New CPR Technique?

[Guest WolfEMT]

I just saw an piece on the NBC Nightly News which described a new technique in CPR which is being developed by a Doctor at the University of Arizona Medical Center. Instead of doing the traditional 15 compressions and 2 breaths, this new technique says to do 100 compressions and NO breaths; the theories being that there is a "crucial lapse of time between compression and breathing" when the rescuer is switching positions and (and this is the kicker) lay people are "generally afraid" to perform mouth-to-mouth because of the risk of disease (this was supported by none other than a scene from "Seinfeld"). This poses two issues for me:

- First and foremost, how is oxygenated blood supposed to reach the brain if there are no breaths in the process? Since there was nothing about a patient being bagged at 15 LPM during the CPR process, I am assuming that this doctor wants to eliminate it completely.

- Secondly, since all rescuers use either pocket masks or BVMs to give a patient oxygen, isn't it counterproductive to the patient to eliminate the administration of breaths/oxygen?

[tbendick 27]

I am not sure if it was posted..

NYC EMD no longer informs callers to do rescue breathing.. EMD instructions are for chest compressions only. I know a lot of people have been looking at this Issue.

[Guest WolfEMT]

If CPR is supposed to provide steady bloodflow to the brain (and the rest of the body) in the absence of heart activity so as to prevent brain damage and eventual death, then how can the absence of rescue breathing be beneficial? The brain and body cannot survive without oxygen, which is circulated via the blood, so if you cut out the oxygen, then what's the point of doing CPR at all?

[Guest]

Do The compressions like jumpstart the heart and maybe help it more that is the only thing that I could think of

[roeems87 0]

Two things on the issue:

The first I may be incorrect about, so please correct me if I am wrong, but just like many other CPR changes, the changes are only for NON-RESCUER CPR. Just like the NON-RESCUER (community, heart saver, what have you) changes made with the unconscious choking protocol stating chest compressions instead of abdominal thrusts. The changes that are being proposed are not for professional rescuers, only for people who would not be called upon to do CPR all that often. The rationale is simple, they can't screw up as much. The reason they teach chest compressions for choking now to the non-rescuer is so that it is the same technique and skill for everything they need to do for an unconscious person. The thought is that they can't hurt the person, both are perhaps (in theory) effective and there is less room for error for someone who may be acting as the good samaritan. They have dumbed it down for everyone's good. That would be my assumption on this reason for changing things without the breaths. There is a physiology issue to this though, that I would like to bring up.

That's my second comment. From what I have heard about this, there is no problem with eliminating the breaths. Though the breathing provides additional oxygen and oxygenated blood (WHEN PERFORMED CORRECTLY--which may be difficult for a non-rescuer who does not do this all that often or at all, not someone who does it on a regular basis), there is no significant loss without it though. What I have learned about this is that there is enough oxygen in the blood that is already there that will be enough sustenance until more advanced care can be provided. The circulation and profusion of that blood (with the oxygen it has) is more important than adding more oxygen to it. This is the rationale, primarily I would assume, behind removing the breathing steps. Note, this change doesn't remove the rescue-breathing protocol (pulse, no breathing--need to keep the pulse, by keeping breaths going), just rescue breaths from the CPR protocol (no pulse, no breathing). Recall that CPR will not result in the spontaneous return of circulation (i.e. doing CPR will not get you a pulse). Thus, just as important as the oxygen is, the supplies to restart the heart in the first place are much more important. The need for oxygen is real, obviously, but the need for more advanced care is needed more than any additional oxygen is going to provide during non-rescuer CPR. I would venture to assume this doctor has proven that the oxygen intake is not much greater with the breathing part of CPR instated as with lacking it. Thus, similar to previous changes, I think it dumbs it down to the essential steps until better and more advanced care can get there.

[Guest WolfEMT]

I don't agree with the new changes at all. First off, I think it's very short sighted in the interests of the patient. Secondly, it will probably create more of a problem and more work for the responding rescuer.

Here's a hypothetical:

Let's just say that it's 3:00AM and the local volley squad doesn't staff their quarters 24/7 (like mine - there is a crew there between 0800 and 2300). There's an elderly male who goes into cardiac arrest in his sleep; his elderly wife only knows there is a problem because he rolled over before he went into arrest and she cannot get him to wake up to roll back over and get off of her. There is a middle-aged male who is the son of the elderly man in cardiac arrest; he is sleeping in an adjacent room. He was once certified in CPR but it lapsed a few years ago. He remembers that he saw on the news that you don't have to do breathing, so he only does compressions. However, the volley squad has a 10 minute ETA to their building to roll a rig and then they have another 10 minute ETA to the scene. There is no PD available because of a large-scale incident on the other side of the town. If the brain cannot go more than 5 minutes without oxygen, and there will be at least a 20 minute delay before more advanced professionals arrive, then won't the new CPR protocols for the lay person actually hurt the patient?

That may be a bit of an extreme case, but if studies show that the lay person is ill-equipped to perform adequate CPR then they should educate the lay person in a better manner, not dumb down the entire curriculum. When a life is at stake, there is absolutely no reason to dumb down a curriculum that is meant to save a life.

[roeems87 0]

The way it is taught is so that good can be done regardless of the level of training. I agree with the changes in the non-professional rescuer CPR because of the way people react in a situation like that. Have you ever walked into a scene where someone is doing CPR (who has never done or seen it before) on someone who just collapsed in front of them. Two instances I can just throw out of examples show both ends of the spectrum. In both cases, the person doing it was scared to death. Maybe not scared, but certainly quite nervous, upset, whatever. In the first instance, the person doing CPR was indeed doing it in the right scenario, however not correctly (i.e. ratios were all off, the head wasn't tilted back enough). That said, the person was doing compressions and doing that correctly. That seems to be the skill most people can get down...partially because it's the only one that Rescue-Anne can adequately help you with. The head is 40 times the weight of the little plastic maniquin and that skill is something that not many people could ever get right their first time (and probably their only time, God-willing). The compressions he was doing I am sure were helping, but the time he wasted trying to get the breaths going, wasn't helping, and in the end, didn't result in any meaningful oxygen help anyway.

The second scenario was someone who was doing CPR on somebody with a pulse...a slow one, but not a faint one--somsone who was partially conscious the whole time. This is not going to prove my point about doing compressions and no breaths (NOTE: I am not the advocate for this new type of CPR, just playing it's reasons.); however, it goes to show that the lay rescuer, when thrown into this situation of having to help is not always (if ever) calm enough to think through what they are doing. You would probably agree that most EMS training (at least CPR for example) is taught so that little thinking is really necessary--i.e. you see something, you treat that. The person is not breathing--rescue breathing; no pulse--CPR. For someone who sees situations like this rarely if ever, I truly do believe that teaching the skill as simply as possible to do the most good until help gets there (as long a hypothetical time as you can imagine) is the best idea.

A couple things about your scenario, Wolf. First, imagine the state of mind of the wife and son of your man in cardiac arrest in the middle of the night. Go beyond that, imagine the state of mind of anyone calling 911 because they have someone in front of them in cardiac arrest, no less, a relative. If you can picture how that person is going to be, no matter how many times you reassure them and ease them to calm down, their ability to think straight and follow all your directions (or remember the directions they learned up to a year--or even many years--ago) is limited. To expect them (in that state of mind) to be able to complete a set of skills difficult for the un-practiced person without hampered judgement and emotions, is really tough--and reasonably so. That's why I believe "dumbing down" (for lack of a better phrase) the curriculum of community or heart-saver CPR is not a bad idea.

Please also be aware that if this change applies to the professional level, I disagree. Those of us in the medical and emergency response fields should be expected to handle the skills because we would (theoretically for some) see this situation over and over again.

The second point I would like to make about the hypothetical situation posed is that if that man has no pulse and no breathing for a 20 minute (minimum) response time he is dead regardless of how much CPR you did and how well you performed it. If a miracle happens and you are lucky enough to still have a shockable rhythm (or you drug him/her, or you pace, what have you) and you get the person back, they are going to be brain dead, or significantly brain damaged after 20 minutes regardless of how well you performed CPR. CPR will not get someone back, we all know that, it does an small part in keeping profusion throughout the body while it's not working for itself.

More than the breaths and CPR itself, the most important part of your situation was the lack of a responding PD car or FD engine. Getting an AED (or more advanced care--than the lay rescuer) to the scene is the only thing that is going to save that person's life.

[Guest WolfEMT]

That's actually a good point.

[Guest ksneubec]

When you perform chest compressions you force air out of the lungs- this creates a negative pressure when you pause to allow the chest to expand, thus pulling fresh air into the lungs. Remember, 21% in the air around us (on a non-smoggy, not NYC day ), and 16% when you perform rescue breathing.

[mikeinet 37]

Not just NYC EMD... the future versions of all EMD cards are going to only recommend compressions - I believe mainly for the reason that it's easier for phone insturctions and allows the process to move faster.

[ny10570 745]

roeems87, you are absolutly correct in everythign you have said. This has been comming for several years now. As for the previously mentioned seinfeld reference, it has been an in creasing problem where people are refusing or at the very least hesitating before proving mouth to mouth for fear of disease transmission and the all ways mature...eeeww I don't wan't to put my mouth on someone else.