Experts now recommend hands-only CPR

[x635 4,066]

After my last ACLS refresher, and by "studies" the past few years, I could see the writing on the wall.........

NAEMD has actually been doing this for a while now..

Experts now recommend hands-only CPR

By STEPHANIE NANO

Associated Press Writer

3-31-09

NEW YORK (AP) -- You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

On the Net:

Heart Association: http://www.americanheart.org/handsonlycpr

FULL STORY: http://hosted.ap.org/dynamic/stories/H/HAN...EMPLATE=DEFAULT

[IzzyEng4 427]

My last EMT refresher, were were being taught 30:2 and also the 100 compression methods. Its being taught it is important to keep the blood circulating with the O2 that is already in the blood system than trying to give mouth-to-mouth which technically introduces more CO2 into a patient's respiratory system. The only true introduction of O2 is by a two person method with the use of an ambuve bag and a connected O2 cylinder.

[Guest]

I also believe that they are making these changes due to the publics unwillingness to perform CPR due to the mouth to mouth. They probably feel that more people will be more likely to jump in and help now.

[mikeinet 37]

I read some studies about doing abdominal compressions instead of chest compressions with the case being made that since the abd has 15% of your body's blood, pumping on that will circulate blood around, not break ribs, and also force the heart to push some blood and possibly help with oxyginzation.

In terms of the compressions only... sorry, I don't buy that ONLY pumping on a chest will lead to any better survival rate. Yes, people refuse to do M2M, understandable...but telling people to definetly not do that? Eh. Even if you recover from the full arrest with the slim chances... going X minutes without real oxygen movement, what good are you?

But i'm sure AHA has real money to do a study about that, not me talking crap...

[JRS2817 1]

in school im taking cpr and its 30:2

[FFD941 20]

I had to do a double take when I saw this on the news last night. The news coverage also showed a video of two person adult CPR being performed on a streacher with just one hand???

[Remember585 815]

As an Instructor, I recall teaching to those of us that are in Emergency responderland that we should "know better" and never perform direct mouth to mouth. It's been about 3 years since I first heard that mouth to mouth was going to vanish, simply to accomodate the public.

Anything is better then nothing I suppose.

[ny10570 745]

The science behind this study is sound. Without supplemental O2 there is little difference between compressions only CPR and 30:2 CPR.

Mouth to mouth or mask or whatever gives almost as much O2 to the patient as a BVM without supplemental O2. This is because just before ventilating the rescuer takes in a deep breath and expells the breath quickly. There is little time for respiration to occur. So the air they are receiving is close to 20% O2.

When you push on the chest air is forced out of the lungs. This volume of air is actually greater than the anatomical dead space present in the lungs and airway. Over 100 compressions in cadaver and animal tests there is a significant enough exchange of air to provide meaningful ventilation.

Another factor is that it takes between about 15 compressions to generate enough pressure to get blood circulating. So even now with 30:2 half the time we are doing CPR we're just catching up to where we left off. This you can see for yourself. Next time you're working an arrest monitor the CPR pulse. It gets noticeably stronger after the first few compressions.

There may be more changes to come. There is some research that suggests supplemental O2 may be harmful in an arrest or at the very least retarding our efforts. Saturating the limited circulation with oxygen may be no different than hyperventilating your patient. This leads to cerebral vascular constriction. For the vast majority of cardiac arrests, it is a problem with the heart and not with the lungs or any other organ. Years ago it was shown that administering glucose just because its an arrest did nothing to help patients, because hypoglycemia wasn't the problem. There was still glucose in the body, it just wasn't getting to the brain. The same should be true for oxygen. Its there, its just not getting where it needs to be. The body's metabolism is all but shut down, so it doesn't even need as much oxygen as before the arrest. Just enough to keep the brain alive.

[Goose 188]

I read some studies about doing abdominal compressions instead of chest compressions with the case being made that since the abd has 15% of your body's blood, pumping on that will circulate blood around, not break ribs, and also force the heart to push some blood and possibly help with oxyginzation.

In terms of the compressions only... sorry, I don't buy that ONLY pumping on a chest will lead to any better survival rate. Yes, people refuse to do M2M, understandable...but telling people to definetly not do that? Eh. Even if you recover from the full arrest with the slim chances... going X minutes without real oxygen movement, what good are you?

But i'm sure AHA has real money to do a study about that, not me talking crap...

Are you sure about that information? They took away abdominal thrusts for unconscious choking because of fear of internal trauma. I would think that chest compressions, would be far more effective in terms of circulating blood than pounding on someones abdomen, it just doesn't make any sense to me.

Edited April 1, 2008 by Goose

[ny10570 745]

People keep on putting forward the abdominal thrusts, but they only work on healthy individuals. Too much gut or skin and bones and the numbers don't work. Then of course there is the abdominal trauma that Goose mentioned.

[GM911 0]

I'd like to add my two cents...

I had to do a double take when I saw this on the news last night. The news coverage also showed a video of two person adult CPR being performed on a streacher with just one hand???

Not sure what video this is, but in a moving ambulance, I usually hold onto the ceiling rails with one hand and compress the chest with the other so that I have some grounding if the truck hits a bump, turns, or stops.

As for the hands only CPR... When we compress the chest, we are NOT doing it in order to compress the heart and act as the Left Ventrical contraction. The reason that we are taught to compress the chest is to create a vacuum inside the chest wall in order to suck the blood out of the heart through the blood vessels. What the research is showing is that it takes approximately 30 compressions in order to create that vacuum. Except we are taught that once we hit 30, we are supposed to stop in order to ventilate, thus ruining the vacuum and having to start all over.

Even if you recover from the full arrest with the slim chances... going X minutes without real oxygen movement, what good are you?

When we breathe, we breathe in 21% oxygen. When we exhale, we exhale about 16%. So unless someone has a BVM with 100% o2 with a full chamber, it is a very minimal amount of o2 we are giving the pt anyway, much less than is needed to sustain life.

I'm sure that someday soon we will be making the switch to continuous CPR, just like we are supposed to be doing once an advanced airway is in. This stuff is very interesting, I'm looking forward to seeing what changes are in store for us.

[mfkap 0]

As for the hands only CPR... When we compress the chest, we are NOT doing it in order to compress the heart and act as the Left Ventrical contraction. The reason that we are taught to compress the chest is to create a vacuum inside the chest wall in order to suck the blood out of the heart through the blood vessels. What the research is showing is that it takes approximately 30 compressions in order to create that vacuum. Except we are taught that once we hit 30, we are supposed to stop in order to ventilate, thus ruining the vacuum and having to start all over.

Do you have a source or two for this? As I was taught, part of doing correct CPR is allowing the heart time to refill. Creating a vacuum would not work without pumping the heart, because the blood would stop at the capillary level, wouldn't it? I don't see how creating a vacuum works in a closed system, only an open system. Also, your coronary arteries come off of the aorta directly above the aortic valve. If you were creating a vacuum downstream of the heart, then there would be no pressure (or even negative pressure) into the coronary arteries, and you would have a dead heart, no? I might be wrong on this, but I have not heard of this before. Perhaps you are referring to the vacuum created on the right side of the heart? That vacuum is being created by the left side pumping and the pulmonary valve not allowing backflow. However, if your pumping wasn't ejecting blood from the left side of the heart, you would have no vacuum created.

When we breathe, we breathe in 21% oxygen. When we exhale, we exhale about 16%. So unless someone has a BVM with 100% o2 with a full chamber, it is a very minimal amount of o2 we are giving the pt anyway, much less than is needed to sustain life.

I'm sure that someday soon we will be making the switch to continuous CPR, just like we are supposed to be doing once an advanced airway is in. This stuff is very interesting, I'm looking forward to seeing what changes are in store for us.

I am not sure if this is correct. If you are doing CPR on someone, and the blood is circulating, their O2 levels in the lungs will drop below 16%. Hemoglobin has a high affinity for O2 at low O2 levels and can readily gain O2 at relatively low O2 partial pressure in the lungs.

This isn't to say that there isn't sound science behind the decision to go compressions-only, I am just not sure that your facts are correct. I think that the hope is removing the mouth-to-mouth from CPR will help increase the amount of people who will be trained and act in an emergency, and they have proven that the loss of mouth-to-mouth is less significant if the chance of early compressions is increased.

Edited April 2, 2008 by mfkap

[ny10570 745]

mfkap, there is very little actual compression of the heart. As you increase the pressure inside the chest cavity pressure back into the venous system is stopped by the valves in the vasculature. Over time pressure builds up in the arteries and pushes the blood through the capillaries. It is when the pressure finally builds up in the venous system that CPR reach peak effectiveness. Circulation through the coronary arteries into the heart works opposite of the rest of the system. During recoil the pressure in the arterial system pushes back up against the aortic valve forcing it closed. At this time it pushes into the coronary arteries. At the same time the recoil pulls blood out of the venous side or the coronary circulation.

Ventilation without supplemental O2 is effective because the body's oxygen demands are much lower in arrest. That and right before arrest the blood was most likely fully oxygenated.

Edited April 2, 2008 by ny10570

[RWC130 594]

Hands-Only CPR is for the lay public (i.e. untrained rescuers)

[mikeinet 37]

Are you sure about that information? They took away abdominal thrusts for unconscious choking because of fear of internal trauma. I would think that chest compressions, would be far more effective in terms of circulating blood than pounding on someones abdomen, it just doesn't make any sense to me.

Sure -- here ya go: http://www.hr-hpr.com/reuters_article.asp?...921scie001.html

[Guest alsfirefighter]

RWC posted it correctly...hands only is for out of hospital...witnessed arrest for an adult only!

Secondly...as 10570 poignantly discusses all the reasons why it still works and why thing are changing and much of it seems more common sense stuff backed up with the studies they have done. Anyone who has worked a number of arrests can see what they are talking about is pretty factual particularly with the compressions. Get the blood moving...for EMS is doesn't matter we are still going to bag...but get things circulating and at a higher percentage then it use to.

There is strong discussion about a potential hypothermia protocol for arrest victims as well...change is inevitable gang, whether you believe in something or not..means squat...have an open mind and if someone drops...compression only is a lot better then nothing. Seattle was teaching compression only and they have some of the highest Out of hospital arrest survival rates in the country, coupled with their public access AED and their tiered response system of EMS.

1 hand or 2 hands....does it really make a difference as long as you are getting the depth correct? I often do child CPR with 2 hands because I find I don't fatigue as quickly...its the depth that counts...I'm a professional not a lay person...CPR curriculums are delivered the way they are to allow lay persons to remember as much as possible for correct delivery. Hence another reason why abdominal thrusts for unconscious choking victims went bye bye. Too much to remember and studies showed people couldn't retain the info for an extended period of time...so they do chest compressions to remember less. I'm not a chef and don't read cookbooks...I am a professional medical provider.