AHA Compressions Only?

[Medic27]

Hey everybody, I remember hearing about a study. Not sure how long ago it was, but what I received from it was if there is a single rescuer it is better to do just compressions? Anyone with me on this or maybe I am not remembering something right?

1 Rescuer : 1 Patient

 

[VFlutter]

The key to getting ROSC is coronary perfusion pressure. CPP gradually builds as you do compressions and abrutly drops off when stopped hence why uninterrupted CPR is so important. Single rescuer stopping compression to ventilate takes too much time. No point in providing ventilation when blood isn't moving around. Also, there is the idea that with a witnessed arrest the patient has a few minutes worth of oxygen stores and there is some degree of passive ventilation.

 

[EpiEMS]

Hey everybody, I remember hearing about a study. Not sure how long ago it was, but what I received from it was if there is a single rescuer it is better to do just compressions? Anyone with me on this or maybe I am not remembering something right?

For a single untrained lay rescuer, non-health care provider CPR guidelines as per the AHA's 2015 ECC document suggest that it is reasonable to perform compression-only CPR.

I think the key reasons for recommending hands-only CPR among lay rescuers are that it increases the willingness of lay rescuers to assist & reduces the amount of time spent *not* doing compression (people interrupt compression too much during ventilation).

Here's one study comparing compression only CPR and conventional CPR. And here is a meta-analysis. Oh, and here is the Cochrane review.

For professional rescuers (namely, EMS), conventional CPR seems to be best (when we look at neurologically-intact survival to discharge).

 

[Medic27]

For a single untrained lay rescuer, non-health care provider CPR guidelines as per the AHA's 2015 ECC document suggest that it is reasonable to perform compression-only CPR.

I think the key reasons for recommending hands-only CPR among lay rescuers are that it increases the willingness of lay rescuers to assist & reduces the amount of time spent *not* doing compression (people interrupt compression too much during ventilation).

Here's one study comparing compression only CPR and conventional CPR. And here is a meta-analysis. Oh, and here is the Cochrane review.

For professional rescuers (namely, EMS), conventional CPR seems to be best (when we look at neurologically-intact survival to discharge).

This is the answer I was looking for, thank you for your assist!

 

[Medic27]

The key to getting ROSC is coronary perfusion pressure. CPP gradually builds as you do compressions and abrutly drops off when stopped hence why uninterrupted CPR is so important. Single rescuer stopping compression to ventilate takes too much time. No point in providing ventilation when blood isn't moving around. Also, there is the idea that with a witnessed arrest the patient has a few minutes worth of oxygen stores and there is some degree of passive ventilation.

Thank you for the answer, I received two great ones.

 

[StCEMT]

If I am on my own, compressions only from me. Depending on where they are found, the first minute of a code I run may be the same as well.

 

[Medic27]

If I am on my own, compressions only from me. Depending on where they are found, the first minute of a code I run may be the same as well.

I am assuming if you are on shift though you have another EMT-b or higher with you? Wouldn't they do the ventilations / setup an AED / follow local protocol?

 

[ThadeusJ]

After many discussions with colleagues in the equipment side of things, it has been said that the initial recommendations for compression only CPR only was very poorly released, as there was a significant amount of confusion within the professionally trained response community. I have personally been told that BVM's and suction were "on their way out" because of it (seriously).

The responses provided above are the strongest reasons to support bystander compressions only CPR.

 

[Medic27]

After many discussions with colleagues in the equipment side of things, it has been said that the initial recommendations for compression only CPR only was very poorly released, as there was a significant amount of confusion within the professionally trained response community. I have personally been told that BVM's and suction were "on their way out" because of it (seriously).

The responses provided above are the strongest reasons to support bystander compressions only CPR.

Do you have a different opinion or do you just believe it was presented poorly?

 

[ThadeusJ]

I immediately understood the rationale to make it easier for the lay person to initiate CPR. Back in the day, there was one large international company who taught a lot of CPR, but used rulers to measure compression depth and intimidation to drive their lessons home. Their insistence on perfection undermined the confidence of the students to the point where it was too intimidating of a task to attempt (reports from former students after the organization switched CPR educators). Coming from a research based education before getting into healthcare, I got the message behind the change.

What I was referring to above was that the release of the new standards (apparently) were accompanied by a poorly designed marketing campaign such that it even confused the professionals. A lot of healthcare professionals I worked with just read the headline and assumed that it applied to everyone in all situations (I have seen this before with other practice standards).

 

[StCEMT]

I am assuming if you are on shift though you have another EMT-b or higher with you? Wouldn't they do the ventilations / setup an AED / follow local protocol?

They would. What I meant by that though is the people you find in less than ideal locations. Vehicles, small bathrooms, between the bed and a wall (all examples I've come across). You can't do much with that.

 

[Medic27]

They would. What I meant by that though is the people you find in less than ideal locations. Vehicles, small bathrooms, between the bed and a wall (all examples I've come across). You can't do much with that.

For sure, I totally understand. My first code went really well but it was hard to perform compressions, unsafe scene, roommate hostile towards LE/EMS had an outstanding order. We had to move him to the ambulance. It went as good as a code could go once he was in the rig, but yeah took 2 minutes for fire to him to the rig.

 

[Bullets]

Our agency protocol is 10 minutes of continuous (or near so) compression. 02 via nasal cannula and bilateral NPAs. 2nd provider sets up AED and applies O2 in that order.

Once a third person arrives we can ventilate with a BVM if we so choose, but usually we just do compressions until ALS arrives ad tubes or we get 10 minutes on the chest