Are we doing CPR Wrong?

[ems-buff 81]

From FoxNews.com

DALLAS — Updating the way everyday people do CPR, new recommendations urge many more chest compressions for victims of cardiac arrest.

The revised guidelines issued Monday by the American Heart Association on cardiopulmonary resuscitation advise giving 30 chest compressions — instead of 15 — for every two rescue breaths.

"Basically, the more times someone pushes on the chest, the better off the patient is," said Dr. Michael Sayre, an Ohio State University emergency medicine professor who helped develop the new guidelines.

"When you stop compressions, blood flow stops," said Mary Fran Hazinski, a clinical nurse specialist at Vanderbilt University Medical Center who also helped develop the guidelines.

"You have to make up for that lost ground," she said. "We think that the fewer the interruptions, the better for blood flow."

The guidelines also recommend cooling cardiac arrest patients for 12 to 24 hours to about 90 degrees Fahrenheit. Two significant studies have shown that practice can improve survival and brain function for those who are comatose after initial resuscitation.

More than 300,000 Americans die each year of cardiac arrest, when the heart suddenly stops beating. The heart association estimates that more than 95 percent of cardiac arrest victims die before they get to the hospital.

Studies show that the chest compressions create more blood flow through the heart to the rest of the body, buying time until a defibrillator can be used or the heart can pump blood on its own. Studies have also shown that blood circulation increases with each chest compression and must be built back up after an interruption, the association says in its online journal Circulation.

The new guidelines also cut down on the number of times a rescuer needs to use a defibrillator and they advise rescuers not to stop after giving two rescue breaths to check for signs of circulation before starting compressions. The bottom line advice is to focus on the chest compressions.

Instead of applying the defibrillator pads up to three times before beginning CPR, the guidelines advise rescuers to just give one shock and then do two minutes of CPR beginning with chest compressions before trying the defibrillator again.

Studies show that the first shock works more than 85 percent of the time.

Defibrillators have been popping up in public places like airports and businesses, but the heart association says that more public places need to install the devices. Survival rates have been as high as 49 to 74 percent for lay rescuer programs when defibrillators are placed in casinos, airports or used by police.

The guidelines also urge that 911 operators be trained to provide CPR instructions by phone.

"For the bystander that witnesses a collapse, the main danger is inaction," Sayre said. "We believe there is very little downside to trying to attempt a resuscitation."

According to the heart association, about 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.

Sudden cardiac arrest can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.

"The most common reason many people die from cardiac arrest is no one nearby knows CPR," Sayre said.

The new guidelines provide an opportunity for those who have taken CPR in the past to take a refresher course, said Dr. Ahamed Idris, professor of surgery and medicine at the University of Texas Southwestern Medical Center.

"I think it's a good idea for people to take CPR lessons at least every couple of years," said Idris, also involved in creating the guidelines.

Hazinski said that she expects the new guidelines will be disseminated over the next few months to those who teach CPR.

The heart association says that currently about 9 million Americans a year are trained in CPR, but the association has a goal of more than doubling that number in the next five years to 20 million.

"The bottom line is we think more people need to learn CPR," Hazinski said. "We have more and more evidence that good CPR works. We're doing our best to increase the number of bystanders that learn CPR."

So the bottom line more Compressions for cardiac arrest.

[ny10570 745]

Just wait, soon the guidelines are going to state compressions only when you are performing single recuer cpr.

[Skooter92 7]

This is a file I got off of EMS House of DeFrance (Great site for EMS types in general!) that breaks down the new guidelines vs. previous AHA recommendations. Interesting reading.

heart_breakout.txt

[CAM502 6]

Didn't we discuss a change in CPR not that long ago? Wasn't there a big thread on this?

[CAM502 6]

http://emtbravo.net/index.php?showtopic=4444

[ems-buff 81]

http://emtbravo.net/index.php?showtopic=4444

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Opps didn't see that there ah well if they want to delete this they will I have know problem with it I just thought it was interesting that they are saiding do more compresions and not more breathing?

[CAM502 6]

30:2 makes more sense than 100:1....I think that is what the other thread said.

Edited November 29, 2005 by CAM502

[Remember585 815]

I first took CPR at the age of 12. Back then the ratio was 15:3 for adults and 5:1 for children and infants.

When I re-certed once, it was 15:2 and 5:1.

Another time I re-certed I was taught 15:2 for one man, 5:1 for 2 man.

Most recently, it is back to 15:2 for one AND two man, plus a 5:1 for kids.

I was told in my latest EMT refresher that studies show that with the 5:1 we weren't making a sufficient enough blood movement in the body. I can see their point, but here's another question for all of you out there....

DO YOU REALLY COUNT ANYMORE?

Doesn't it seem like one person at a time is pumping non-stop on the chest while someone is hyper-ventilating with a BVM?

Don't get me wrong, every call I go to gets the full work up, but I can't recall the last time I heard someone calling of the cadance "1,2,3,4,5 BLOW"

Edited November 29, 2005 by Remember585

[CAM502 6]

Don't get me wrong, every call I go to gets the full work up, but I can't recall the last time I heard someone calling of the cadance "1,2,3,4,5 BLOW"

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Not so much you, but I've seen it being called out by the guy who had no training other than a Red Cross course. The changes are more for the common person, aren't they?

[antiquefirelt 994]

I can recall a study from Boston EMS that said we did not oxygenate pt.s enough and you needed to bag more often. For awhile we bagged on 1, 3 and 5. Now they say more compressions, less o2?

[Guest]

The new protocols for one man rescue are 30:2, as stated above they show a need for more circulation. Also AED methods are now going to be different. The lay recuer should shock immediatley (as done in the past), and we the health care proffesionals must do 1 full minute of CPR prior to shocking the patient. Also we only shock once now!

I think its a ploy to sell some AED software! haha

It was put simply to me earlier... 1st we werent getting enough O2 with ventilation quality, then we needed to shock more, and now as our methods and equipment have progressed they can see that the compressions aren't as effective. One day we'll see every agency with an autopulse type machine.

[roeems87 0]

If you go to the AHA website and check out their newest journal release, it explains all the changes... there are MANY... CPR is almost much of the EXACT opposite we have always been taught... here are some examples:

1) the 30:2 ratio is so that we get more blood moving. It usually takes the first 6-7 compressions (if they are done correctly) to get the pressure buildup necessary to move the blood around anyway. This compression change also has psychological value for lay rescuers. (it's now going to be 15:2 for both peds and infants as well...) It's "keep it simple, stupid" and makes their notion of "push hard, push fast" and lets people do the right thing when in a situation they don't face very much. For rescuers, the purpose is to move more blood through the heart and lungs (and to perfuse) to reduce acidity and increase gas exchange as best possible. The thought is that enough air is moving into the lungs from the negative pressure your compressions make in the first place (after all, we breathe by negative pressure anyway).

2) Rescue breathing is being changed... they are now recommending much more time for the exhale and CO2 outward movement. The beginnings of acidosis are setting in when someone crashes, the build up of carbonic acid and CO2 needs to be moved out more importantly... The rate of diffusion for Oxygen is much faster and will get in anyway. They are recommending that Rescue breaths be a smaller depth (6-7mL/kg, roughly 600-700mL for your average adult, compared to the 1100mL recommended now--or 800-1000mL on O2) and only over a period of one second. This is quite counter-intuitive to the "slow and deep," "breeeeeeeeaaatthhhhh" mentality we have now.

3) holy crap AED companies will be making money! Just about every AED out there will need to be reprogrammed. The AHA now states that there is no purpose for stacks of 3 shocks. Data now shows that 90% of all rhythm converesions will convert in the first shock, and if they don't, there is only a 3% (some low, single degit number, not sure if it's 3) chance that it will convert to a stable rythm again anyway. Now they are stating, if it is witnessed arest, apply the AED and shock ONCE immediately. If it is known down time of >5minutes, they now say to complete (get ready!) 1.5-3 MINUTES of CPR before using the AED. The reasoning is that after 5 minutes, your chances of recovery are not much different after 8. If you still have a shockable rhythm at 5 minutes, then hopefully it holds on. They feel it is now more important to begin circulation before attempting defibrillation. The ACLS protocols are changed a bit as well, with drugs (doses, sequence, options) and defibrillation, but listing all that may be more long-winded than necessary.

One last thing I thought was incredibly well pointed out and something everyone can learn from (even if you hear it a million times), the AHA includes the following sentence:

"In the most dire of cardiac emergencies and cardiac arrest, no ACLS measure can compare to excellent performance of BLS skills."

[JohnnyOV 2]

I think im personally doing something wrong cuz i've never had a save

[ems-buff 81]

I think im personally doing something wrong cuz i've never had a save

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LOL how many Black Bars do you have anyways? angel of death!!!!

[WAS967 97]

For the full set of guidelines, go HERE

Most of you will be interested in Parts 3-6.

Edited November 30, 2005 by WAS967

[JohnnyOV 2]

LOL how many Black Bars do you have anyways? angel of death!!!!

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6 stay away from me if your dying.

Edited November 30, 2005 by EMSJunkie712

[Remember585 815]

Another dumb question...

Are we expected to do anything different then what our most recent training tells us?

[ny10570 745]

6 stay away from me if your dying.

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Don't sweat it. I know one EMT who in 20+ yrs has never had a save. Excellent emt, just all ways gets the f-ed up cases.

[JohnnyOV 2]

Don't sweat it.  I know one EMT who in 20+ yrs has never had a save.  Excellent emt, just all ways gets the f-ed up cases.

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wow, i would have given myself a bad nickname by then...thats a long time w/o a save!

[Stepjam 118]

Hmmmm......30:2.......

Is there anything in the guidelines about sending a spare CFR or EMT to resuscitate the first responder when he arrests?

They better start making do-it-yourself pocket AED's.

Edited November 30, 2005 by Stepjam

[IzzyEng4 427]

Don't worry all, they'll change it again in the next 2 to 6 years. Fourth change I have been throughsince being CPR certified.

[capt36 9]

Hmmmm......30:2.......

Is there anything in the guidelines about sending a spare CFR or EMT to resuscitate the first responder when he arrests?

They better start making do-it-yourself pocket AED's.

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[WAS967 97]

Are we expected to do anything different then what our most recent training tells us?

At the moment, no. Right now these are just the new guidelines being released for review by anyone and everyone. None of the instructors have been updated to teach the new courses yet. (At least none that I know.) It's probably being disseminated to regional faculty now and the ITs and Instructors will soon follow. No idea if they have a set date to start teaching the new material.

Edited December 2, 2005 by WAS967

[Guest]

I am an instructor and i havent got the official update yet............