AHA Hands-Only CPR

VentMedic

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It's now official that the AHA has approved the Hands-Only CPR for bystanders.

AHA Hands-Only website with information for the public:
http://handsonlycpr.eisenberginc.com/


AHA Says Hands-Only CPR OK

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=7297

By STEPHANIE NANO
Associated Press Writer

You can skip the mouth-to-mouth breathing and just press on the chest to save a life.

In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.


Circulation Journal: (Free Full Article)
Hands-Only (Compression-Only) Cardiopulmonary
Resuscitation: A Call to Action for Bystander Response
to Adults Who Experience Out-of-Hospital Sudden
Cardiac Arrest

A Science Advisory for the Public From the American Heart Association
Emergency Cardiovascular Care Committee


published online Mar 31, 2008; Circulation
Roger D. White
Michael R. Sayre, Robert A. Berg, Diana M. Cave, Richard L. Page, Jerald Potts and

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380v1

http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.107.189380v1
 

MMiz

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I just saw this on CNN. I understand that we keep dumbing it down so that the majority can learn the skill, but 100% of my seventh grade students this year were able to learn and be certified in AHA Heartsaver CPR. Is it really that hard?
 

JPINFV

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Well there are a few issues. First, people are going to be hesitant to provide ventilations if they lack either mechanical means (BVM) or a barrier device. It's possible that people would rather not provide any care in fear of harming the patient than doing compressions only.

As far as the 2005 guidelines go, if I remember correctly one of the problems was that lay providers were having trouble properly assessing for a pulse. Mind you, this is a skill that they might never actually need to check for a pulse prior to the event. Essentially expecting perfection would be like cutting an EMT (B or P) loose after their skill test. Thus, it's better to do compressions on a person only in respiratory arrest than not do compressions or delay compressions in a patient with in full arrest.
 

EMTryan

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I teach CPR and whenever I teach a class I always ask the students...let's assume that you have been doing CPR for several minutes and you are starting to get tired, do you think that you could teach someone else to do it?

Almost everyone says yes...CPR is NOT hard at all. Place on hand on the center of the chest, place the other hand on top of it and lace your fingers together. Press down hard and fast on the chest allowing for full recoil of the chest with each compression. Alternate 30 compressions with 2 rescue breaths. The youngest person I have ever seen learn CPR was 6 years old. I tell students to go home and teach someone else how to do CPR. Teach your kids, teach your spouse, it will improve your confidence with the technique. All kids should know how and when to do CPR, it is not hard.

I think deemphasizing rescue breaths (just like deemphasizing the pulse check) is a good step because doing something is a lot better than nothing. Ultimately though CPR is NOT hard and I think this change just might help more people realize that CPR is NOT hard and they may be less hesistant to use it in a real emergency.
 

jms2185

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I really don't understand why people find CPR so hard to learn. I mean if you can walk and breathe at the same time you should be able to do perform CPR. I just think everyone is afraid of getting sued for something.
 

skyemt

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I really don't understand why people find CPR so hard to learn. I mean if you can walk and breathe at the same time you should be able to do perform CPR. I just think everyone is afraid of getting sued for something.

here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...

that does not even cover the ventilations... are you aware of the studies finding that health care providers are overventilating during CPR? that this overventilation is building up intrathoracic pressures to the point that it is inhibiting venous return? basically building up pressures that fight against the compressions you are doing... is that really taught in CPR class? it wasn't in mine, and apparently there is a large knowledge gap here, because the overventilation by "professionals" is a serious issue... if one had a true grasp of the concept of negative intrathoracic pressures and it's effect on venous return, they would not dream of overventilating... this theory is behind the development of the impedance threshold devices, designed to lower intrathoracic pressures, creating a vacuum effect.. how many are well versed in this?

so, back to my earlier point... learning CPR is easy... learning to do it really well without mistakes is another story.
 
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JPINFV

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I really don't understand why people find CPR so hard to learn. I mean if you can walk and breathe at the same time you should be able to do perform CPR. I just think everyone is afraid of getting sued for something.

Well, it doesn't help that last time I did my recert (it might be expired now, actually), the people running it thought I was doing it too hard. They weren't amused when I replied, "Well, err, the patient's currently dead anyways." It didn't help that Annie was so worn out that it didn't take much effort to actually do compressions.
 

jms2185

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here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...

that does not even cover the ventilations... are you aware of the studies finding that health care providers are overventilating during CPR? that this overventilation is building up intrathoracic pressures to the point that it is inhibiting venous return? basically building up pressures that fight against the compressions you are doing... is that really taught in CPR class? it wasn't in mine, and apparently there is a large knowledge gap here, because the overventilation by "professionals" is a serious issue... if one had a true grasp of the concept of negative intrathoracic pressures and it's effect on venous return, they would not dream of overventilating... this theory is behind the development of the impedance threshold devices, designed to lower intrathoracic pressures, creating a vacuum effect.. how many are well versed in this?

so, back to my earlier point... learning CPR is easy... learning to do it really well without mistakes is another story.

Wow, you know a lot about CPR you should be an EMT or something. To answer your previous questions no I am not a CPR instructor and have never claimed to be one. So since it appears that you are the definitive source in CPR, what exactly constitutes "quality CPR"? What separates "quality CPR" from a "waste of time"? Douse this mean that the new guidelines from AMA are a "waste of time" because they don't explain the anatomy or physiology as in depth as you? So intern would that mean all CPR is a waste of time? Have you considered giving seminars or speaking at University's to share your wealth of knowledge on this subject?

Oh my God!!! Study s suggests that Health Care providers are over ventilating patients? More importantly you had to read study s to find this out? As I recall I didn't say anything about Health Care providers lacking the abilities to learn CPR, (but fell free to correct me as you are all knowing). Do you think that AMA changed its guide lines because of health care providers over ventilating patients? Do you regularly bash other fellow health care providers? Did you read the article on AMA's website or watch it on T.V? Did you know that this was aimed at "laypersons" or bystanders that are unwilling to give mouth to mouth? I look forward to your answers.
 
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skyemt

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you know, if CPR was so easy, then why is it going wrong in the field?

i never claimed to be a university instructor, or a proclaimed expert.

there are issues in CPR, and i raised them, and offered my opinion as to why it may not be as easy as it seems.

why so defensive?

if you do not find any value in my posts, please, feel free to ignore and move along. i am not going to get into a 'personal' attack situation, so it better i don't really reply to you questions.

if i hit a nerve, perhaps one should ask why.

if i did not, then just ignore me as someone who doesn't know what he's talking about, and move along.

your choice.
 
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Ridryder911

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Wow, you know a lot about CPR you should be an EMT or something. To answer your previous questions no I am not a CPR instructor and have never claimed to be one. So since it appears that you are the definitive source in CPR, what exactly constitutes "quality CPR"? What separates "quality CPR" from a "waste of time"? Douse this mean that the new guidelines from AMA are a "waste of time" because they don't explain the anatomy or physiology as in depth as you? So intern would that mean all CPR is a waste of time? Have you considered giving seminars or speaking at University's to share your wealth of knowledge on this subject?

Oh my God!!! Study s suggests that Health Care providers are over ventilating patients? More importantly you had to read study s to find this out? As I recall I didn't say anything about Health Care providers lacking the abilities to learn CPR, (but fell free to correct me as you are all knowing). Do you think that AMA changed its guide lines because of health care providers over ventilating patients? Do you regularly bash other fellow health care providers? Did you read the article on AMA's website or watch it on T.V? Did you know that this was aimed at "laypersons" or bystanders that are unwilling to give mouth to mouth? I look forward to your answers.

Okay, I will answer some of your questions and as well as some of your poor thought dribble.

I am a university professor, as well as an AHA instructor (all levels, pick a vowel) probably longer than you have been alive. So as one that not only reads and but also participates in those studies. If you have read the studies over the past ten years, you would had not even mentioned "law suits" as one of the reasons for change. Also it appears you lack knowledge in the methodolgies of educational standards of emergency cardiac care. AMA does NOT set standards nor have they ever, it is the Emergency Cardiac Committee (ECC) that develops those standards and they set such recommended standards to organizations such as AHA, ARC, etc. Those standards are published in the AMA Journal for review. Again, if properly educated as in CPR courses following the ECC & AHA recommended course outline, this subject should had been covered and discussed to make participants feel at ease, and eliminate worries of potential litigation.

In actuality, what the studies have demonstrated was broke down in major items. I will not go into detail, as they are lengthy and really dull , as well most on this site would not understand them; as well could care less. One of the reasons were, most students (of non-medical background) demonstrated poor retention of CPR methodology (about 4-6 months). As mentioned many were hesistant upon performing ventilations, which is common.

The issue addresses, ventilation is being found not to be as essential in the first few minutes as comparrision of build of ATP per compressions.

Yes, the CPR training has been extremely watered down. Will this help? Doubtful. It is not litigation they fear rather most people prefer not to get involved period. This is demonstrated as per the Seattle Medic One CPR project over 25+ years ago, when 1:4 citizens knew and could perform CPR (may, I say the technique was much harder as well). Demonstrating, it is not so much the method, rather the interest or lack of apathy.

CPR is the only choice we currently have. If there were another procedure available, we would abolish it because of the very poor sucess rates both prehospital and even in-hospital (which is less).

If you would like I can link you to about six AHA and American Cardiology journals and citations backing my claims, as well some current studies just addressed this past weekend.

Before bosting and attacking posts, let's be sure we have our own ducks in a row.

R/r 911
 

skyemt

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i do have to say, i feel like the posts on this site are getting a bit personal, and rude...

we all have a lot to say, and have strong opinions...

i tend to to post it like i see it... i have been right, i have been wrong, and i have changed some views through healthy debate...

that is what this site is supposed to be about... i don't mind flared tempers, i don't mind fierce debates... as long as it is about the knowledge and information... if i'm right, great. if i'm wrong, i'm wrong and i've admitted as much... and it means i've learned something...

but i have to say, lately, differences of opinions are leading to personal attacks, and i don't think it's called for at all.
 
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VentMedic

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here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

This is also what I see as the problem being for lay person CPR. How many people are going to do effective depth and rate to be successful at maintaining the intrathoracic pressure demonstrated in the studies for compressions only CPR? Most are going to imitate what they have seen on TV which doesn't break a sweat.

Although, any effort is probably better than no effort at all.

I have seen a lot of changes in CPR over the past 30 years. The compression rate and depth has for effective CPR has gotten challenging even for the experienced and physically in shape professional provider. The old one-one thousand........five-one-thousand...breathe, rest...was easy to do but complicated to remember with all the variations and numbers to remember. And, yes, we did save a few people with that method of CPR or maybe it was just not their time to go. Who knows? I actually think there was more enthusiasm for CPR amongst both the lay persons and professionals back in the 1970s and 80s.
 

LucidResq

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i do have to say, i feel like the posts on this site are getting a bit personal, and rude...

we all have a lot to say, and have strong opinions...

i tend to to post it like i see it... i have been right, i have been wrong, and i have changed some views through healthy debate...

that is what this site is supposed to be about... i don't mind flared tempers, i don't mind fierce debates... as long as it is about the knowledge and information... if i'm right, great. if i'm wrong, i'm wrong and i've admitted as much... and it means i've learned something...

but i have to say, lately, differences of opinions are leading to personal attacks, and i don't think it's called for at all.

I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.
 

skyemt

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I agree that personal attacks are not okay, but you do occasionally give off a pretty condescending vibe which I believe makes people feel insulted. It's just something you might want to be aware of, because I think it has led to some of these personal attacks. You may not realize it but you may be making some people feel like you attacked them first.

ok... so you feel the right thing to do is to come back and make things personal again??

so, you presume a lot about me, that you really don't know....

if you have an opinion like that, perhaps a PM is more appropriate?

would you care for others to post their personal opinions about you on this thread, Lucid?

i rather think you probably wouldn't want that...

so, if you have something of a personal criticism, do me a favor and tell me in private...

it's the same courtesy you'd expect from others.
 

ffemt8978

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Get back on topic, people.
 

LucidResq

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ok... so you feel the right thing to do is to come back and make things personal again??

so, you presume a lot about me, that you really don't know....

if you have an opinion like that, perhaps a PM is more appropriate?

would you care for others to post their personal opinions about you on this thread, Lucid?

i rather think you probably wouldn't want that...

so, if you have something of a personal criticism, do me a favor and tell me in private...

it's the same courtesy you'd expect from others.

I don't think it's appropriate to come back and make things personal and you're right... that comment would have been better made over private message. I apologize.
 

jms2185

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I posted this reply earlier but it was taking down due to reasons I won’t go into.
Skyemt, I found your response to be very informative and insightful, but I did feel as if you were singling me out and telling me my opinion was wrong and trying to in a way to belittle me, which is why I got so defensive. If you did not intend this then I apologize to you for my previous post.

I do not know every thing and never have claimed too. I will not be making a distasteful comment to Ridryder911, rather I will ask him if he will stop referring to my thoughts as " poor thought dribble" I did nothing to him to deserve this type of comment directed toward me (even though I must admit I thought it was funny). So with that said we are all professionals so there is no reason that we can’t get along and have conversations over the internet that is civilized. I find this subject vey interesting and think it will be interesting to see everyones opinion on this website about the new guidelines AMA has realeased.
 

el Murpharino

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here is the problem... doing CPR is not hard... doing QUALITY CPR is not easy...

if the compressions are not deep enough, they are ineffective... if the rate is not there, ineffective... if the interruptions are too long, again, CPR is rendered ineffective... it is all about building up coronary perfusion pressures, and maintaining them... do you teach about that? most heartsaver CPR courses do not... most "health care providers" who are not medics have a hard time explaining the physiology behind CPR... if the understanding is not there, mistakes happen.. there are not "degrees" of CPR... it can not be "pretty good"... it is either quality, effective CPR or a waste of time...

that does not even cover the ventilations... are you aware of the studies finding that health care providers are overventilating during CPR? that this overventilation is building up intrathoracic pressures to the point that it is inhibiting venous return? basically building up pressures that fight against the compressions you are doing... is that really taught in CPR class? it wasn't in mine, and apparently there is a large knowledge gap here, because the overventilation by "professionals" is a serious issue... if one had a true grasp of the concept of negative intrathoracic pressures and it's effect on venous return, they would not dream of overventilating... this theory is behind the development of the impedance threshold devices, designed to lower intrathoracic pressures, creating a vacuum effect.. how many are well versed in this?

so, back to my earlier point... learning CPR is easy... learning to do it really well without mistakes is another story.

We learned the same thing in the "new" ACLS guidelines about overventilating the patients. Instead of doing rescue breaths every 5 seconds (in adults), they're recommending ventilating your patients 8-10 times a minute during CPR. This being said, proper ventilations must be provided, with an adequate seal with a mask...or with a secured advanced airway device. Also what happens when you overventliate your patient is that the air that doesn't go into the lungs go into the stomach, increasing upward pressure on the diaphragm (and decreasing the amount of pressure in the thoracic cavity), and increasing the chance for vomiting and subsequent aspiration - not to mention the decreased venous return. Ventilation should be provided just enough to see chest rise. We should all know this...but as we all know, there are people out there who took CPR about 10 years ago, and think it's still the same now as it was then.

As far as the compressions during CPR...I've found it much easier to have 3 providers during CPR - two to manage the airway, one to do compressions. Switch every 5 cycles of compressions, and you should be good to go. Alot of providers don't give deep enough compressions. It's startling how many EMT students I get doing compressions nowhere near deep enough. Inadequate compressions don't help much...but I s'pose they're better than nothing.
 
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enjoynz

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There was talk here when I did my last CPR course, of them changing the
adults bag on the BVM, for the child's bag, to stop EMT's (or whomever) from squeezing in too much air when ventilating.
It hasn't happened yet, but it seemed like a good idea to me.
Especially for the newer EMT's at their first few cardiac arrests.
I'm not sure what size bags you use there, but as it was on topic, I thought I'd mention it.

Cheers Enjoynz
 

Ridryder911

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I find this subject vey interesting and think it will be interesting to see everyones opinion on this website about the new guidelines AMA has realeased.


Again it is NOT AMA... please, if you are going to cite, cite correctly.

This is the information I recieved from the national today.


....Dear Training Network:

Last week, we asked you, our valued Training Network, to visit the ECC Web site the afternoon of March 31st to learn about an important "lifesaving initiative." If you've been to the Web site, you now know that lifesaving initiative is the American Heart Association's advisory statement on Hands-Only CPR, and you're probably wondering what it means to you as an instructor.
First and foremost, through this advisory statement, ECC hopes to do two things:
Significantly increase the number of people who take action when they witness an adult sudden cardiac arrest. Despite training almost 12 million people in CPR and ECC each year, the national average for survival from sudden cardiac arrest remains less than 7 percent.
Drive CPR training – ECC advocates that people take a CPR course to practice and learn the skills of CPR, including giving high-quality chest compressions. People who have had CPR training are more likely to give high-quality chest compressions and are more confident about their skills than those who have not been trained. We know that CPR is a psychomotor skill that is best learned through hands-on practice.
Both of these goals mean more training opportunities for you as an instructor, and more people trained equals increased survival rates from sudden cardiac arrest. We can't emphasize enough the critical role you play as part of ECC's Training Network.

.......
What do you need to know?
This short Web Cast will provide you with guidance on how to incorporate Hands-Only CPR into the courses you teach.
Everything else you will need (flyers, lesson maps, FAQ) can be found in the "What's Hot" section of the Instructor Network. Keep in mind that you will must be registered with the Network, confirmed as an instructor by your Training Center, and logged into the site to see the information. If you are not a member of the Network, please contact your Training Center Coordinator.
We hope that, by viewing the Web cast and the documents (http://americanheart.org/presenter.jhtml?identifier=3055324 ) on the Instructor Network, you will feel informed and prepared to talk about Hands-Only CPR. We thank you for your support in helping us get the word out about this lifesaving action and for promoting CPR training....


This is the link to the new PEARS network for CPR.
http://my.americanheart.org/eccportal/ecc/ecc

R/r 911
 
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