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Each year about 300,000 people die from sudden cardiac arrest. Many of those victims couldve been saved if someone performed CPR. But people are often afraid to do it because they dont want to give mouth-to-mouth resuscitation. For the last 15 years, an Arizona doctor has pushed an alternative form of CPR that he says is not only easier, but more effective.

Arizona Public Radio's Daniel Kraker reports.

DANIEL KRAKER: A few months ago, Scott Harden was just about asleep when he heard his 33-year-old wife gasping for air.

Deputy SCOTT HARDEN (Sheriffs Department, Coconino County): So thats when I turned on the lights and she was not the right color. She was starting to go pale.

KRAKER: Harden, who's a sheriff's deputy, called 9-1-1. Then he started giving CPR, the way he was first taught five years ago, with 15 compressions and two breaths.

Deputy HARDEN: I started that and I wasn't able to get a breath in. And I just thought, you know, you better just do chest compressions. And dispatch, the doctor told me the same thing.

KRAKER: The phone dispatch counted out the compressions with him, 100 per minute. Pete Walka with Flagstaff's Guardian Medical Transport was one of the first paramedics on the scene.

Mr. PETE WALKA (Guardian Medical Transport, Flagstaff): She's alive because he did really good compressions till we got there.

KRAKER: Arizona health officials are convinced compression-only, or hands-only CPR gives them the best chance to save someone's life from cardiac arrest. The man behind that conviction is cardiologist Dr. Gordon Ewy at the University of Arizona. Ewy says he stumbled on the importance of chest compressions when he listened to a recording of a woman trying to resuscitate her husband.

Dr. GORDON EWY (University of Arizona): She came back to the phone and said, why is it every time I press on his chest he opens his eyes, and every time I stop to breathe for him he goes back to sleep?

KRAKER: Ewy says a victim's blood is already oxygenated for several minutes after a cardiac arrest. What's most important, he says, is to keep both the heart and the brain alive by pumping that blood around the body. And his research, based on animal models, shows rescue breathing can interfere with that. Just last year, the American Heart Association acknowledged Ewy's findings - in part. It updated its guidelines to say if you're not trained in CPR, then it's okay to do compressions only. Ewy doesn't think that goes far enough.

Dr. EWY: Because if you're trained or not, you want to do chest compression-only CPR. You want to get the blood going to the head, to the brain, and you don't want it to stop until somebody gets there to defibrillate the patient.

KRAKER: A recent study in the British medical journal, The Lancet, supports Dr. Ewy's point of view. The study is the largest on the issue so far. It tracked 4,000 victims of cardiac arrest in Japan. Those who received compression-only CPR had a survival rate nearly twice as high as those who received compressions plus mouth-to-mouth.

But Dr. Michael Sayre, who helped write the new guidelines for the American Heart Association, still isn't convinced compression-only CPR is better. Sayre teaches emergency medicine at the Ohio State University. He says there just isn't enough evidence yet.

Dr. MICHAEL SAYRE (Emergency Medicine, Ohio State University): Honestly, I think the research that we have to date shows that the outcomes for patients seems to be very similar, regardless of the kind of CPR they get.

KRAKER: So Arizona has forged ahead on its own. The state began promoting chest compression-only CPR about five years ago. Dr. Ben Bobrow directs Arizona's Bureau of Emergency Medical Services.

Dr. BEN BOBROW (Director, Bureau of Emergency Medical Services, Arizona): And we found that three out of 100 people who had a cardiac arrest outside the hospital in Arizona, went home with their family. Ninety-seven percent of everybody died. And we basically said that's not good enough. We have to do better. And we even felt that we should be urgent about it and we shouldn't wait, for example, till five years that - until the next set of guidelines get updated.

KRAKER: Bobrow helped convince most emergency responders across the state to adopt a new protocol, also developed by Dr. Ewy, called Cardio-Cerebral Resuscitation. CCR involves long sets of 200 chest compressions. And instead of forcing air into the lungs through a tube, paramedics give oxygen passively with a mask. Bobrow then compared the new results using compression-only with historic data.

Dr. BOBROW: And what we pretty much consistently found is that it was at least three times as many people survived neurologically intact and went home, if they got this new form of resuscitation.

KRAKER: Bobrow's research has been published in the Journal of the American Medical Association and elsewhere. Still, the American Heart Association remains skeptical. It wants more conclusive evidence before it changes its guidelines any further.

For NPR News, Im Daniel Kraker.

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