Thanks for the info! When did all of that start coming to light? I went to school last summer, and there wasn't a lick of mention of even studies relating to that. I no hands-only has been around for a few years now, but like I said, I thought that was very much so a bystander thing.
So given what you just explained, resulting in decreased cardiac output, when is the right time to start ventilating, if ever? Or was that the whole point of this thread? Is it just whenever the Pt has their own pulse?
I suppose that if the airway is open, the lungs would be able to passively take in some O2 through diffusion. How efficient it would be, not only in diffusing, but also in the gas exchange and distribution is the real question? Are you thinking about this as an alternative to PPV during CPR or as a means between CCR.
Here's this advocating no PPV for the first few mins. on scene:
I agree! The pivotal questions are whether compressions could physically displace enough volume then allow enough refill time to allow any real gas turnover, and if so, would it be enough to make a difference?
I say you still need oxygenation of the circulating fluid to occur or hypoxia will occur. Otherwise you might as well be squishing the heart to circulate Koolaid.
Simple examination of the pragmatics involved (oxygenation requirements; mechanics and physics and physiology of oxygenation; capability and practicality of prehospital measures. AKA "Science") should guide us in what is going to work. (And don't ever forget the element of trading time on scene for a temporizing measure, versus time since insult until definitive care).
Some patients will not oxygenate without an airway, and some may need a tube. We just are in the process of evolving away from "tube everyone". (Just as we are from spine boarding everyone).
It's a protocol in one of the counties by me.. They slap a non rebreather on the person ( yes on a non breathing person) and just do compressions non stop. And while you are doing this in a public area or around the family people will question EMS why they are not giving breaths... Makes for an awkward situation.
I agree! The pivotal questions are whether compressions could physically displace enough volume then allow enough refill time to allow any real gas turnover, and if so, would it be enough to make a difference?
Until the stagnant air or gas's oxygen partial-pressure falls below the oxygenation threshold; actually, it will start to lose available oxygen a bit before that cutoff threshold is reached.
Remember the old "artificial resuscitation" mantra?
"Out with the old air, in with the new".
Note the dates in the far left column!
PS this comes from a 1997 article in CIRCULATION entitled "A Reappraisal of Mouth-to-Mouth Ventilation During Bystander-Initiated Cardiopulmonary Resuscitation"
Is it just whenever the Pt has their own pulse?
