The New Science of CPR?

[nycemt728 49]

Found this on MSN.com this morning. What does everyone think about it just being posted on a popular site w/ minimal explanations, no enorsements...is this a good idea? Can it save lives or do we as providers and instructors advocate for laymen taking the organization (ARC, AHA, ASHI) sponsored corses and waiting until the protocols change again. Will Good Samaratan Laws cover this, I mean given CPR's history, will a reasonable person just do compressions?

The New Science of Cardiac Arrest

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Everything you've been taught about CPR is wrong. Here's how to save a life — maybe your own.

Heather Hurlock, Best Life

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A Seattle 911 dispatcher receives a call from a woman whose husband has just collapsed and has no pulse. Believing correctly that the man has gone into cardiac arrest, the operator coaches the woman to perform CPR, a rotating series of quick chest compressions followed by two quick breaths into his mouth to provide oxygen. "Why is it that every time I press on his chest, he opens his eyes, and every time I stop and breathe for him, he goes back to sleep?" the woman asks.

"When I heard the tape of this conversation, I was astounded,"says Gordan Ewy, MD, chief of cardiology at the University of Arizona College of Medicine. "This woman had learned in 10 minutes what it took us 10 years of research to find out." That is to say, giving mouth-to-mouth to someone in cardiac arrest is not only wrong — it could also be deadly.

Every year, about half a million Americans go into sudden cardiac arrest. It's the leading cause of death in America, and 95 percent of its victims die within minutes. Cardiac arrest happens when the heart stops pumping blood because the rhythm becomes disordered and unsynchronized (called ventricular fibrillation). This happens most often as the result of underlying heart disease. Experts have taught for more than 40 years to give someone in cardiac arrest mouth-to-mouth between chest compressions, but in a recent study published in The Lancet, scientists found that survival rates of cardiac victims were higher when compressions were not accompanied by mouth-to-mouth (echoing studies that have been coming out for more than a decade). That's because a person's blood remains fully oxygenated when the heart stops. The only time mouth-to-mouth is necessary, some heart specialists now believe, is in the case of a drowning or a drug overdose. In those cases, the heart is still pumping blood, so the body's oxygen levels are quickly depleted.

"If you see someone drop to the ground suddenly with abnormal breathing and no pulse, that's cardiac arrest," says Dr. Ewy, who has been recognized by the American Heart Association for his contributions to the science of CPR. "What you need to do is immediately call 911. If there's a defibrillator around, send someone to get it while you start continuous chest compressions (CCC) at a pace of 100 per minute." A defibrillator is the only thing that can depolarize the muscle fibers that are spasming out of sequence (i.e., jumpstart the heart). Chest compressions simply buy the person time by moving blood into his heart and brain, keeping the blood pressure from falling to zero and the person from slipping into a coma while medical services race to the scene. It takes only six minutes for someone to go from ventricular fibrillation to flat line if nothing is done, but — as we now know — there is a twofold increase in survival when chest compressions are applied.

Learn how to perform CCC's.

Provided by Best Life

Edited September 14, 2007 by nycemt728

[firefighter36 52]

In my CPR instructor class, the intructor coordinator noted that research shows that the oxygen level in the blood at the time of a cardiac arrest is often times adequate enough to support life, and that deep, strong chest compressions are critical to keeping tissue alive. Obviously, early defribrilation and early advanced care are an integral part of the entire process.

I have also heard that research is being done to track how effective ACLS treatment is, and whether or not patients will be transported if there is no change in status after 2 rounds of cardiac drugs. (That, however, is beyond my scope of practice, so I apologize if the ACLS info. is not 100% accurate.)

[Guest partyrock]

nycemt where have you been the past year. This is the new standard of care for EMD instructions and civilian CPR. On the EMS side the new focus is continued high quality compressions with minimal interruptions. This research began in the South West after trying to find a way to get around people's resistance towards mouth to mouth on a stranger. While looking to see if CPR would still be effective enough they found that it may actually be more effective to just give compressions than the old 15 - 2 ratio. It turns out that the force of chest compressions creates enough air exchange to match the effect of mouth to mouth. The only hurdle is finding a way to maintain the open airway during CPR to allow continued air exchange. While the ratio for EMS has been increased to 30 to 2 in the near future you may see ventilations removed from single rescuer CPR.

[nycemt728 49]

nycemt where have you been the past year. This is the new standard of care for EMD instructions and civilian CPR. On the EMS side the new focus is continued high quality compressions with minimal interruptions. This research began in the South West after trying to find a way to get around people's resistance towards mouth to mouth on a stranger. While looking to see if CPR would still be effective enough they found that it may actually be more effective to just give compressions than the old 15 - 2 ratio. It turns out that the force of chest compressions creates enough air exchange to match the effect of mouth to mouth. The only hurdle is finding a way to maintain the open airway during CPR to allow continued air exchange. While the ratio for EMS has been increased to 30 to 2 in the near future you may see ventilations removed from single rescuer CPR.

If you had bothered to read my questions, you wouldn't have had to waste your breath berating me. I am well aware of the reasoning behind the 2005 changes, and I know that the next step will be the elimination of breaths with the compressions. Yet another wasted discussion b/c no-one bothers to read and respond appropriately, only preach like a know-it-all. How about some moderation??? EMTBRAVO, if you want suggestions for the site, this is it: have moderators who actually foster a discussion instead of allowing these nonsensical free-for-alls where everyone preaches to eachother instead of discussing the topic orgionally posted!!!!

Edited September 14, 2007 by nycemt728

[Guest partyrock]

wow, relax there big guy. This wasn't intended to attack you. I wish you hadn't edited your original post, but there are some changes to the original including some comment about this info coming out of China being deleted if I'm not mistaken.

Will Good Samaratan Laws cover this, I mean given CPR's history, will a reasonable person just do compressions?

I guess I wasn't clear so I'll claify...given the latest research, compressions only cpr appears to be capable of delaying cell death until ems can respond. Good Samaritan laws protect you so long as you don't do something you know you shouldn't be doing. An EMD operator instructing a civilian to perform compressions only CPR is an acccepted standard and would be perfectly accepted. You as an EMT doing compressions only CPR because you didn't have BBP barrier would be perfectly acceptable.

[nycemt728 49]

I did get the country wrong, it was Japan.

NY Times Article

Point was, the research was not endemic to this country!

[ckroll 101]

The focus now is on quality compression. Rightly so, without circulation, the other skills are meaningless. In a perfect world we do not stop there, but we have to start there. What I took away from retraining was that the first 5 or 10 compressions got the pressure up to where subsequent compressions were effective at moving blood, hence more good compressions at 30:2 than 15:2. That said, the suggestion that rescuers switch out every cycle is awkward.

Part of the movement away from focusing on the breath I think has to do with a better understanding of how much air exchange is needed, and it is not as much as many of of were trained to deliver-- or ended up delivering in the heat of the moment. It isn't just oxygen in, it's also CO2 out, with some awareness of blood chemistry.

Capnography. What a useful and underused tool! If we want to know how effective CPR is --and will be-- in the effort to reach ROSC [return of spontaneous circulation], then measure elimination of the byproduct of metabolism. It tells you that circulation is getting oxygen to the cells, that cellular exchange is happening, that pulmonary exchange is happening, and it tells you something about blood chemistry, as well as being a real time indicator if circulation is restored, or if restored when it fails again. It monitors tube placement in real time as well.

Waveform analysis when taken with the raw CO2 value is a window into the patient and record showing how successful the various components of CPR are. It can also tell you when best efforts have been exhausted and termination needs to be considered. If monitored early in the resuscitation, it can even distinguish between respiratory failure leading to cardiac arrest and cardiac arrest leading to respiratory arrest. And a whole bunch of other things..

In short, capnography with waveform isn't just for technology buffs anymore. There's a lot of good material about it on the net. Please, read it, use it, and maybe take your game up notch.

[nycemt728 49]

Let me clarify: I am not asking if the new CPR is effective, nor am I disputing the value of chest compressions! I am asking if an artice directing people to begin compressions (w/o the history and extra info and training a CPR course will provide) is wise and will it save lives or is it better to advocate people take a full class in CPR. Does this particular article help or hinder our job as responders? If someone has no experience and has simply read this article (and is not on the line w/ an EMD), and therefore attempts to perform CCC's,(no word on effectiveness) is that better or worse than having someone trained in CPR? I'm trying to get at whether this article would have served better advocating for CPR courses in their current format.

[ckroll 101]

Does this particular article help or hinder our job as responders? If someone has no experience and has simply read this article (and is not on the line w/ an EMD), and therefore attempts to perform CCC's,(no word on effectiveness) is that better or worse than having someone trained in CPR? I'm trying to get at whether this article would have served better advocating for CPR courses in their current format.

Advocating CPR is always a good thing. If a poorly educated general population envisions CPR as having to lock lips with a drooling dead person and therefore, they don't want to do it, then getting the word out that CPR is drier and easier is, in my opinion, a step forward.

Help or hinder? Unlikely to hinder and if it buys the patient an extra 5 minutes of circulation and makes the situation salvageable, then it saves a life. I don't know about your territory, but I cover 46 to 90 square miles on a good day, I'm not getting there in time to turn an arrest around unless bystanders have stepped up.

[Guest]

I agree Ckroll. Advocating CPR Is ALWAYS a good thing and this is easier for people to remember. No more freakout about what to do regarding breaths and all that. It's 'just' compressions - might make people less hesitant to jump in.

Oops I didnt actually answer your question (too early still....) my thinking is that CPR guidelines are constantly changing so even if you took a course now what you learn might only be good for say 15 months before protocols are changed. So yes it would have been good for that article to promote CPR classes as well but a lot of people who wont bother with a class might read that article. At the end of the day I think anything might be better than nothing.

Edited September 16, 2007 by Babyheart