For more than two decades, Dr. Gordon Ewy has been on a crusade to change the way people are treated for sudden cardiac arrest, a leading cause of death in the nation.
The 76-year-old cardiologist and director of the University of Arizona's Sarver Heart Center has challenged what for years was a kind of sacred cow in the medical profession and a prescription for good Samaritan behavior worldwide: the mouth-to-mouth rule of cardiopulmonary resuscitation, or CPR.
Ewy (pronounced AY-vee) has pioneered the use of chest compression-only CPR on adults whose hearts suddenly stop pumping. Mouth-to-mouth only detracts from the more effective compressions, he insists.
Since the mid-1990s, Ewy's advocacy has often been a thorn in the side of venerable medical establishments such as the American Heart Association. Ewy has written letters in medical journals demanding change and accused the association, whose influence is strong, of not moving quickly enough.
In the past five years, though, there has been a gradual realization that the outspoken Tucson doctor is on to something.
In a major shift in 2008, the American Heart Association issued an advisory that said compression-only CPR can be used to save lives and is an option for people who aren't trained in CPR or who are unsure of their CPR abilities. People who are trained can do either, it says. The advisory applies only to cases of adults in cardiac arrest, not children, and excludes drowning and drug-overdose cases.
Now, the compression-only version may be on the verge of going worldwide, as an international health group considers whether to revise its guidelines to make it the preferred method.
Not everyone has bought into Ewy's approach. Evidence is mixed. Research in the U.S., Netherlands and Japan has found that chest-compression-only yields similar or better survival rates than standard CPR. Some European studies report better results with mouth-to-mouth. Still, Ewy is convinced it's only a matter of time before compression-only CPR becomes the standard for cardiac arrest.
Every year, cardiac arrest kills about 325,000 people in the U.S. Its main underlying cause is heart disease, and the majority of cardiac arrests happen outside the hospital.
As bad as that is, prospects were worse for victims before modern CPR emerged about five decades ago.
Two American doctors, Peter Safar and James Elam, are credited with inventing CPR, and the technique spread rapidly after the American Heart Association endorsed the idea in 1963.
CPR works under the premise that pressing on the chest moves blood to the vital organs while mouth-to-mouth breathing gets oxygen into the lungs.
When a person's heart stops beating, the first few minutes are critical. If nothing is done, the chance of survival drops 7 to 10 percent every minute.
Ewy says the compression-only method is better than standard CPR for a simple reason: In standard CPR, when a rescuer stops after 30 compressions to give two breaths, the blood stops moving through the patient's body, essentially starving the organs. Continuous compressions keep the blood flowing. Doing only those also is simpler and easier to remember than standard CPR.
Next month, Ewy will fly to Dallas for a meeting of the world's major resuscitation groups. No one knows whether the International Liaison Committee on Resuscitation will endorse compression-only CPR as the preferred method. It's fair to say the discussion will be controversial and Ewy again could face an uphill battle.