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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Saunas: Health Benefits (& Caveats)
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The Heat Is On
In Tuesday’s newsletter, we asked you your (health-related) opinion on saunas, and got the above-depicted, below-described, set of responses:
- About 53% said it is “a healthful activity with many benefits”
- About 25% said it is “best avoided; I feel like I’m dying in there”
- About 12% said “it feels good and therefore can’t be all bad”
So what does the science say?
The heat of saunas carries a health risk: True or False?
False, generally speaking, for any practical purposes. Of course, anything in life comes with a health risk, but statistically speaking, your shower at home is a lot more dangerous than a sauna (risk of slipping with no help at hand).
It took a bit of effort to find a paper on the health risks of saunas, because all the papers on PubMed etc coming up for those keywords were initially papers with “reduces the risk of…”, i.e. ways in which the sauna is healthy.
However, we did find one:
❝Contraindications to sauna bathing include unstable angina pectoris, recent myocardial infarction, and severe aortic stenosis.
Sauna bathing is safe, however, for most people with coronary heart disease with stable angina pectoris or old myocardial infarction.
Very few acute myocardial infarctions and sudden deaths occur in saunas, but alcohol consumption during sauna bathing increases the risk of hypotension, arrhythmia, and sudden death, and should be avoided. ❞
~ Dr. Matti Hannuksela & Dr. Samer Ellahham
Source: Benefits and risks of sauna bathing
So, very safe for most people, safe even for most people with heart disease, but there are exceptions so check with your own doctor of course.
And drinking alcohol anywhere is bad for the health, but in a sauna it’s a truly terrible idea. As an aside, please don’t drink alcohol in the shower, either (risk of slipping with no help at hand, and this time, broken glass too).
On the topic of it being safe for most people’s hearts, see also:
Beneficial effects of sauna bathing for heart failure patients
As an additional note, those who have a particular sensitivity to the heat, may (again please check with your own doctor, as your case may vary) actually benefit from moderate sauna use, to reduce the cardiovascular strain that your body experiences during heatwaves (remember, you can get out of a sauna more easily than you can get out of a heatwave, so for many people it’s a lot easier to do moderation and improve thermoregulatory responses):
Sauna usage can bring many health benefits: True or False?
True! Again, at least for most people. As well as the above-discussed items, here’s one for mortality rates in healthy Finnish men:
Not only that, also…
❝The Finnish saunas have the most consistent and robust evidence regarding health benefits and they have been shown to decrease the risk of health outcomes such as hypertension, cardiovascular disease, thromboembolism, dementia, and respiratory conditions; may improve the severity of musculoskeletal disorders, COVID-19, headache and flu, while also improving mental well-being, sleep, and longevity.
Finnish saunas may also augment the beneficial effects of other protective lifestyle factors such as physical activity.
The beneficial effects of passive heat therapies may be linked to their anti-inflammatory, cytoprotective and anti-oxidant properties and synergistic effects on neuroendocrine, circulatory, cardiovascular and immune function.
Passive heat therapies, notably Finnish saunas, are emerging as potentially powerful and holistic strategies to promoting health and extending the healthspan in all populations. ❞
~ Dr. Jari Laukkanen & Dr. Setor Kunutsor
(the repeated clarification of “Finnish sauna” is not a matter of fervent nationalism, by the way, but rather a matter of disambiguating it from Swedish sauna, which has some differences, most notably a lack of steam)
That reminds us: in Scandinavia, it is usual to use a sauna naked, and in Finland in particular, it is a common social activity amongst friends, coworkers, etc. In the US, many people are not so comfortable with nudity, and indeed, many places that provide saunas, may require the wearing of swimwear. But…
Just one problem: if you’re wearing swimwear because you’ve just been swimming in a pool, you now have chlorinated water soaked into your swimwear, which in the sauna, will become steam + chlorine gas. That’s not so good for your health (and is one reason, beyond tradition and simple normalization, for why swimwear is usually not permitted in Finnish saunas).
Want to read more?
You might like our previous main feature,
Turning Up The Heat Against Diabetes & Alzheimer’s ← you guessed it, sauna may be beneficial against these too
Take care!
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Hantavirus Skin Signs, Symptoms, & More
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Did you know it does these things?
When the virus is cruising, your skin may be bruising
First, what it is, besides “that virus on the news”: it’s a relatively rare group of rodent-borne RNA viruses spread mainly through inhaling aerosolized particles from infected rodent urine, droppings, or saliva, with different strains causing either hantavirus pulmonary syndrome (HPS), which primarily affects the lungs, or hemorrhagic fever with renal syndrome (HFRS), which primarily affects kidneys and blood vessels.
Most infections occur when dried rodent waste is disturbed during cleaning in enclosed spaces such as barns, sheds, cabins, attics, or garages, causing contaminated dust to become airborne and inhaled, and rodent bites, scratches, contaminated food, or direct handling of nesting materials can also transmit infection.
As such, farmers, campers, construction workers, and people cleaning buildings where many rodents live—especially in rural or western US regions—face the greatest exposure risk.
Notably, hantavirus doesn’t spread easily like COVID or flu, and public health authorities continue to consider general public risk very low (at time of writing).
All that said, it’s good to know things, so:
- HPS can rapidly worsen into cough, shortness of breath, low oxygen, shock, and respiratory failure, where facial redness, petechiae, bruising, pale skin, sweating abnormalities, red eyes, or bluish-gray skin from oxygen deprivation can signal severe systemic illness.
- HFRS can cause facial flushing, petechiae (tiny red or purple bleeding spots), purpura, bruising, bleeding gums, nosebleeds, kidney problems, and widespread internal bleeding.
While infection risk is low, mortality can be around 40%, and there’s no specific antiviral cure, so treatment focuses on supportive care such as oxygen, ICU monitoring, mechanical ventilation, ECMO for lung failure, or dialysis for kidney failure.
For more on all of this plus visual illustrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
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How To Triple Your Chances Of Getting The “Razorblade Throat” COVID Variant Or Long COVID
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Well, that sounds like fun, doesn’t it? More formally known as variant NB.1.8.1, also called Nimbus (after the “NB” in its official name), comes under the Omicron variant umbrella, and is generally not nice.
Along with all the usual COVID symptoms, it is characterized by usually causing a razorblade sensation in the throat, along with gastrointestinal upset, including nausea and vomiting, which latter is probably the last thing you want if you have a “razorblade throat”.
Stats we know: in the US, it’s currently (at time of writing) the most popular variant, accounting for 43% of cases
Stats we don’t know: in the US, it’s currently (at time of writing) responsible for:
- a 21% increase in infections since the previous week
- a 40% increase in hospitalizations since the previous week
- a 36% decrease in deaths since the previous month
You may be wondering how we are giving numbers for what we said we don’t know. The answer is that COVID reporting is increasingly suffering from considerable reporting bias, that is to say, “it doesn’t count if we don’t count it”; low numbers look better for the government.
It’s the statistical equivalent of the old “if you need to use our accessible bathroom for disabled customers, please ask for the key at the desk upstairs” and then reporting that there was very low demand for it since almost nobody went upstairs to ask for the key.
Indeed, the above infection rate is generally being reported as, for example:
❝More of an uptick than a surge, the COVID case weekly positivity rate increased to 5.1% as of July 19, compared to 4.2% the week before, representing an increase of 0.3%, according to the CDC.❞
…and, that is mathematically very incorrect! A jump from 4.2 to 5.1 is not a 0.3% increase! It’s not even a 0.3 percentage points increase, it’s a 0.9 percentage points increase. Frankly, we don’t know where they got the 0.3% figure from, since the 0.9 percentage points increase can be arrived at easily by counting on one’s fingers.
As for the actual percentage increase:
- 4.2 is (of course) 100% of 4.2
- 5.1 is (grabbing a calculator) 121% of 4.2
- That is a 21% increase
…which is very different from the 0.3% increase claimed.
One important thing to understand before we get to tripling your chances of getting it
Remember when we said:
- a 40% increase in hospitalizations since the previous week
- a 36% decrease in deaths since the previous month
It’s easy to read that and think “ok, so, it’s less deadly, that’s at least one good thing”, and while there’s a logic to that… We would suggest that the death rate has gone down because the hospitalization rate has gone up, not because the variant is less deadly per se. Consider:
- You get a cough, it’s annoying, but whatever, you’re pretty sure it’s nothing. Then you can’t breathe, go to hospital, but it’s too late and you die.
- You get a cough, and nausea, and vomiting, and a razorblade throat. You go to hospital, get diagnosed, get treated, and you live.
So, the very unpleasant symptoms themselves are a protective factor, because it means you are more likely to go get treatment.
On which note…
How to triple your chances of getting it
Firstly we’ll note, the two (Omicron variant NB1.8.1, and long COVID) are linked, because higher survivorship rates mean higher long COVID rates (can’t get long COVID if you’re dead).
With that in mind, we’re going to talk about some long COVID research; just keep in mind that this new(ish) variant is more likely to produce long COVID than previous ones.
Researchers (Dr. Candace Feldman et al.) investigated social determinants of health that contribute both to infection rates and long COVID rates.
In few words: people facing financial hardship, food insecurity, limited healthcare access, low social/community support, crowded living conditions, or social disadvantages (e.g. being part of some socially marginalized demographic) are two to three times more likely to develop long COVID (it was already established that they were commensurately more likely to get infected in the first place).
This was arrived at by looking at 3,700 adults infected during the Omicron wave, tracking social risk factors at infection, and long COVID symptoms six months later. The significance of the data was high, and more social risk factors correlated with higher long COVID risk, even after adjusting for age, sex, race, ethnicity, disease severity, vaccination, and pregnancy status.
The researchers concluded that addressing social risk factors—like improving access to food, healthcare, and safe housing—may be essential to reducing long COVID burden.
You can read the paper here: Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort
What this means for you: let us imagine that you, dear reader, are financially secure with good healthcare access, and generally not subject to most of the problems above.
You have to act like it!
So…
If you want to triple your chances of getting infected with the latest variant, if you want to triple your chances of getting long COVID, here’s how to do it:
- Do not get updated vaccinations, even if you have good healthcare access
- Spend time in crowded places, even if you can afford not to
- Eat unhealthily, even if you are not in food insecurity
It’s easy, but a lot of people don’t think about it!
Want to learn more?
Check out:
Why Some People Get Sick More (And How To Not Be One Of Them)
Take care!
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The Beetroot Benefits That Depend On Your Age
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We’ve written before about beetroot’s considerable health benefits: Beetroot For More Than Just Your Blood Pressure
We even covered how to make it better in a surprising way: Beetroot Juice & Caffeine Work Better Than Either Alone
But what’s this about age differences?
Different for younger and older people
Researchers (Dr. Anni Vanhatalo et al.) investigated this, and wondered how much of beetroot’s beneficial effect is due to boosting nitric oxide (NO) production, something that aging typically reduces, but that nitrate-rich beetroot improves.
To test this, they did a randomized, placebo-controlled, double-blind crossover trial with young adults (18–30) and older adults (67–79). They excluded participants with cardiovascular, metabolic, pulmonary, or oral disease; smokers; anyone with high blood pressure (here defined as >140/90, notwithstanding that the usual standard is >130/90), and anyone who had recently used antibiotics.
The interventions were:
- nitrate-rich beetroot juice (2 × 70 ml/day, ~595 mg nitrate each)
- nitrate-depleted beetroot juice (same quantity of juice, no nitrate, functioning as placebo)
- antiseptic mouthwash (because they suspected that oral bacteria played a role)
These they tested with two-week treatment phases, with washout periods between (since the groups switched roles, being as it was a crossover trial, it was important to ensure that each group was not still being affected by the previous intervention).
What they measured: they did tongue swabs for microbiome sequencing, they checked plasma nitrate/nitrite for NO bioavailability, they also recorded blood pressure (brachial and central), endothelial function (flow-mediated dilation), and arterial stiffness.
What they found:
- Endothelial function and arterial stiffness remained unchanged in all groups. It seems this is simply not something that beetroot juice affects.
- The older adults had higher baseline blood pressure, and/but nitrate-rich beetroot juice lowered brachial mean arterial pressure in older adults while it had no significant effect in younger adults.
- In the category of oral microbiome changes, they found that in older adults, beetroot juice reduced Prevotella-dominated bacterial linked with DNRA (which diverts nitrite away from NO production), and that reduction in Prevotella correlated with higher plasma nitrite and lower blood pressure; nitrate-rich beetroot juice increased nitrate-reducing genera Neisseria and Rothia, especially in older adults, having only modest benefits for younger adults. Antiseptic mouthwash reduced microbial diversity (shocking nobody) and impaired vascular function.
- Nitrate-depleted juice still raised plasma nitrate/nitrite modestly and had a small lowering effect on blood pressure in older adults. This may have been because of:
- placebo effect doing its thing
- imperfect depletion of nitrates
- other unknown factors
- a combination of the above
In summary: in older adults, beetroot juice improves the oral microbiome and, partly because of that, lowers blood pressure. Younger adults get only marginal benefits at best, and use of antiseptic mouthwash completely wipes out the benefits.
You can read the paper itself, here: Ageing modifies the oral microbiome, nitric oxide bioavailability and vascular responses to dietary nitrate supplementation
Before you get juicing, there are some things you should be aware of: 3 Day Juice Fasting? Not So Fast! ← this isn’t even just about the glycemic index issue (juices being stripped of fiber), and is rather mostly about the microbiome problems juices can cause without sufficient dietary fiber (so, not so much a problem if, for example, you have a juice after a fibrous meal).
Not a fan of juices? This writer doesn’t love juices most of the time either, but we can enjoy: Hearty Healthy Ukrainian Borscht ← from our recipes archive!
Remember when…
…we talked about Dr. Ellie Phillips’ advices with regard to oral health?
In few words, Dr. Phillips promotes protecting oral microbial diversity by avoiding antibacterial mouthwashes; the study we talked about today also validated that, showing how antiseptic mouthwash (unsurprisingly) reduced microbial diversity and (importantly and relevantly) impaired vascular function.
Now, she often points to imbalances where certain bacteria overgrow; this study showed Prevotella dominance (i.e., harmful bacteria being too plentiful) diverts nitrite away from NO production, worsening cardiovascular function—a good example of how oral imbalances have systemic effects.
So, how to kill the bad bacteria without harming the good ones? Critically, diet can feed the protective oral bacteria; here, nitrate-rich beetroot juice improved blood pressure by shifting the oral microbiome towards beneficial nitrate-reducing genera (e.g. the Neisseria and Rothia in this study). As for the rest, Dr. Phillips advocates simple, natural methods (xylitol, remineralizing foods, protective rinses) instead of harsh chemicals. As we’ve learned today, dietary strategies (like beetroot juice) can also play their part as a natural, safe way to help your oral microbiome to help you.
For research on this by a third source, see: Make Your Saliva Better For Your Health
Want to learn more?
With regard to nitrates and health, you might like:
The Nitric Oxide (NO) Solution – by Dr. Nathan Bryan & Janet Zand
…and, with a focus on beets (roots and leaves):
Beet The Odds – by Dr. Nathan Bryan & Carolyn Pierini
Enjoy!
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Practical Programming for Strength Training – by Mark Rippetoe & Andy Baker
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Strength training is an important part of overall health maintenance, but it can be hard to find a good guide to progressive strength improvement that isn’t a bodybuilding book.
This one gives a ground-upwards approach, explaining small details to even quite basic things, before taking the reader through to more advanced progressions, and how to get the most strength-building out of each exercise over time.
As such, this is a good book for anyone of any level from beginner to quite experienced, and you can hop in at any point since there are always catch-up summaries and/or reiterations of the previous concepts that we’re now building on from.
The authors do also talk nutrition, hormones, and so forth, but most of it is about the exercises and the progressions thereof.
There is a slightly patronizing chapter towards the end, about “special populations”, for example offering “novice and intermediate training for women”, but it doesn’t take away from the majority of the book, as the exercises don’t care about your gender. Muscles are muscles, and we all start from wherever we are. Yes, testosterone boosts muscle mass, but let’s face it, there are a lot of women in the world who are stronger than a lot of men.
One thing to bear in mind is that a lot of this is barbell training, so you will need a barbell (or access to one at a gym). If purely bodyweight training is your preference, or perhaps some other form of weightlifting (e.g. kettlebells or such) then this isn’t the book for that.
Bottom line: if strength training is your focus and you like barbells, then this is a great book to take you quite a way along that road.
Click here to check out Practical Programming For Strength Training, and get stronger!
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I lost weight and my period stopped. How are weight and menstruation linked?
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You may have noticed that changes in weight are sometimes accompanied by changes in your period.
But what does one really have to do with the other?
Maintaining a healthy weight is key to regular menstruation. Here’s why – and when to talk to your doctor.
The role of hormones
The menstrual cycle – including when you bleed and ovulate – is regulated by a balance of hormones, particularly oestrogen.
The ovaries are connected to the brain through a hormonal signalling system. This acts as a kind of “chain of command” of hormones controlling the menstrual cycle.
The brain produces a key hormone, called the gonadotropin-releasing hormone, in the hypothalamus. It stimulates the release of other hormones which tell the ovaries to produce oestrogen and release a mature egg (ovulation).
But the release of the gonadotropin-releasing hormone depends on oestrogen levels and how much energy is available to the body. Both of these are closely related to body weight.
Oestrogen is primarily produced in the ovaries, but fat cells also produce oestrogen. This is why weight – and more specifically body fat – can affect menstruation.
Fat cells produce oestrogen, a hormone with a key role in the menstrual cycle. Halfpoint/Shutterstock Can being underweight affect my period?
The body prioritises conserving energy. When reserves are low it stops anything non-essential, such as reproduction.
This can happen when you are underweight, or suddenly lose weight. It can also happen to people who undertake intense exercise or have inadequate nutrition.
The stress sends the hypothalamus into survival mode. As a result, the body lowers its production of the hormones important to ovulation, including oestrogen, and stops menstruation.
Being chronically underweight means not having enough energy available to support reproduction, which can lead to menstrual irregularities including amenorrhea (no periods at all).
This results in very low oestrogen levels and can cause potentially serious health risks, including infertility and bone loss.
Missing periods is not always a cause for concern. But a chronic lack of energy availability can be, if not addressed. The two are linked, meaning understanding your period and being aware of any prolonged changes is important.
How about being overweight?
Higher body fat can elevate oestrogen levels.
When you’re overweight your body stores extra energy in fat cells, which produce oestrogen and other hormones and can cause inflammation in the body. So, if you have a lot of fat cells, your body produces an excess of these hormones. This can affect normal functioning of the uterus lining (endometrium).
Excess oestrogen and inflammation can interfere in the feedback system to the brain and stop ovulation. As a result, you may have irregular or missed periods.
It can also lead to pain (dysmenorrhea) and heavier bleeding (menorrhagia).
Being overweight can sometimes worsen premenstrual syndrome as well. One study found for every 1 kg increase in height (m²) in body mass index (BMI), the risk of premenstrual syndrome went up by 3%. Women with a BMI over 27.5 kg/m² had a much higher risk than those with a BMI under 20 kg/m².
What else might be going on?
Sometimes weight changes are linked to hormonal balances that indicate an underlying condition.
For example, people with polycystic ovary syndrome may gain weight or find it hard to lose weight because they have a hormonal imbalance, including higher levels of testosterone.
The syndrome is also associated with irregular periods and heavy bleeding. So, if you notice these symptoms, it’s a good idea to talk to your doctor.
Similarly, weight changes and irregular periods in midlife might signal the start of perimenopause, the period before menopause (when your periods stop altogether).
Changes in weight and your period could be a sign of menopause approaching. Sabrina Bracher/Shutterstock When should I worry?
Small changes in when your period comes or how long it lasts are usually harmless.
Similarly, slight fluctuations in weight won’t usually have a significant impact on your period – or the changes may be so subtle you don’t notice them.
But regular menstruation is an important marker of female health. Sometimes changes in flow, regularity or the pain you experience can indicate there’s something else going on.
If you notice changes and they don’t feel right to you, speak to a health care provider.
Mia Schaumberg, Associate Professor in Physiology, School of Health, University of the Sunshine Coast and Laura Pernoud, PhD Candidate in Women’s Health, School of Health, University of the Sunshine Coast
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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