Ladies' Home Journal's 3rd Annual Health Breakthrough Awards
Benjamin S. Abella, MD, MPhil: Saving Lives by Improving CPR
What kills a greater number of people in America than cancer or strokes? It's sudden cardiac arrest (SCA), when the heart abruptly stops beating and blood stops circulating through the body. Each year an estimated 310,000 Americans die from SCA, both in and out of hospitals.
Cardiopulmonary resuscitation (CPR), which consists of chest compressions and mouth-to-mouth breathing, can save lives if it's done in time, but the scary truth is that most people have no idea how to perform it or how to use the defibrillators, available in many public places, that can stop an abnormal heart rhythm and restore a normal one. Even more alarming, many EMS workers and healthcare providers may not perform CPR or defibrillation correctly. "Resuscitating someone in cardiac arrest is among the most stressful situations in healthcare," says Benjamin S. Abella, MD, MPhil, clinical research director of the Center for Resuscitation Science at the University of Pennsylvania School of Medicine. "It requires people to perform well under pressure without any warning or preparation." But ever since he was a resident, Dr. Abella was struck by how "disorganized and frantic" the process was. "It felt like we were reinventing the wheel every time." Now 38 and the father of three young children, he's playing a pivotal role in changing that picture by developing new recommendations for better CPR training and new technology to improve lifesaving care.
Over the past four years, to help hospital and EMS workers improve their skills, Dr. Abella helped develop and test a manual defibrillator known as the MRX Q-CPR that records various components of CPR, such as the depth and rate of chest compressions -- as a healthcare provider performs it -- and then provides a postcrisis assessment of how he or she did. "CPR has been around for over 50 years," Dr. Abella says. "Yet there have been no serious at attempts to evaluate performance or delivery of care during actual resuscitation until the last decade."
Now Dr. Abella's research has proved that feedback makes a notable difference. In his study, published in the May 26, 2008, issue of Archives of Internal Medicine, resident-level doctors who used the manual defibrillator on 123 patients were debriefed on the data the device had recorded. Analyzing what they'd done incorrectly let them improve their delivery of ventilation and chest compressions. Patients resuscitated after the debriefing had a more rapid return of heart rhythm, pulse, and measurable blood pressure than those treated earlier in the study.
"Dr. Abella has been a pioneer in measuring and recording CPR quality for in-hospital cardiac arrest," says Dana Peres Edelson, MD, director of clinical research in the emergency resuscitation center at the University of Chicago Medical Center, who has worked on several of his studies. "He truly is a visionary. He has opened our eyes to what we suspected: Because we are trained to perform CPR we thought we do it well, and that's just not the case."
Dr. Abella has also worked to improve how CPR is delivered before rescue crews arrive, when only 15 to 30 percent of victims receive it, probably because bystanders don't know what to do and don't realize how important prompt delivery of CPR can be. Since 2005 Dr. Abella has served on a team that revised the American Heart Association's CPR guidelines for laypeople and 911 dispatchers by emphasizing the need for chest compressions and reducing the emphasis on rescue breaths. He also helped develop a new defibrillator device that has voice prompts allowing good Samaritans to assess whether the person needing attention can benefit from a shock and leading rescuers through the steps of both defibrillation (if needed) and CPR. "He is doing incredible work," says Robert O'Connor, MD, chairman of emergency medicine at the University of Virginia in Charlottesville. "His efforts have the potential to save many lives."
For himself, Dr. Abella is optimistic that "with better CPR and more prompt defibrillation delivery, we can save more lives." The new tools he has pioneered are already making a difference.