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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Treadmill vs Road
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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 😎
❝Why do I get tired much more quickly running outside, than I do on the treadmill? Every time I get worn out quickly but at home I can go for much longer!❞
Short answer: the reason is Newton’s laws of motion.
In other words: on a treadmill, you need only maintain your position in space relative the the Earth while the treadmill moves beneath you, whereas on the road, you need to push against the Earth with sufficient force to move it relative to your body.
Illustrative thought experiment to make that clearer: if you were to stand on a treadmill with roller skates, and hold onto the bar with even just one finger, you would maintain your speed as far as the treadmill’s computer is concerned—whereas to maintain your speed on a flat road, you’d still need to push with your back foot every few yards or so.
More interesting answer: it’s a qualitatively different exercise (i.e. not just quantitively different). This is because of all that pushing you’re having to do on the road, while on a treadmill, the only pushing you have to do is just enough to counteract gravity (i.e. to keep you upright).
As such, both forms of running are a cardio exercise (because simply moving your legs quickly, even without having to apply much force, is still something that requires oxygenated blood feeding the muscles), but road-running adds an extra element of resistance exercise for the muscles of your lower body. Thus, road-running will enable you to build-maintain muscle much more than treadmill-running will.
Some extra things to bear in mind, however:
1) You can increase the resistance work for either form of running, by adding weight (such as by wearing a weight vest):
Weight Vests Against Osteoporosis: Do They Really Build Bone?
…and while road-running will still be the superior form of resistance work (for the reasons we outlined above), adding a weight vest will still be improving your stabilization muscles, just as it would if you were standing still while holding the weight up.
2) Stationary cycling does not have the same physics differences as stationary running. By this we mean: an exercise bike will require your muscles to do just as much pushing as they would on a road. This makes stationary cycling an excellent choice for high intensity resistance training (HIRT):
3) The best form of exercise is the one that you will actually do. Thus, when it’s raining sidewise outside, a treadmill inside will get exercise done better than no running at all. Similarly, a treadmill exercise session takes a lot less preparation (“switch it on”) than a running session outside (“get dressed appropriately for the weather, apply sunscreen if necessary, remember to bring water, etc etc”), and thus is also much more likely to actually occur. The ability to stop whenever one wants is also a reassuring factor that makes one much more likely to start. See for example:
How To Do HIIT (Without Wrecking Your Body)
Take care!
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The Energy Plan – by James Collins
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There’s a lot of conflicting advice out there about how we should maintain our energy levels, for example:
- Eat fewer carbs!
- Eat more carbs!
- Eat slow-release carbs!
- Eat quick-release carbs!
- Practise intermittent fasting!
- Graze constantly throughout the day!
- Forget carbs and focus on fats!
- Actually it’s all about B-vitamins!
…and so on.
What Collins does differently is something much less-often seen:
Here, we’re advised on how to tailor our meals to our actual lifestyle, taking into account the day we actually have each day. For example:
- What will our energy needs be for the day?
- Will our needs be intense, or long, or both, or neither?
- What kind of recovery have we had, or do we need, from previous activities?
- Do we need to replace lost muscle glycogen, or are we looking to trim the fat?
- Are we doing a power-up or just maintenance today?
Rather than bidding us have a five-way spreadsheet and do advanced mathematics for every meal, though, Collins has done the hard work for us. The book explains the various principles in a casual format with a light conversational tone, and gives us general rules to follow.
These rules cover what to do for different times of day… and also, at different points in our life (the metabolic needs of a 13-year-old, 33-year-old, and 83-year-old, are very different!). That latter’s particularly handy, as a lot of books assume an age bracket for the reader, and this one doesn’t.
In short: a great book for anyone who wants to keep their energy levels up (throughout life’s ups and downs in activity) without piling on the pounds or starving oneself.
Click here to check out The Energy Plan on Amazon and fuel your days better!
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Apples vs Figs – Which is Healthier?
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Our Verdict
When comparing apples to figs, we picked the figs.
Why?
These two fruits are both known for being quite rich in sugar (but also rich in fiber, which offsets it metabolically), and indeed their macros are quite similar. That said, figs have slightly more protein, fiber, and carbs. Both are considered low glycemic index foods. We can consider this category a tie, or perhaps a nominal win for apples, whose glycemic index is the lower of the two. But since figs’ GI is also low, it’s really not a deciding factor.
In terms of vitamins, apples have more of vitamins C and E, while figs have more of vitamins A, B1, B2, B3, B5, B6, B9, and choline, with noteworthy margins of difference. A clear for figs here.
When it comes to minerals, apples are not higher in any minerals, while figs are several times higher in calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. An overwhelming win for figs.
Of course, enjoy either or both, but if you want nutritional density, apples simply cannot compete with figs.
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Peace Is Every Step – by Thích Nhất Hạnh
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Mindfulness is one of the few practices to make its way from religion (in this case, Buddhism) into hard science. We’ve written before about its many evidence-based benefits, and many national health information outlets recommend it. So, what does this book have to add?
Thích Nhất Hạnh spent most of his 95 years devoted to the practice and teaching of mindfulness and compassion. In this book, the focus is on bringing mindfulness off the meditation mat and into general life.
After all, what if we could extend that “unflappability” into situations that pressure and antagonize us? That would be some superpower!
The author offers techniques to do just that, simple exercises to transform negative emotions, and to make us more likely to remember to do so.
After all, “in the heat of the moment” is rarely when many of us are at our best, this book gives way to allow those moments themselves to serve as immediate triggers to be our best.
The title “Peace Is Every Step” is not a random collection of words; the goal of this book is to enable to reader to indeed carry peace with us as we go.
Not just “peace is always available to us”, but if we do it right: “we have now arranged for our own peace to automatically step in and help us when we need it most”.
Bottom line: if you’d like to practice mindfulness, or practice it more consistently, this book offers some powerful tools.
Click here to check out Peace Is Every Step, and carry yours with you!
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How To Keep On Keeping On?
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How To Keep On Keeping On… Long Term!
For many when it comes to health-related goals and practices, it’s easy to find ourselves in a bit of a motivational dip around this time of year. The enthusiasm of new year’s resolutions has been and gone, and there’s not yet much of a drive to “get a beach body” or “be summer-ready”.
A word to the wise on those before moving on, though:
- How to get a beach body: take your body to a beach. Voilà. Beach body.
- Remember: the beach is there for your pleasure and entertainment, not the other way around!
- How to be summer-ready: the real question is, will summer be ready for you?
But what is this, demotivational rhetoric to discourage you from getting fit and healthy?
Not at all, but rather, to be sure that you’re pursuing your own goals and not just what you feel might be expected of you.
All that in mind, let’s get to the tips…
Focus on adding health
It can be tempting (and even, good) to cut down on unhealthy things. But when it comes to motivation, it’s harder to stay motivated for deprivation, than it is for some healthy addition to life.
So for example, this philosophy would advocate for:
- Instead of counting calories, count steps! Or even…
- Instead of counting calories, count colors! Eat the rainbow and all that. No, skittles do not count, but eating a variety of naturally different-colored foods will tend to result in adding different nutrients to your diet.
- Instead of cutting out sugar, add fruit! How many per day will you go for? If you don’t eat much fruit as it is, consider making it a goal to have even just one piece of fruit a day, then build up from there. Find fruit you like! If you pick the fruit you want instead of the fruit you think you “should” have, it’s basically a dessert snack.
We’ve recommended it before, and we’ll recommend it again, but if you’re interested in “adding health”, you should definitely check out:
Dr. Greger’s Daily Dozen (checklist, plus app if you want it)
More details: it’s a checklist of 12 things you should try to include in your diet, with a free streak-tracking app, if you want it, all based on the same scientific research as the best-selling book “How Not To Die”.
“Minimum effort!”
Did you see the movie “Deadpool”? The protagonist has a catch-phrase as he goes into battle, saying to himself “Maximum effort!”.
And, that’s all very well and good if your superpower is immediate recovery from pretty much anything, but for the rest of us, sometimes it’s good to hold ourselves to “minimum effort!”.
Sometimes, something worth doing is worth doing just a little a bit. It’s always better than nothing! Even if feels like you gained nothing from it, it’s the foundation of a habit, and the habit will grow and add up. Sometimes it may even take you by surprise…
Don’t feel like doing 20 bodyweight squats? Do literally just one. Make a deal with yourself: do just one, then you can stop if you like. Then after you’ve done one, you might think to yourself “huh, that wasn’t so bad”, and you try out a few more. Maybe after 5 you can feel your blood pumping a bit and you think “you know what, that’s enough for now”, and great, you did 5x as much exercise as you planned! Wonder what you’ll do tomorrow!
(personal note from your writer here: I’ve managed to “just extend this exercise a little bit more than last time” my way into hour-long exercise sessions before now; I started with “just 10 squats” or “just one sun salutation” etc, to get myself out of a no-exercise period that I’d slipped into, and it’s amazing how quickly adding just a little bit to the previous day’s “minimum effort!” adds up to a very respectable daily exercise session)
Wondering what a good, easy, respectable short term goal could be?
Check Out, For Example: The Seven-Minute Workout
(You might have heard of this one before; it’s an incredibly efficient well-optimized short complete workout that requires no special equipment, just a bit of floorspace and a wall—the above app allows for customizations of it per your preferences, but the basic routine is an excellent starting point for most people)
Commit to yourself (and do any self-negotiation up-front)
Really commit, though. No “or I will look silly because I told people I’d do it”, no “or I will donate x amount to charity” etc, just “I will do it and that’s that”. If you find yourself second-guessing yourself or renegotiating with yourself, just shut that down immediately and refuse to consider it.
Note: you should have break-clauses in this contract with yourself, though. For example, “unless I am ill or injured” is a sensible rule to have in advance for most exercise regimes that weren’t undertaken with your illness or injury in mind.
Make a “To-Don’t” list
Much like how addicts are often advised to not try to quit more than one thing at once, we must also be mindful of not taking on too much at once. It can be very tempting to think:
“I will turn my life around, now! I’ll quit alcohol and animal products and sugar and refined grains, and I’ll go for a run each morning, and I’ll do this and that and there, I’ve got it, here is the blueprint for my healthy perfect life from this day forth!”
And, it’s great to have any and all of that as your end goal if you want, but please, pick one or two things at most to start with, focus on those, and when those have become second nature to you and just a normal part of your life, then choose the next thing to work on.
(You can plan out the whole thing in advance if you want! i.e., I’ll do this, then this, then this, but just… make sure that you’ve really got each one down to a matter of comfort and ease before you take up the next one)
In summary:
- Focus on adding health, whatever that looks like to you
- Figure out what “minimum effort!” is for you, and let that be your baseline
- Commit to yourself (and do any self-negotiation up-front, not later)
- Decide what you’re not going to do yet, and stick to that, too.
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- How to get a beach body: take your body to a beach. Voilà. Beach body.
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Krill Oil vs Fish Oil – Which is Healthier?
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Our Verdict
When comparing krill oil to fish oil, we picked the krill oil.
Why?
Both of these products are good sources of omega-3 fatty acids EPA and DHA, and for the specific brand depicted above, in both cases 2 softgels will give you the recommended daily amount (which is generally held to be 250–500mg combined omega-3s per day).
This brand’s fish oil gives more (640mg combined omega-3s per 2 softgels, to the same brand’s krill oil’s 480mg per 2 softgels), but since the krill oil is already in the high end of RDA territory, the excess beyond the RDA is not helpful, and not a huge factor. More quantity is not always better, when the body can only process so much at a time.
However, the krill oil gives some extra things that the fish oil doesn’t:
- Astaxanthin, a “super-antioxidant”
- and neuroprotectant, heart-healthy phospholipids
Additional considerations
We have declared “the winner” based on health considerations only. That’s a sticking point for us in all our writings; we’ll occasionally look at and mention other factors, but we know that health is what you’re here for, so that’s what we’ll always treat as most critical.
However, in case these factors may interest you and/or influence you to one or the other:
• The fish oil is about 30% cheaper financially
• The krill oil is a lot more sustainable environmentallyBack to the health science…
Read more:
• What Omega-3 Fatty Acids Really Do For Us
• Astaxanthin: Super-Antioxidant & NeuroprotectantWant some? Here for your convenience are some example products on Amazon:
(brands available will vary per region, but now you know what to look out for on the labels!)
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