A new take on CPR looking at rural scenarios

[ThadeusJ]

Has anyone seen this latest report from St Michael's Hospital in Toronto? It looks at performing CPR in regions where EMS response time is greater than 15 minutes. This goes back to my discussions with key thought leaders who often base their protocols on scenarios where they are surrounded by the latest technology, 20 interns/residents and limitless resources.

http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130501_hn

 

[Summit]

I love it when this forum provides research links for breakfast reading.

 

[Summit]

I remember making those arguments when the 2010 guidelines came out, and also for arrest suspected 2* hypoxia/acidosis.

 

[Bullets]

I dont buy it. Still isnt anything that shows ventilation do anything for the patient. And hands only CPR is for untrained bystanders, not trained personel with AEDS and such

Even in a "urban" system, we dont transport CPR. patient gets 20 minutes of our best effort and if we dont get pulses then we call it. So a person doing 15 minutes of good CPR is not getting much less then EMS would give them. The only thing lacking is AED access, which should needs to be on rolling stock. However when AEDs first became cheap enough to use you saw cities putting them everywhere but AED usage not increase, because people were unfamiliar with them and afraid to use them

 

[cprted]

The whole point behind Hands-Only CPR is to encourage bystanders to start compressions as studies have shown that lay rescuers are reluctant start traditional CPR especially if barrier devices aren't available (which they usually aren't). The other point behind Hands-Only CPR is that it can be taught in five minutes or by watching a youtube video. While It would be great if everyone came out to a 6 hour CPR class every year or two, that isn't realistic.

So this study is actually kind of meaningless as the question that actually needs to be asked is not is 30:2 vs Hands-Only, but Hands-Only vs No CPR.

I love this video ... if anyone hasn't seen it ... Vinnie Jones Hands-Only CPR

 

[BateMan]

dont want to ask a stupid question but what is rural and urban?

 

[Handsome Robb]

Urban is intracity whereas rural is countryside.

In the simplest of terms. Suburban would be the outskirts of a city.

 

[Brandon O]

The whole point behind Hands-Only CPR is to encourage bystanders to start compressions as studies have shown that lay rescuers are reluctant start traditional CPR especially if barrier devices aren't available (which they usually aren't). The other point behind Hands-Only CPR is that it can be taught in five minutes or by watching a youtube video. While It would be great if everyone came out to a 6 hour CPR class every year or two, that isn't realistic.

Well, the other half of it is that hands-only (well, CCR) seemed to actually produce better outcomes than CPR with ventilations.

 

[Mariemt]

Well, the other half of it is that hands-only (well, CCR) seemed to actually produce better outcomes than CPR with ventilations.

I can't imagine brains deprived of O2 longer than those not deprived as long having better outcomes

 

[Brandon O]

I can't imagine brains deprived of O2 longer than those not deprived as long having better outcomes

I can't imagine fecal implants, but the Scientists assure me they work.

If you want the physiological explanation, it's usually that:

1. In sudden collapse, arterial oxygen tension is high and remains adequate for a number of minutes, since metabolism is low.

2. Maintaining high oxygen saturation with frequent no-flow interruptions is much worse than maintaining continuous flow with somewhat lower saturations.

3. Playing with BVMs takes away time and attention from compressions.

4. Positive pressure ventilation increases intrathoracic pressure, which impedes cardiac filling and output.


If you want the evidentiary explanation, it's that:

1. In most studies CCR patients have done as well or significantly better than standard CPR patients.

But I grant that these have usually been with relatively short, urban-type response times. Longer rural settings may be a different story, although without bystander CPR, bystander can be expected to be so low that you might as well do a rain dance to get the same outcome in most patients.

 

[Mariemt]

I can't imagine fecal implants, but the Scientists assure me they work.

If you want the physiological explanation, it's usually that:

1. In sudden collapse, arterial oxygen tension is high and remains adequate for a number of minutes, since metabolism is low.

2. Maintaining high oxygen saturation with frequent no-flow interruptions is much worse than maintaining continuous flow with somewhat lower saturations.

3. Playing with BVMs takes away time and attention from compressions.

4. Positive pressure ventilation increases intrathoracic pressure, which impedes cardiac filling and output.


If you want the evidentiary explanation, it's that:

1. In most studies CCR patients have done as well or significantly better than standard CPR patients.

But I grant that these have usually been with relatively short, urban-type response times. Longer rural settings may be a different story, although without bystander CPR, bystander can be expected to be so low that you might as well do a rain dance to get the same outcome in most patients.

Lol I laugh at the fecal implant .

I have had a seriously I'll daughter with histoplasmosis, possibly blastomycosis of the lungs but we got a positively histo culture after several hospital stays and they hit her with massive antibiotics.

Unfortunately, she has battled c diff, twice now and is on a long term vanvomyicin taper treatment.
She is 19 years old and as her mom, and an EMT I watched her go into shock... not good. Anyway.

They want to consider a stool transplant, and she's so disgusted, just saying the word "poop" is torture. And she's a nursing student /EMT.


Anyway. It made me chuckle when you said that

 

[Rialaigh]

I thought this discussion would go more this way...

Has anyone seen this latest report from St Michael's Hospital in Toronto? It looks at performing CPR in regions where EMS response time is greater than 15 minutes and finds that we shouldn't even attempt resuscitation if the PT is in a non shockable rhythm.. . This goes back to my discussions with key thought leaders who often base their protocols on scenarios where they are surrounded by the latest technology, 20 interns/residents and limitless resources.

http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130501_hn

No but seriously, you cannot effectively tailor individual system protocols to match exactly what that system needs, instead currently we must go off national protocols. Nationally we are much better off with CCR than CPR. I don't believe for a minute that if the person has been down longer than 15 minutes with NO bystander CPR that the outcomes for CPR and CCR are any different at all...(non hypothermia or pulmonary related arrests)