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July 27, 2005

BehindTheMedspeak: Jump–Start the Heart?

Aswq_1

Kim–Mai Cutler wrote a most interesting article for yesterday's Wall Street Journal about a radical new development in cardiopulmonary resuscitation (CPR).

It's called the AutoPulse (above).

Long story short: it delivers battery–powered whole chest compressions with one push of a button.

Tell you what: anything would be better than what we're doing right now: things haven't gotten any better in terms of recovery and restoring brain function in decades.

The yield for successful CPR, even when the cardiac arrest is witnessed by professionals in a hospital, is dismal at best.

Recently some experts have recommended abandoning rescue breathing entirely in favor of concentrating solely on compressing the chest.

That's not a bad idea, really: sometimes it's very difficult even for me — and I've been doing it for a living for a long, long time — to maintain a good airway even under perfect conditions, i.e., in the OR with a paralyzed patient.

Zoll Medical makes the AutoPulse and they've sold 620 of them since early 2003.

The machine costs $15,000 and the one–time–use disposable belt that wraps around the patient's chest runs $125.

Tell you what: if it's even marginally better than what we're doing now it's a bargain.

Big time.

The figure below says it all.

Survivalpostarrest_4

Here's the story.

    Paramedics Praise CPR Alternative

    Device to Jump-Start Heart Saves Lives on the Street; Experts Want More Proof

    A device that performs cardiac resuscitation is drawing good reviews from some paramedics, even though other emergency-medicine experts say more tests are needed to prove that it works as well as proponents say it does.

    The AutoPulse delivers a battery-powered squeeze to a patient's entire chest.

    A paramedic or other rescuer slips a backboard under the patient, fastens a wide band across the patient's chest and presses a button on the device.

    The device automatically adjusts the force of its compressions based on the patient's weight and chest circumference.

    "I've been in this field since 1979. This is going to change the way we resuscitate," said Mike Poniatowski, the director of operations for EVAC Ambulance in Daytona Beach, Fla.

    In San Francisco, many patients have been successfully revived with the device, reports Marshall Isaacs, director of emergency medical services for the San Francisco Fire Department.

    But some medical experts advise caution.

    In the past, many treatments and drugs heralded as magical cures didn't pan out.

    Even if the device saves lives, experts say they want to be sure that it doesn't inflict serious injuries and that it is measurably better than manual cardiopulmonary resuscitation, known as CPR.

    Health officials in Riverside County, Calif., suspended use of the AutoPulse this month after a 77-year-old man who was treated with the device later died, showing an unusual number and type of rib fractures.

    The death is under investigation and the device is being returned to the company to check for possible defects.

    "The coroner was concerned enough that we just thought it would be prudent on our part to take any precautions we could," said Michael Osur, director of emergency medical services in Riverside County.

    Bob Katz, president of the Zoll Medical Corp. division that produces the AutoPulse, said the device is often used in conjunction with manual CPR, which often causes cracked ribs.

    Still, there is clearly a need for something better than CPR, a technique taught to thousands of people every year.

    Television shows that depict patients coming back to life have helped to create overly high expectations of how effective CPR can be, said Robert Shmerling, a professor of medicine at Harvard Medical School.

    Most CPR patients are elderly and for them the manual procedure works less than 10% of the time, he said.

    One reason for this low success rate is that a rescuer's hands often miss the right spot on the chest because CPR tends to displace the heart, said Thomas J. Fogarty, a cardiovascular physician who helped invent AutoPulse.

    By strapping the patient into the device, the entire chest is enveloped so compressions land on target.

    This is critical in CPR, where resuscitation may be interrupted as a medic moves a patient down stairs, out of bathtubs and onto gurneys.

    Zoll, Chelmsford, Mass., late last year bought Revivant Corp., developer of the AutoPulse.

    Dr. Fogarty, who is also an early developer of balloon catheters used to remove blockages from arteries, owns Zoll stock but isn't active in the company.

    Zoll says it has sold about 620 AutoPulses since early 2003.

    The device frees up paramedics to give medicine or run intravenous lines, the company said.

    Besides scientific questions, Zoll must overcome resistance to the product's $15,000 price tag.

    There is also a $125 per-use cost for the disposable band that is placed over the patient's chest.

    Some cities that have purchased the device have had to hold community fund-raisers or get state or federal grants to pay for it.

    Zoll says the price is in line with other comparable medical equipment.

    The American Heart Association, a nonprofit research and information organization based in Dallas, says the AutoPulse's method of CPR is a "reasonable" alternative to manual CPR, but doesn't recommend either approach.

    The association's position was reached after the method was evaluated with the help of medical experts, two of whom were Revivant consultants.

    Eyes are now on a study being run by researchers at University of Washington in Seattle that is tracking patient outcomes for as many as three months after resuscitation.

    The test was temporarily suspended in late March because one of five test sites showed better outcomes with manual CPR, said Richard Packer, Zoll's chief executive.

    Researchers are trying to determine if paramedics at that site used different techniques than their counterparts at other locations.

    Still, even without a complete body of evidence, some emergency-services departments are taking the risk that science will eventually prove the value of the AutoPulse.

    "When I first saw this machine four years ago, I thought it was the wackiest thing I ever saw," said Don Lundy, an EMS director in Charleston County, S.C.

    But now, after experience with the device, he says he has just signed an order for eight more AutoPulses to outfit every truck in the county.

    July 27, 2005 at 04:01 PM | Permalink | Comments (1) | TrackBack

    Motion–Activated Dummy Surveillance Camera

    P27641_1

    "The security of an expensive video surveillance camera without the high cost."

    You know, this isn't as silly as it might seem at first glance.

    For about 1% of the cost of a real camera you get a reasonable facsimile that will probably encourage an amateur, at any rate, to move on.

      From the website:

      Looks just like the real thing.

      Same high–tech design.

      Same fully–adjustable mounting.

      Same authentic video cable.

      Same peace of mind, but no costly electronics.

      When someone walks by, red LED light flashes and camera methodically scans from side to side for 15 seconds.

      Install maintenance–free, rust–proof housing above entrances, in hallways, wherever surveillance is needed, indoors or out — and forget it.

      Unobtrusive styling adds to the realism.

      Includes mounting hardware.

      Uses 2 AA batteries (not included).

      7" x 5.5" x 2".

    $12.98 here.

    If I were still working at the University of Virginia School of Medicine I'd buy one for my office in a New York minute.

    July 27, 2005 at 03:01 PM | Permalink | Comments (1) | TrackBack

    WAG — 'A Magazine for Decadent Readers'

    Sdew_1

    What a wonderful website.

    Reviews of classic and contemporary books, films, and music; interviews with writers from all over the globe and all manner of other stuff, written with flair and verve.

    I'm smiling because I'm thinking of certain joeheads who will experience paroxysms of pure pleasure when they visit this internet pot of gold equivalent.

    Why is it called WAG?

      From the website:

      "What a rascal our Hans Castorp is. Or, as Herr Settembrini would have expressed it with belletristic delicacy, what a 'wag' — reckless, even brazen, when dealing with personalities, but just as clever at extricating himself when he must."

      Thomas Mann (The Magic Mountain)

    July 27, 2005 at 02:01 PM | Permalink | Comments (1) | TrackBack

    Indoor Electric Dryer Lint Trap

    Kjiuiy

    This is a great invention.

    Suppose you've got an electric clothes dryer but no way to vent it to the outside.

    You hook up this nifty device to the end of the (included) 5–foot hose and the thing collects all the lint for you.

    Just empty the accumulated schmutz, lint and dust into the trash or throw it out the window or off the roof or down the stairwell, whatever: it's not gonna be in your place, that's the thing.

    "Saves energy by recirculating heat."

    Cool.

    Lint trap measures 9"H x 6.5" Diameter.

    Made of "easy–to–clean, durable plastic."

    Remember: it's for electric dryers only, not gas.

    $14.99 here.

    July 27, 2005 at 01:01 PM | Permalink | Comments (2) | TrackBack

    Santiago Calatrava's 'Drill' To Be Tallest Building in the U.S.

    123_2

    His proposed 115-story Chicago skyscraper (above and below), 1,458 feet tall and rising to 2,000 feet at the tip of its spire, will easily eclipse the nearby Sears Tower, currently the tallest building in the U.S. at 1,353 feet.

    The new structure's formal name is the Fordham Spire after its developer, Chicago-based Fordham.

    Calatrava bristled and "denied that the tower looks like a drill bit on its end"

    Mjhg_1

    when Wall Street Journal reporter Alex Frangos asked him about the nickname for a story that appeared in yesterday's paper.

    The architect said, "It has more to do with a natural sense of growth and verticality than any metallic tool–like object."

    Hmmph.

    050726_fordhamspire_vmed_1pwidec

    If it walks like a drill, and talks like a drill, well... you know the rest of the drill. (Ouch. Why didn't you give me some novocaine? Brute.)

    July 27, 2005 at 12:01 PM | Permalink | Comments (1) | TrackBack

    Mirror Puzzle

    Zxcdsa

    "Puzzles can be a lot of fun to assemble, but after all the excitement of putting it together, the picture is always the same."

    Never again.

    Lucite top and base.

    Measures 15" x 15".

    $200 here.

    July 27, 2005 at 11:01 AM | Permalink | Comments (0) | TrackBack

    Fun with cork — The exquisite furniture of Daniel Michalik

    Zxsa_1

    When I first looked at his work I thought it was a variation on Frank Gehry's corrugated cardboard creations but boy was I wrong.

    Michalik takes waste cork from the bottle stopper industry and forms it into beautiful, flexible and comfortable furniture.

    Since cork is 100% waterproof and impervious to rot and mold his furniture can move from indoors to out and back without any special care or precautions.

    On his website Michalik writes, "One client has hers sitting outside, and last I looked, they look the same as when I delivered them one year ago! Amazing."

    He notes that his pieces might well be usable in the pool as floats, though he has not yet experimented with them as such.

    The 72"–long chaise longue pictured above "allows the user to rock gently from side to side with a great degree of stability. The result is a sensation of floating, weightless yet totally supported."

    [via AW who, as major domo of the extraordinary beachfront resort Aspasia Phuket on Kata Beach in Thailand, has a vested interest in furniture that's impervious to "jungle rot."]

    July 27, 2005 at 10:01 AM | Permalink | Comments (2) | TrackBack

    Chanel Boot

    Chanel

    It's a fitting — very fitting — response to the Foot Condom featured here yesterday.

    Ultimate high boot in stretch lambskin.

    $2,920 at Chanel boutiques everywhere.

    July 27, 2005 at 09:01 AM | Permalink | Comments (0) | TrackBack

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