Chest presses, not breaths, better CPR?

[mysterl33]

Chest presses, not breaths, better CPR

March 16, 2007 04:12:20 PM PST

Chest compression — not mouth-to-mouth resuscitation — seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.

A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.

More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.

Full article here.
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On the Net:

Lancet article: http://tinyurl.com/2fup97

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

What do you guys think? I think rescue breathes are needed because the organs in our body need oxygen and compressions will only be pushing de-oxygenated blood through the body if breaths are not given every 30 compressions.

 

[Recycled Words]

It's not the break between the compressions and rescue breaths that's the issue, it's the time it takes for perfusion to restart once compressions are pause. I think it's something like the first 5-6 compressions until perfusion starts which is why the old CPR didn't work as well. A patient needs both resps and compresions.

 

[Medic's Wife]

what do you guys think? I think rescue breathes are needed because the organs in our body need oxygen and compressions will only be pushing de-oxygenated blood through the body if breaths are not given every 30 compressions.

Those were my exact thoughts as I read the article. It would be interesting to see this study duplicated with the rate of 30 compressions vs the 15 that was done in this study.

 

[Medic's Wife]

oops, sorry- duplicate post.

 

[AndiBugg]

I think both are important. I think the big problem with bystander CPR is placement of compressions(they are usually a little too far to one side or another) or they dont do hard enough compressions.

 

[Ridryder911]

It is way too early too make changes. One study should not reveal we should make changes drastically, especially with so little numbers. Yes, it should peak our interest but not redo our process until more research is performed. We have just had one of our first major changes in CPR and it is too early to see the outcomes of that yet.

Albeit, newer and more research is demonstrating that the heart is more responsive to acidotic states with high ATP, causing more irritability thus more responsive for electrical conversion (defibrillation).

Again, we are compromising again. We much rather describe and teach citizens to perform poor CPR than to do nothing. This is were the ethical debate begins. Would it be better to perform poor care or have no care being performed ? Unfortunately, over all the outcome percentages are poor. If one would read the new study of only 22 % out of 412 (new procedures) and 10% out of 712 .. it still a very poor outcome. Maybe, we should be looking at some other delivery of resuscitation.. obviously what we are doing is not working.

R/r 911

 

[BossyCow]

Our organs need oxygen but they get it from the oxygenated blood, which, without compressions goes nowhere. Also, think about the air you breathe.... about 25% oxygen, we inhale it, then exhale only about 12%... so in layperson CPR (the CPR mentioned in the study) the pt is only getting a miniscule amount of oxygen so the effect of the breaths are minor.

I think that removing breathes from "LAYPERSON" CPR is a good move.

 

[Jon]

Our organs need oxygen but they get it from the oxygenated blood, which, without compressions goes nowhere. Also, think about the air you breathe.... about 25% oxygen, we inhale it, then exhale only about 12%... so in layperson CPR (the CPR mentioned in the study) the pt is only getting a miniscule amount of oxygen so the effect of the breaths are minor.

I think that removing breathes from "LAYPERSON" CPR is a good move.

Some of the studies I've seen say that there is enough oxgenated blood in the body, and enough oxygen in the lungs to last for several minutes... AND most bystanders are hesitant to do CPR because they don't want to kiss some old geezer with gingavitis that they've never met, and they think that you have to do breaths if you do CPR.

 

[MMiz]

As a teacher I'm gravely concerned by the nation's dumbing down of material to make it appeal to the masses. Our public schools are doing it, EMS programs are doing it, and the AHA/Red Cross are doing it.

That said, I'd rather see a bystander give some compressions instead of totally avoiding CPR in fear of getting some germ.

 

[chocchipsmom]

I have to agree with MMIZ. Having bystanders act is better than nothing being done. I don't think there is a "perfect" solution, but as an instructor, I hear the same concerns about mouth to mouth. The public does not usally carry barrier devices with them, so they need to know that just compressions will help.

 

[Stevo]

More than 300,000 Americans die from cardiac arrest each year. 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.

Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital — partly because they don't get CPR.

methinks Ryder nailed it here;

This is were the ethical debate begins. Would it be better to perform poor care or have no care being performed ?

what is/was the premis of ems? imho, it was to proliferate the public with the most help a minimally trained entity could achieve

~S~

 

[BossyCow]

As a teacher I'm gravely concerned by the nation's dumbing down of material to make it appeal to the masses. Our public schools are doing it, EMS programs are doing it, and the AHA/Red Cross are doing it.

That said, I'd rather see a bystander give some compressions instead of totally avoiding CPR in fear of getting some germ.

I agree with the 'dumbing down' of teaching. It seems new curriculum is based more on providing the pencil neck geeks with the data that a class was taught than in actually teaching anyone anything.

But on the CPR thing, I gotta agree with the AHA on the breaths. I see a lot of negatives and few positives for incorporating the breathing in layperson CPR. HCP is a whole different animal however!

 

[hangit]

haven't they been doing this in europe for a few years?

 

[Stevo]

yeah, and btw, whatever happened to the precardial euro-thump?

~S~

 

[Jon]

yeah, and btw, whatever happened to the precardial euro-thump?

~S~

The precardial thump? I think it is still Class IIA or I for wittnessed arrests without immediate defib availible.

 

[mace85]

I believe Phoenix area services have been using the continous chest compression method for a while now. It may actually be Arizona wide. The new (non-AHA approved trial protocol) is to give 2 cycles of CPR with no ventilation for unwitnessed arrests, then start normal 30:2 CPR. If an AED is available it is to be used only after the first 2 cycles. They are using the compressions to get the perfusion level up before they try any rhythm corrections. At least this is how it was explained to me. I will try to see if i can dig up the research on this.

Heres what I found for now.

http://www.azshare.gov/ewy_circulation_article.pdf

 

[Alexakat]

There is an article (albeit, brief) in the April '07 issue of JEMS about uninterrupted chest compressions.

From that article: Two counties in Wisconsin switched their protocol from chest compressions w/respirations to chest compressions alone. The systems had a 300% improvement in cardia arrest survival rates.

Wow.

 

[LIFEGUARDAVIDAS]

In my opinion, I think that bystander CPR providers should be divided into two, those that perform CPR based on what they've seen on TV, and those that took some basic training (AHA Family & Friends or similar). For the latter, I think rescue breaths shouldn't be removed from CPR education (at any level) unless a future study shows otherwise.

It is not rocket science, and if a person cares on learning CPR (even at the general public's level), well, he/she will be able to learn proper rescue breaths and compressions (as well as he/she will get interested in doing it properly).

For those "brave"/impulsive bystanders that with absolutely no training start to perform CPR (without even the 9-1-1 dispatcher remote guidelines)... I don't think there will be a significant difference in the result between poor continuous chest compressions and poor "complete" CPR.

I agree -about waiting to see the new statistics of the recent changes (30-2 ...)

Guri

 

[Medic's Wife]

(non-AHA approved trial protocol) is to give 2 cycles of CPR with no ventilation for unwitnessed arrests, then start normal 30:2 CPR. If an AED is available it is to be used only after the first 2 cycles.

Hubby and I had a discussion/debate about doing 30:2 vs just compressions just a couple of days ago. He explained that it was not so much that the 2 breaths in the 30:2 were not doing any good, or even hurting, but that in studies John Q. Idiot was taking up to 2 minutes to perform those two breaths, and taking up to 30 seconds to find the carotid pulse when they re-asses. So during those two minutes the pressure dropped to the point that profusion was no longer possible.

My suggestion was to change the standards to what is mentioned above, because even though the compressions are very important for proper profusion, and the body maintains acceptable levels of oxygen in the blood for a period of time, every minute that goes by the blood becomes less and less oxygenated. So it seems to me that mathematically at some point the breaths would become necessary, and I think that this would be a good compromise.

I could not understand why people in general, and first responders in particular could not be taught something this simple. I felt like there was way too much dumbing down of the process going on. I asserted that the majority of the general public could not possibly be that stupid, but he assured me that yes- they can. Given that he's been dealing with them as a paramedic for 10 years, I guess I'll have to take his word on that one. He told me that he has seen a decreasing morbidity rate since the standards have changed, so as much as this new standard might irk me, something must be working.