CPR and advanced airway

[skyemt]

well, then you weren't reading the posts...

compression only = no ventilations = no oxygenation

from medic755 above

"in the initial 8-15 minutes after arrest (which is usually caused by VF/VT...but not always) compressions have a better chance at restoring a rhythm than a combo of compressions/ventilations which reduce the amount of time that blood is flowing."
once again, eliminating ventilations 8-15 minutes after arrest...

these are what i am responding to, i'm not really sure what you are responding to, since compression only means no ventilations.

 

[triemal04]

well, then you weren't reading the posts...

compression only = no ventilations = no oxygenation

from medic755 above

"in the initial 8-15 minutes after arrest (which is usually caused by VF/VT...but not always) compressions have a better chance at restoring a rhythm than a combo of compressions/ventilations which reduce the amount of time that blood is flowing."
once again, eliminating ventilations 8-15 minutes after arrest...

these are what i am responding to, i'm not really sure what you are responding to, since compression only means no ventilations.

Actually, that was from me. If you haven't done it, go through the links that I and dissociative posted; read the entire thing (especially the one dissociative linked). There is some fairly compelling evidence coming out that favors compressions vs compressions/ventilations vs compressions/ventilations/ACLS during the HEMODYNAMIC stage of cardiac arrest. (I misspoke a bit earlier; in the intial 4 or so minutes during the electrical phase, some studies have shown equal results with CCR or CPR and ACLS) That would be 8-15 minutes after arrest. A lot of the evidence that supports CCR is what drove the changes in CPR; it takes quite a few compressions to build up enough pressure to really perfuse the organs, and the moment you stop to ventilate, that pressue is lost; thus the longer compression cycles and less emphasize on ventilations. In later stages of arrest (8-15min) good perfusion is being shown to be extremely important. It won't matter how much O2 you get into the system if the blood itself isn't being circulated.

Some of the findings from there also tie into the resqpod; to much positive pressure is actually a bad thing, and in at least one study there was no difference when a BVM was used vs a NRB. Now how's that for shocking? :wacko:

Now, I don't know if CCR or compressions with free-flowing O2 instead of positive pressure initially is the way to go or not. I don't know if CCR period is the way to go. Most of the people running the studies on it don't seem to be sure either. But what I (and they) do know is that the results of these trials are pretty shocking and food for a lot of thought. More work definetly needs to be done, and how CCR would mix with ACLS needs to be looked at, but, so far, it's pretty interesting stuff that's being done.

What I do know is that the new guidelines of 2 minutes of CPR before shocks, drugs, tubes, anything ALS is creating a lot more code saves, and more of these people are making it to discharge than before. Why is that? Because their blood is actually being circulated, and good, continous compressions (not ventilations) are being pointed out as extremely important. More food for thought.

Bottom line...medicine changes. And sometimes it happens fast, no matter how much all of us drag our feet and kick and scream. I don't know if this is the way of the future or not, but look back a few years and look at how things have changed.