Over the last three decades, CPR procedures and standards have been refined and improved. But survival rates haven't changed, and patients suffering sudden cardiac arrest outside of a hospital are just as likely to die today as they were back in the 1970s.

 "The battle for life and death is usually won or lost in the field, before they see the doctor," Dr. Gordon Ewy told physicians, students, and other health professionals during the Knorr Family Healthy Lifestyles Lectureship at the Family Medicine Winter Symposium.

An excellent tool in the battle against the nation's leading cause of death, he said, is chest-compression-only resuscitation, describing the "new CPR" that he has studied and advocated for, for more than a decade. Studies have found that 24-hour survival rates for "witnessed/shockable" patients - those most likely to survive - are nearly double if new CPR is used. That means a survival rate of one-third of patients with the new method, versus 18 percent if the standard method is used.

The weak link in the chain of survival for cardiac arrest is that only 1 in 4 bystanders will perform traditional CPR. The reason for bystanders' hesitance is simple: They don't want to perform mouth-to-mouth resuscitation.  

Most of the time that's not even needed, said Ewy, professor emeritus of cardiology at the University of Arizona and a graduate of the KU School of Medicine. In most cases of cardiac arrest, the blood is fully oxygenated when the victim is stricken, and doesn't yet need the oxygen that mouth-to-mouth provides.

"It's really the heart and the head that you need to resuscitate and not the lungs," said Ewy.

Research convinced Ewy and colleagues in Arizona and around the world to advocate for new CPR, putting them at odds with existing standards. Among other things, research revealed that bystanders performing traditional CPR often took much longer to switch between assisted breathing and chest compressions than the standards recommended, putting patients at risk of permanent damage. Similarly, intubation in the field often took a long time, depriving patients of exactly the oxygen it is designed to deliver.  

In 2003, Ewy and others pushed for compression-only resuscitation as the standard in Tucson and soon began a statewide campaign for the method in Arizona. Now, the method is much more widely accepted nationally and is working its way to becoming the standard of care, he said. Said Ewy,

"We knew we were right ... 169 experiments all showed the same thing."

Ewy's lecture was one of more than 20 sessions at the winter symposium, organized annually by the KU School of Medicine-Wichita's  Department of Family and Community Medicine.

The symposium provides physicians and health care professionals from across Kansas the opportunity to learn about new and developing changes in medicine. Topics ranged from migraines to sports dermatology to diabetes to bipolar affective disorder.

Dr. Gretchen Dickson, program director of Wesley Family Practice Residency, updated attendees on treatment of otitis media and ear infections.

Unlike cardiac arrest, ear infections aren't often deadly. However they are common - 80 percent of children are likely to suffer at least one - and they're expensive. They cost about $4 billion annually, including $2.8 billion in antibiotics and millions more in lost work time for parents. They're also painful for children. Those factors result in treatment challenges for doctors. Parents wanting to minimize pain and disruption push for solutions - antibiotics - even though they're often not effective.

Parents, like doctors, are increasingly aware of antibiotic resistance. Still, the case can be tough to make when a 3-year-old is in pain. The latest recommendations, which are near approval, urge watchful waiting - as most ear ailments resolve without them - but also office visits and pain relief such as ibuprofen.

"The folks who wrote these recommendations really thought about not just the antibiotics piece or the meningitis piece that we as docs care about, but they also thought about the families - they need pain control, they need to get into the office," she said after her presentation.

"Ear infections are not the most exciting thing to treat, but they occur a lot," she said. "It's a huge deal to our patients and their families, so it's important to treat them effectively."