Hands Only CPR

[codethree]

The American Heart Association is promoting hands only CPR where the rescuer only does compressions until EMS has arrived and taken over. The theory is that there still oxygen in the patients blood, enough to be circulated throughout the body. In addition they are promoting this to try and get more of the public trained in CPR since now they don't have to worry about bodily fluid transfers.

I find this interesting and wonder what you all think about hands only CPR.

 

[Aprz]

I thought everyone was for it already.

 

[STXmedic]

This has been going on for a couple of years, now.

The idea is that it makes laypeople more likely to do CPR (if they don't have to put their mouth down by the patient's). The compressions themselves also theoretically create enough negative pressure in the chest during recoil to allow for sufficient gas exchange. There are a number of systems participating in a trial that has the responders place only a nonrebreather for the first 10 minutes of a code, with no BVM or advanced airway. Again, the negative intrathoracic pressure being sufficient for adequate gas movement and exchange, and also limiting/eliminating breaks in chest compressions.

 

[Handsome Robb]

I feel like I just went back in time.

 

[DesertMedic66]

I feel like I just went back in time.

Back to the days of Epi and Atropine for all full arrests....

 

[xrsm002]

Some services are moving to the CCR (cardio cerebral resuscitation) as well.

http://www.azdhs.gov/azshare/ccr_share.htm

 

[Achilles]

Some services are moving to the CCR (cardio cerebral resuscitation) as well.

http://www.azdhs.gov/azshare/ccr_share.htm

That's nothing new.

 

[mycrofft]

I haven't seen where chest compressions are adequate for resuscitation breathing, we had that in the forties and fifties and it was dumped.
So far compression only CPR is to get laypersons to do CPR when otherwise they might not.
In an unconscious patient without decent history, there's no way to know if there's an airway obstruction without attempting to inflate. If all that's wrong is suffocation from a food bolus or laryngeo-edema, then a cryc or needle jet resuscitation may be what it takes to make a save, when otherwise the compressions are for bupkiss.

 

[Christopher]

The American Heart Association is promoting hands only CPR where the rescuer only does compressions until EMS has arrived and taken over. The theory is that there still oxygen in the patients blood, enough to be circulated throughout the body. In addition they are promoting this to try and get more of the public trained in CPR since now they don't have to worry about bodily fluid transfers.

I find this interesting and wonder what you all think about hands only CPR.

CCR is the preferred modus operandi for the entire bystander phase and the first 2-3 cycles of a cardiac arrest once EMS arrives. Once you've optimized compressions you can institute ventilations, provided you do not muck up compressions.

In the obscenely rare case you've found somebody who chokes to death, it will be noticed by a good history and scene size-up (or their very purple/blue presentation upon your arrival, much like a PE).

The honest answer is if you're not working a 75yr+ patient or a <5yr patient, the incidence of choking is far too low to care about for the first 2-3 cycles.

CCR works very, very well for healthcare providers and if you're not monitoring the rate, depth/pressure, and EtOC2 while ventilating...you're doing it wrong probably 80-90% of the time. In fact, some studies have shown that you can even give people allll of the information necessary to ventilate a cardiac arrest victim properly and they'll still mess it up. (But if they have a pulse people ventilate them well...makes no sense)

Long story short: CCR, it's not just for laypersons.

 

[ThadeusJ]

There was a study published on May 1st (http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130501_hn) from a trauma centre in Toronto that suggested that hands only CPR may not be effective in rural areas where EMS response is longer (12 minutes, I believe).

Personally when its my time and you arrive, please maintain my airway and apply oxygen to achieve and maintain normal SpO2 levels. There's an extra 10 spot in there for you and your partner...

 

[Arovetli]

I believe we discussed this, including the paper cited, in another thread recently, for those inclined to search.

 

[ThadeusJ]

I thought we had...

 

[Christopher]

There was a study published on May 1st (http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130501_hn) from a trauma centre in Toronto that suggested that hands only CPR may not be effective in rural areas where EMS response is longer (12 minutes, I believe).

That meta-analysis mentioned basically notes dismal outcomes if you're not seen by responders for >15 minutes...This is not new or exciting, nor a plug for conventional CPR or CCR.

Keep in mind that conclusion was based on a single study from 1998-2003 using older CPR as well. The other issue is the sample size was very, very small for survivors from OOHCA >15 minutes, such that it would be very hard to chalk it up to the method of bystander CPR.

The key take-away from that meta-study is that CCR is very helpful, but that ANY CPR is better the earlier it is started. We have no conclusive data to support one method over another for prolonged arrests, but common sense would say we should include some oxygenation.

Personally when its my time and you arrive, please maintain my airway and apply oxygen to achieve and maintain normal SpO2 levels. There's an extra 10 spot in there for you and your partner...

Did you know that very few providers do this properly? Even when benchmarked most providers do this incorrectly. Incorrect ventilations contribute to your death. Strategies which minimize the focus on ventilations and maximize the focus on uninterrupted chest compressions maximize your chance for survival.

What you'd like to throw in a 10 spot for is "appropriate management of my ventilation and oxygenation, without interruptions of chest compressions." (although in 5-10 years we'll be doing stutter CPR for the first round, but until then...go with the best evidence)

 

[All Ryle Dup]

Speaking of oxygenation and ventilation, isn't the newest research showing that we should be guiding our ventilatory rate by keeping the EtCO2 WNL and keeping SpO2 between 95-99%?

Hyperventilation is out, and depending on the nature of the illness excessive O2 is actually harming patients. Free radicals (O2 ions) are being shown to attack sites of ischemia in MI and CVA patients. Even for TBI with suspected herniation you're still only supposed to allow for permissive hyperventilation maintaining an EtCO2 between 30-35... Closer to 30.
And even that, according to a Trauma Intensivist I spoke to a few weeks ago is showing not to be very beneficial to patient outcome.
For medical it is even being shown that high flow isn't even necessary, 2-4Lpm via NC is all you really need to maintain adequate oxygenation in a breathing patient with good TV; provided no V/Q mismatch mechanism is present or evident. Obviously, circumstances may be unique and other interventions may be required.

Obviously, this is ground breaking research as we were all taught O2, O2, O2 all day, everyday as youngsters. We're all aware of EMS being a very fluid environment with things changing and providers adapting as our science and technology evolve to beat out the things we do because we've just always done them.

I don't debate that O2 is crucial in an arrest, but the reserve of unused O2 in circulation is one reason why "hands only" is the new standard. The public doesn't want to be putting their mouth on other people who are "dead." Thus, the AHA concluded it was better for them to do something beneficial until advanced providers arrived. The study and reasoning, as it was explained to me by the AHA education coordinator for my region, was that the goal of "hands only" was to use that O2 reserve in the blood to feed the coronary arteries during diastole, and to help perfuse the brain while EMS is on the way. It increases the "salvagability" of the patient even without oxygenation so that when we arrive, we actually have a better fighting chance at getting a "save" provided we get to the patient within 8-15 minutes (more or less.)

Granted, it is debatable as some would say it is better to do "this or that" than be dead. But the goal of a true "save" is to prevent death OR debilitating injury so that a patient is discharged home to the same or near the same quality of life they had prior to the event. Not to just get pulses back in the ED, and create a new customer for some awful SNF. Maitaining adequate respiration and circulation (uninterrupted compressions) is critical in obtaining that result.

Sorry, I kind of went off on some tangents, but ... Yeah...there it is.

 

[Christopher]

Obviously, this is ground breaking research as we were all taught O2, O2, O2 all day, everyday as youngsters. We're all aware of EMS being a very fluid environment with things changing and providers adapting as our science and technology evolve to beat out the things we do because we've just always done them.

I'd just like to note that it was "ground breaking" in the late 1990's / early 2000's when we started down this path. Since ~2005 it should have been "business as usual". EMS is just severely late to the game in most of the country unfortunately.

 

[All Ryle Dup]

Since ~2005 it should have been "business as usual". EMS is just severely late to the game in most of the country unfortunately.

Agree 100%


Should be widespread common knowledge/practice by now.

 

[takl23]

An EMT friend went to a work site where a woman had a seizure. A co-irker started "hands only" when the seizure stopped. They never ABC'd the woman. My friend and partner got on scene to find the pt trying to fight off the co-irker as she was doing compression's.

Apparently she took some sort of hands only class on the interwebz...

 

[Christopher]

An EMT friend went to a work site where a woman had a seizure. A co-irker started "hands only" when the seizure stopped. They never ABC'd the woman. My friend and partner got on scene to find the pt trying to fight off the co-irker as she was doing compression's.

Apparently she took some sort of hands only class on the interwebz...

Even if they took an actual CPR class they would learn that.

Begin CPR if:

• The patient is unresponsive (to shake and shout)
• Not breathing or not breathing normally (e.g. only gasping)

No ABC's, no CAB's either for that matter.

 

[xrsm002]

That's nothing new.

It's new to where I live now. They are a little behind in medicine here.

 

[mycrofft]

None of the companies/agencies I teach with sell hands only CPR as primary for any level of samaritan or responder.