Studies: CPR Often Performed Inadequately

[x635 4,066]

Gee this is a suprise. Duh! This is part of the reason why I like the "new thumper" that Mohegan has, and why it IS useful.

Studies: CPR Often Performed Inadequately  

By LINDSEY TANNER, AP Medical Writer  

CHICAGO - CPR is often performed inadequately by doctors, paramedics and nurses, according to two studies of resuscitation efforts during cardiac arrest.  

Whether a stricken patient is in the hospital or on the way, the guidelines for administering cardiopulmonary resuscitation frequently are not followed.  

Among the problems commonly cited: Rescuers did not push hard enough or frequently enough on the victim's chest to restart the heart, and breathed air into the lungs too often — either mouth-to-mouth or through breathing tubes.  

Both studies used an experimental monitor that assesses CPR quality, and both received funding from Laerdal Medical Corp., a Norwegian company that developed the device with Philips Medical Systems.  

The studies appear in Wednesday's Journal of the American Medical Association (news - web sites).  

The researchers explained that skills learned in the classroom can fall by the wayside in the stress-filled chaos of a real-life emergency. Also, they noted that chest compressions strong enough to break ribs are sometimes required, and rescuers can tire quickly.  

In one of the studies, involving 67 adult patients at the University of Chicago, doctors and nurses failed to follow at least one CPR guideline 80 percent of the time. Failure to follow several guidelines was common.  

"Patients who had it perfectly done were in the distinct minority," said Dr. Benjamin Abella, one of the researchers.  

The other study involved 176 adults with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden; Akershus, Norway; and London. Chest compressions were done only half the time, and most were too shallow.  

More than 600,000 people die from sudden cardiac arrest each year in North America and Europe. The heart suddenly stops beating, either because of a heart attack or other underlying heart disease.  

The combination heart monitor and defibrillator used in the studies includes a small sensor that attaches to the patient's chest and evaluates depth of chest compressions and other aspects of CPR. The monitor includes an automated voice that provides on-the-spot coaching, telling rescuers when chest compressions are not strong enough or frequent enough. But that feature was not used during the studies.  

Both studies were too small to determine whether using the device saved lives, but the Chicago researchers said it could improve patients' survival chances.  

"Without a device that gives you feedback in the heat of the moment, you can't drive an airplane that way — and we can't take care of sick critical patients without the appropriate monitors," said the study's leader, Dr. Lance Becker, director of the university's emergency resuscitation research center.  

The device is approved for experimental use in the United States, and the manufacturer is seeking Food and Drug Administration (news - web sites) permission to sell it commercially in this country.  

While other studies have found CPR techniques lacking, the JAMA studies are the first using a monitor to evaluate "what's going on during real cardiac arrests and in real people," said American Heart Association (news - web sites) spokesman Vinay Nadkarni. "It's outstanding information."  

The studies will be taken up at a medical conference next week in Dallas that could lead to an update of the CPR guidelines, Nadkarni said.  

The studies add to evidence that the guidelines need to be simplified so that they "can be readily used in the real world," Drs. Gordon Ewy and Arthur Sanders, emergency medicine specialists at the University of Arizona, said in an accompanying editorial.  

   

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On the Net:  

JAMA: http://jama.ama-assn.org  

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

[Guest]

whatever they are dead anyway. peace

[LCFD994 8]

I bet they never factored in the length of downtime of patients in hospital or out of hospital.

[mikeinet 37]

I like how it says "they did not push hard enough to restart the heart" -- because CPR doesn't do that anyway... so of course they "arnt doing the right thing" #-o [-(

[firemn23 8]

not for nothing but if you are going to put a devise on someone wouldn't it be in the crash cart where the defib is making it obsolete. .

[lss207 0]

Read the article in the paper this morning. Definitely not surprised. AED's within the first 5 minutes of the arrest is important, though nearly impossible to provide.

[Pudge3311 5]

Can someone tell me what two patients are alike? how about the placement of these pads? they arent in the same place either. To me, sounds like people just dont have much else to do but try and make it seem like emts are not doing their jobs. Oh, heres another one, ever notice that EMTs are never mentioned, its always paramedics?

[Guest alsfirefighter]

Same here Seth in regard to the new compression device. It is no secret that CPR performed by providers in highly unefficient. Inconsistant depth, angle of compression, often all over the place. Not so with that device, consistant effective, efficient compressions, improving cardiac output.

17X2, thanks for your enlightening post. I'm soooo thrilled I may actual need medical care in your area. Do us all a favor, become a mechanic or something instead of a firefighter or EMS provider. Let me give you a professional lesson in patients whom are "dead." They are either pulseless and apneic or in cardio-pulmonary arrest, medical conditions. They are only dead when a doctor or Paramedic says they are dead.

For the rest of my gang on here normally I apologize for the above tone, but I'm not having much tolerance for undereducated pinheads in our profession lately.

[roeems87 0]

granted, CPR is not perfect all the time, nor do I think it is always possible to be. The whole 15:2 ratio is kinda thrown out the door when you have three people trying to save someone's life which involves a lot more than just worrying about compressions and bagging. I would like to see that study done in the US before I would make a full judgement on it, but nonetheless, sometimes there are burned out EMTs who tend to have that same "they're already dead, no matter what I am doing, I'm helping" attitude and it is totally out of place. If it doesn't interest you to try to save someone's life (this being the prime example of when that is most needed) then what the hell are you doing in EMS? Sorry to wake you up to someone's parent or brother or sister or grandparent or aunt or uncle who needs your help. That attitude annoys me too. As for not being mentioned...yeah paramedics are mentioned though, that's a step...usually only FFs are the heros...

CPR is something that you do your best with. In a moving ambulance you can't expect perfection, and unless you are in a system where you do codes every other day, CPR is also a skill that no matter how many times you have done it on Anne, you can only get good at from doing the real thing. It only takes a few times to get in the swing of things, and get the feel for what exactly is necessary, but the best point on here (Pudge) is that no patient is the same. You can't possibly tell me that CPR is the same for (though it is on Anne): grandma that is 75 pounds with osteoperosis; or the 45 year old weight lifter with a chest as hard as rock; or the 400 pound McDonalds fanatic who just had her 4th MI with a side of a stroke... No two cases are always the same, and I would like to hear something more positive like, CPR was performed adequately or well-enough on 90% of patients instead of, they "missed one thing" on 80% of the patients.

[Guest EMSwhitecloud]

17x2 you are apparently laking in the compassion and caring department...maybe time to find another hobby? It just doesnt matter to you right now bc it doesnt effect you...well it should. Like ALS said no one is dead until time is called...until then you work your a** off to possibly give that person another chance....Have you ever heard that expression "its better to better to look stupid rather than open your mouth and prove it?" point proven Your not someone that the community should be subjected to with that atittude

[Guest]

CLASS IN SESSION.... SUCCESSFUL RESUCITATION OF A PT IN CARDIAC ARREST IS 0.5% THATS PRETTY BAD RIGHT. MOST PTS THAT ARE "BROUGHT BACK FROM DEATH ARE VEGGIES.THE DIFFRENCE IS EARLY DEFIB PERIOD! SO IF YOU THINK A "THUMPER " HAS ANYTHING TO DO WITH PT OUTCOME START RUNNING CALLS. SO TO PUT THIS TO BED , WHO CARES THE PT IS DEAD I STAND BY THAT COMMENT. YOU SHOULD BE FOCUSING YOUR MEDICINE ON STUFF THAT REALLY EFFECTS PT OUTCOMES.I'VE WORKED IN WESTCHESTER EMS, I WAS A MEDIC WITH FDNY AND WITH DENVER MEDICSTO NAME ONLY A FEW ORGINZATIONS IN MY 13 YRS OF EMS. PUT THAT IN YOUR NEB AND SMOKE IT. PEACE!

[Guest alsfirefighter]

LOL. Class is in session...for what topic ignorance. Looking at your resume explains your ignorance, poor attitude and I'm sure your skills are as poor as your attitude as well. No kidding their dead, you say class is in session and that's the most you can come up with? The fact of the matter is, if you read the literature and studies out there, newer conmpression devices, not the "thumper" device that's been around for year, significantly increase the amount of circulation when compared to conventional chest compressions. Which can significantly increase the chances of survival WHEN USED IN CONJUNCTION WITH DEFIB AND ACLS. Who cares? The majority of those in EMS and on this site becasue we are professionals.

Any day you want a lesson about professionalism and accountiblity. Let me know I'll be more then glad to open my classroom up to you. By the way the percentage you state is factual in one of the cities you state you worked in. It is much higher in other areas who treat EMS as part of the medical profession filled by professionals instead of deadbeats like you whom like to call yourself "experienced," because of your systems. Run calls, I do, just as much as you did anywhere else you've worked and I don't need a second medic to hide behind or wipe my @ss. My patients, no matter what condition they are in get the best treatment across the board. Through assessment, treatment both through informed aggressive medical treatment and professional compassionate interacton. If any of those words are too big for you let me know, I'll be more then glad to refer you to a dictionary. Because here is your final lesson. Those who are the stupidest and most ignorant in fire and/or EMS have the biggest mouths.

Class is now over and there won't be any certificate or CME's given.

[Guest]

iv'e seen the research and still beg to differ. obviously good cpr is important with defib and so on. but i feel the discussion on mechanical devices vs manual compressions is a non issue. and by expessing this by "who cares the pt is dead" comment you statred with personnel attacks of the quality of care my pts get and what my career should be. you are the one with the big mouth sir. what's your resume. the bigger systems don't show the the attitudes of the person working in it . i have also worked many a systems with emt-b partners throughout the country. so throw your shots be the big man in the small department. get in the building. peace

[Oswegowind 17]

I have a dnr...i don't want some vollies dirty hands touching me when i am dead...lol

[Guest alsfirefighter]

LOL. Well you actually got something right for once, I do have a big mouth and I am a big guy. For all the right reasons. Personal attacks, I didn't make one single personal attack at you specifically. Read my post again, I just merely stated a general opinion about you based on your ridiculous, unprofessional and ignorant tone. I never said you had a big mouth, and I never told you what your career should be that maybe you might want to do us all a favor by getting a new one. I got more personal as you got more arrogant with your bang on your chest mentality. My resume. I'm proud of my resume, and other then trying to maintain some semblance of animity on here for several reasons, I'd have no problem matching my Fire, Paramedic and educational career. There are several on here that now me that would agree and probably are laughing at your small department comment. I'd rather have care in most of the smaller departments with the same per capita call volume ratio to a big city. Just so you know this all stems from that one ignorant and off the wall comment you made and then you try to back it up with posts after the fact when you get called out.

To get back to the topic of discussion at hand, how can mechanical vs. manual CPR not be an issue in extended cardiac arrest. I will agree the thumper sucked, but newer technology and devices utilize a squeeze instead of compression which dramatically increases circulation. I've used one, have seen the difference in patient color and we have had 2 reversals when using the devices. It affords the cardic arrest patient the best chance of survival after initial defib attempts are unsuccessful. Again, don't take this the wrong way, but I'm thinking long term with every patient, you made the comment in your first post that many of us took as that's it. If you say they are just dead, you can't tell me that you are doing everything to the max and best for that patient with that mentality buried in your head.

[JohnnyOV 2]

I personally have seen the "squeeze" device in use and I do not think it works very well. I know I should not be jumping to conclusions off my first use of the device, but I felt I should share my story and see if other had similar accounts.

We had a call for an unresponsive person down in a home. We had/have (unsure if its still in use) an agreement with a neighboring department to show up on scene with us to utilize the device and see how it preformed. Upon finding the patient, she was a frail, small 80 y/o woman who looked like you could break her in two if you touched her. The ok was given to try the device out and we did. It took 1-2 minutes to get the device on her and another to program all of the information required to properly perform the compressions. Well, even though the trained operator put all of the correct information in, and the device was hooked up properly, when it was started, it compressed her so hard that her legs shot up in the air and her stomach distended to the point that it looked like it was going to blow up. After 2 or 3 compressions, the device was immediately shut down and manual compressions resumed. I was the "lucky one" to perform the compressions.

I do not mean to sound grotesque or disgusting, but those who are squeamish pass this next paragraph of the post.

Upon starting them, it felt as if her chest had turned into jelly and I could feel multiple ribs that had been crushed in multiple places and along the sternum. The sternum its self was intact (as we know it is very hard to break).

Although this particular woman was basically dead already, down approximately 30 min. before found, we have this woman every chance possible to survive, not because protocol said so, but because she had family there and no DNR or living will; do not take that the wrong way i.e. I only truly apply myself to people without DNR and Living wills and people with family. Every call should be treated as if you are trying to help someone that you love.

Getting back to the discussion on mechanical vs. manual, my vote so far has to go to the manual way of performing CPR. Like I said before, I personally have yet to see the device work properly but I am looking forward to using it and seeing it work properly. However, until then, I have to stick by manual CPR.