Opinionated. Cantankerous. A zealot.
Dr. Gordon A. Ewy has a gleam in his eyes as he recounts some of the ways he's been described during his tenure as director of the University of Arizona's Sarver Heart Center, where he leads a team that has changed attitudes about CPR worldwide.
He's rubbed a few people the wrong way in the process of persistently promoting continuous chest-compression CPR over mouth-to-mouth for cases of primary cardiac arrest. But that's no surprise for someone on a mission to change the status quo. Ewy (pronounced Ay-vee) is definitely on a mission, and he's been credited with saving thousands of lives.
"What Dr. Ewy did was challenge the dogma of resuscitation, and he did that when it really was not very popular to do so," said Dr. Ben Bobrow, medical director of the state's bureau of EMS and trauma system. "He persisted over several decades, and it turned out Dr. Ewy was right. There really is a much better way to save people from sudden cardiac arrest.
"Thousands of people are alive now because of his work."
Ewy and the Sarver Center's Resuscitation Research Group team developed the simple, user-friendly "hands only" CPR, where a bystander's hands pressing on the patient's chest act as the heart.
His efforts to spread the word about the technique made him an unlikely Internet star -a six-minute instructional video featuring Ewy went viral and has been viewed 8 million times. He's now developing another video for paramedics.
While his quick banter and enthusiasm for saving lives evoke a youthful exuberance, Ewy is, improbably, 79 years old. He recently announced his retirement from a 43-year career at the UA, including 22 years as director of the UA's Sarver Heart Center. His last day will be June 30.
"It was a difficult decision although I am warming up to it rapidly," Ewy said last week. "It was actually my wife who decided that at age 80, that's enough."
In 2010, Ewy stepped down from his job as chief of cardiology at the UA College of Medicine. It was a position he'd held for 28 years, and at the time he was the longest-serving active chief of cardiology of any medical school in the U.S.
But what has really put Ewy on the map is the work he's done as director of the Sarver Heart Center, where his team both developed and promoted chest compression CPR. In a major nod to that work, the American Heart Association in 2008 said anyone who sees an adult collapse from sudden cardiac arrest should call 911 and then immediately start hard and fast chest compressions - not mouth-to-mouth. The policy does not apply to people who are trained in conventional CPR, however.
"That's still a bunch of malarkey," Ewy said. "Trained people will not do it in most of the situations because they don't want to do mouth-to-mouth on someone they don't know."
If chest-compression-only CPR was adopted nationwide, the result would be 11,800 saved lives per year, Ewy said. That number is big because the number of people killed by cardiovascular disease is big: It's the nation's number one killer, accounting for about a third of U.S. deaths in 2010.
Ewy soon will be putting such work in the hands of others, and he has no worries. He is confident the team he's leaving behind will continue the mission. A national search is under way for his replacement.
MAJOR HEALTH PROBLEM
Sudden cardiac arrest kills about 15 Arizonans every day, and the odds of surviving if it happens outside of a hospital are grim.
And since every male over the age of 40 has a one in eight chance of suffering sudden cardiac arrest, Ewy's mission to improve the odds has been both relentless and urgent.
"What's the most common cause of death in the United States? It's sudden cardiac arrest," he said. "It is a major, major public health problem."
Initially, the hands-only technique was a way of encouraging more bystander CPR since people are often reluctant to give mouth-to-mouth and instead call 911 and do nothing. As time went on, the Sarver Center team discovered that survival rates with just chest compressions were not just as good as traditional CPR - they were better.
Ewy recalls hearing a 911 tape that summed up the reason. In the recording, a Seattle woman whose husband had collapsed from cardiac arrest and was giving him CPR asked the dispatcher why her husband was opening his eyes when she pressed on his chest but "going back to sleep" when she breathed for him.
"This woman in 10 minutes learned the importance of continuous chest compression," Ewy said. "What she was really saying is, 'Why is it every time I press on his chest he's not in a coma, and when I stop and breathe for him he goes into a coma?' So that was really, really important."
The chest compression method technically isn't cardiopulmonary resuscitation because in a sudden cardiac arrest, the patient still has ample air in the lungs and blood, so breaths aren't required. Instead, chest compressions get blood flowing to the heart and brain. Still, Ewy and other scientists refer to their method as chest compression or "hands only" CPR because the term CPR is more recognizable.
The procedure has its critics.
Mostly, the method isn't for everyone. It shouldn't be used on newborns, near-drowning or choking victims, or people who have had a drug overdose or carbon monoxide poisoning. It also isn't for someone in respiratory arrest, though using the chest compressions will not harm that patient.
But for someone who has had cardiac arrest, chest compression could mean the difference between life and death, Ewy says. And it's so easy. The test is, if someone unexpectedly collapses, is not responding and is not breathing normally, that person is a good candidate for hands-only CPR.
If an automated external defibrillator is available, turn on the unit and follow voice instructions. If not, he says, chest compressions should begin at a rate of 100 per minute.
The Tucson Fire Department led the nation by adopting chest compression CPR instead of mouth-to-mouth in 2003 and never looked back, Assistant Chief Joe Gulotta said.
When Ewy first approached the department about the technique, which he had been testing in his lab and wanted to get into the field, "we thought it sounded great, but we were a little concerned," Gulotta said. "We had to be protective of our patients."
After talking to the Sarver team and reviewing their evidence, Tucson fire officials decided to give it a try. Paramedics immediately began reporting improved patient outcomes. The dramatic effects happened so quickly and have been so consistent that fire officials have never once questioned whether they are doing the right thing, he said.
Most use technique now
Most emergency medical service providers in Arizona now use the hands-only method of CPR .
As a result, state officials say survival rates for out-of-hospital sudden cardiac arrest in the places that use hands-only have increased four- or five-fold. Using data collected by first responders, the state says 1,106 lives in Arizona have been saved by the chest compression method.
The Sarver Heart Center consistently hears from people around the country who say they've been saved by chest compression CPR. Recent local cases include a city of Tucson worker who saved a jogger, a local pharmacist who helped save a man who had a heart attack while waiting in line to get his flu shot, and a Girl Scout who helped revive a high school bandmate who collapsed.
In his 2009 book "Cheating Death," CNN medical expert Dr. Sanjay Gupta calls Ewy brave, cantankerous and opinionated. Gupta quotes another doctor saying Ewy is a zealot for chest compressions.
To Ewy, that's a compliment.
"It's OK to be cantankerous and opinionated if you are always right," he said. "And on this subject, I'm right."
If you go
Dr. Gordon A. Ewy plans several public talks before his retirement:
• "Stress and the Heart," 10 a.m. Thursday , at the Canoa Hills Social Center, 3660 S. Camino del Sol, Green Valley
• "So, You're 40 and Feel Fine: It's Time to Be Serious about Heart Attacks," 5:30 p.m. Wednesday, Jan. 9, at Murphy-Wilmot Library, 530 N. Wilmot Road
• UA Sarver Heart Center Healthy Heart Conference, Saturday, Feb. 16, University of Arizona Medical Center's DuVal Auditorium, 1501 N. Campbell.
• "A Future Free of Heart Disease & Stroke," 2 p.m. Friday, March 8, UA Medical Center's DuVal Auditorium, 1501 N. Campbell Ave. This event will be followed by a community reception in honor of Ewy's career at the UA College of Medicine.
For more details about the events and to learn chest compression CPR, visit heart.arizona.edu
His path to doctor
Dr. Gordon A. Ewy will tell you that most of what he learned in medical school at the University of Kansas School of Medicine isn't useful anymore - but that's a good thing, he says ,
Ewy earned his medical degree in 1961 and came to the UA in 1969.
"Everything has changed," he said. "The major example is cardiopulmonary resuscitation. You know, everything I learned about CPR is wrong. Medicine has improved. People live longer. They are healthier.
"Let's take high blood pressure. The month before President Roosevelt had his stroke, his blood pressure was 240 over 180. His physician never told him he had high blood pressure for two reasons - one, he didn't want him to worry. But the second reason is that we had no way of controlling high blood pressure at that time."
Now, blood pressure can be controlled with medication.
Realizing a lot of the medical textbooks were wrong fueled Ewy's feistiness. But he's always been determined. At the age of 9 he decided to be a doctor, though he had no idea what it meant. He grew up in a small town in Kansas, and the only doctor he knew was a general practitioner who worked out of his home.
"I guess it was because I thought doctors did good things," he said.
Ewy remembers treating a young father of two who died of kidney failure, and then deciding to specialize in nephrology, which focuses on kidney disease. But as he recalls it, the first few nephrologists he met weren't very likable. The cardiologists were nicer.
"To heck with it, I was going into cardiology," said Ewy, who went on to train under renowned cardiologist Dr. W. Proctor Harvey at the Georgetown University School of Medicine and the District of Columbia General Hospital.
Contact reporter Stephanie Innes at 573-4134 or firstname.lastname@example.org