can I protect the immunocompromised people around me?

    You never know who may be immunocompromised. The best way to protect immunocompromised people around you is to avoid spreading illnesses. 

    If you know you’re sick, isolate whenever possible. Wear a well-fitting mask around others—especially if you know that you’re sick or that you’ve been exposed to germs. Make sure you’re up to date on recommended vaccines, and practice regular hand-washing.

    If you’re planning to spend time with someone who is immunocompromised, ask them what steps you can take to keep them safe.

    For more information, talk to your health care provider.

    This article first appeared on Public Good News and is republished here under a Creative Commons license.

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  • Nutrivore – by Dr. Sarah Ballantyne

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    The core idea of this book is that foods can be assigned a numerical value according to their total nutritional value, and that this number can be used to guide a person’s diet such that we will eat, in aggregate, a diet that is more nutritious. So far, so simple.

    What Dr. Ballantyne also does, besides explaining and illustrating this system (there are chapters explaining the calculation system, and appendices with values), is also going over what to consider important and what we can let slide, and what things we might need more of to address a wide assortment of potential health concerns. And yes, this is definitely a “positive diet” approach, i.e. it focuses on what to add in, not what to cut out.

    The premise of the “positive diet” approach is simple, by the way: if we get a full set of good nutrients, we will be satisfied and not crave unhealthy food.

    She also offers a lot of helpful “rules of thumb”, and provides a variety of cheat-sheets and suchlike to make things as easy as possible.

    There’s also a recipes section! Though, it’s not huge and it’s probably not necessary, but it’s just one more “she’s thinking of everything” element.

    Bottom line: if you’d like a single-volume “Bible of” nutrition-made-easy, this is a very usable tome.

    Click here to check out Nutrivore, and start filling up your diet!

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  • Eat to Your Heart’s Content – by Dr. Sat Bains

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Making food heart-healthy and tasty is a challenge that vexes many, but it doesn’t have to be so difficult.

    Dr. Sat Bains, a professional chef with multiple Michelin stars to his name, is an expert on “tasty”, and after surviving a heart attack himself, he’s become an expert on “heart-healthy” since then.

    The book contains not only the recipes (of which there are 68, by the way), but also large sections of explanation of what makes various ingredients or methods heart-healthy or heart-unhealthy.

    There’s science in there too, and these sections were written under the guidance of Dr. Neil Williams, a lecturer in physiology and nutrition.

    You may be wondering as to why the author himself has a doctorate too; in fact he has three, none of which are relevant:

    1. Doctor of Arts
    2. Doctor of Laws
    3. Doctor of Hospitality (Honorary)

    …but we prefix “Dr.” when people are that and he is that. The expertise we’re getting here though is really his culinary skill and extracurricular heart-healthy learning, plus Dr. Williams’ actual professional health guidance.

    Bottom line: if you’d like heart-healthy recipes with restaurant-level glamour, this book is a fine choice.

    Click here to check out Eat To Your Heart’s Content, and look after yours!

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  • Meditation That You’ll Actually Enjoy

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    Meditation That You’ll Actually Enjoy

    We previously wrote about…

    No-Frills, Evidence-Based Mindfulness

    this is a great primer, by the way, for the science and simplicity of mindfulness, along with the simplest mindfulness meditation to get you going.

    Today, we’re going to have some fun with meditation.

    First: The Problem

    Once the usefulness and health benefits of meditation have been established, often people want to meditate, but complain they don’t have the time.

    But that’s not the real reason, though, is it?

    Let’s face it, a basic meditation can give benefits within two minutes. Or within two breaths, for that matter. So, it’s not really for a lack of time.

    The real reason is because it doesn’t feel productive, and it’s not fun. For us to feel motivated to do a thing, usually we need at least one or the other. And even if we know it really is productive, it not feeling that way will hobble us.

    So instead, let us make things a little more fun, with…

    Meditation games!

    As it turns out, there are good kinds of meditation with which one can have a little fun.

    Catch the next thought

    A common feature of many meditative practices is the experience of having fewer, or ideally no, thoughts.

    But it’s hard to enact a negative, and thoughts keep coming.

    So instead, make yourself comfortable, settle in, and lie in wait for thoughts. When one comes along, pounce on it in your mind. And then release it, and wait for the next.

    At first, your thoughts may be coming thick and fast, but soon, you’ll find the pauses between them lengthening, and you have moments of contented not-knowing of what the next thought will be before it comes along.

    This state of relaxed, ready alertness, calm and receptive, is exactly what we’re hoping to find here. But don’t worry about that while you’re busy lying in wait for the next wild thought to come along

    Counting breaths

    Many meditative practices involve focus on one’s breath. But it’s easy for attention to wander!

    This game is a simple one. Count your breaths, not trying to change your rate of breathing at all, just letting it be, and see how high you can get before you lose count.

    Breathing in and out, once, counts as one breath, by the way.

    You may find that your rate of breathing naturally slows while you’re doing this. That’s fine; let it. It’ll add to the challenge of the game, because before long there will be lengthy pauses between each number.

    If you lose count, just start again, and see if you can beat your high score.

    This meditation game is an excellent exercise to build for sustained focus, while also improving the quality of breathing (as a side-effect of merely paying attention to it).

    Hot spot, cold spot

    The above two meditation games were drawn from Japanese and Chinese meditative practices, zen and qigong respectively; this one’s from an Indian meditative practice, yoga nidra. But for now, just approach it with a sense of playful curiosity, for best results.

    Make yourself comfortable, lying on your back, arms by your sides.

    Take a moment first to pay attention to each part of your body from head to toe, and release any tension that you may be holding along the way.

    First part: mentally scan your body for where it feels warmest, or most active, or most wanting of attention (for example if there is pain, or an itch, or some other sensation); that’s your “hot spot” for the moment.

    Second part: mentally scan your body for where it feels coolest, or most inert, or almost like it’s not a part of your body at all; that’s your “cold spot” for the moment.

    Now, see if you can flip them. Whether you can or can’t, notice if your “hot spot” or “cold spot” moves, or if you can move them consciously.

    This meditation game is a great exercise to strengthen interoception and somatic awareness in general—essential for being able to “listen to your body”!

    Closing thoughts

    All three practices above have very serious reasons and great benefits, but make sure you don’t skip enjoyment of the fun aspects!

    Being “young at heart” is, in part, to do with the ability to enjoy—literally, to take joy in—the little things in life.

    With that in mind, all we have left to say here is…

    Enjoy!

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  • 52 Ways to Walk – by Annabel Streets

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Most of us learned to walk at a very young age and probably haven’t thought much about it since, except perhaps in a case where some injury made it difficult.

    Annabel Streets provides a wonderful guide to not just taking up (or perhaps reclaiming) the joy of walking, but also the science of it in more aspects than most of us have considered:

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    • Boots or shoes? Barefoot?
    • Roads, grass, rougher vegetation… Mud?
    • Flora & fauna down to the microbiota that affect us
    • How much walking is needed, to be healthy?
    • Is there such a thing as too much walking?
    • What are the health benefits (or risks) of various kinds of weather?
    • Is it better to walk quickly or to walk far?
    • What about if we’re carrying some injury?
    • What’s going on physiologically when we walk?
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    Streets writes with a captivating blend of poetic joie-de-vivre coupled with scientific references.

    One moment the book is talking about neuroradiology reports of NO-levels in our blood, the impact of Mycobacterium vaccae, and the studied relationship between daily steps taken and production of oligosaccharide 3′-sialyllactose, and the next it’s all:

    “As if the newfound lightness in our limbs has crept into our minds, loosening our everyday cares and constraints…”

    And all in all, this book helps remind us that sometimes, science and a sense of wonder can and do (and should!) walk hand-in-hand.

    Treat yourself to “52 Ways to Walk” from Amazon today!

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