CPR Whats the point

[OIFXGunner]

Another thing- if we hadn't been providing CPR all of these years, improvements to resuscitative medicine would never have been made. I like to think that if we keep practicing the medicine now, who's to say that 20, 30 years down the road we might be seeing resuscitation statistics of 50-70% of arrests getting a return. Perhaps better? We won't know unless we keep working at it :-D

 

[JPINFV]

who's to say that 20, 30 years down the road we might be seeing resuscitation statistics of 50-70% of arrests getting a return. Perhaps better? We won't know unless we keep working at it :-D

[raises hand]

I have the general feeling that the vast majority of arrests are unwitnessed, which by the time they are found they're well outside of any real window for successful resuscitation.

 

[NYMedic828]

Without reading the entire thread,

I've had patients where CPR was initiated immediately, and I had the pleasure of having a conversation with them in the ICU the next day.

One in particular was only in his 50s. He is relatively undamaged from the occurrence.

These patients are VERY few and far between, but why would we remove something that can legitimately save a life.

What DOES need to be changed, is this criteria to which we actually begin resuscitation.

There should be age criteria primarily...

 

[EpiEMS]

What DOES need to be changed, is this criteria to which we actually begin resuscitation.

There should be age criteria primarily...

I dunno about age criteria, but I certainly agree that conditions incompatible with life is not broad enough. What might you add? I was thinking that many traumatic arrests would be better off called than worked, considering the near-zero survival rates.

 

[gw812]

Hey, CPR is like getting a cardio and upper-body workout, and you get paid to do it! Stealth corporate fitness plan!

 

[mycrofft]

Reasons to do CPR, and why it often fails.

1. It is their only chance to survive long enough for advanced measures, transport,etc.
2. In cases where the initiating cause is transient (electrocution, blunt trauma to the chest, suffocation) it can "bring them back to life. This is especially true with younger people, who have a higher percentage of non-cardiac codes.
3. It, like all EMS, is also social glue, reassuring us that someone will come and give us a chance when we screw up or misfortune overtakes us.
4. If it was my wife/kid/friend down there, I'd sure as hell want you to give it a try.

As I've said before, however, I think many of the CPR survivors either had an undetectable pulse (we don't even teach taking pulses to laypersons), or had a transient cause for apparent clinical death.

Why CPR fails: done wrong, but since each new iteration makes the last one "wrong", this is only part of it. If the heart or whatever organ failed so badly as to cause loss of resp and pulse, there is an excellent chance it is lethal and irreversible.

Use search and see the long debate we had about ECMO.

 

[bahnrokt]

Low chance of recovery but zero risk associated with it so why not?

Personally, Id rather do cpr for 20 minutes than walk into a room full of the guys family and say "Yup, he's dead" and walk out.

 

[Dwindlin]

Low chance of recovery but zero risk associated with it so why not?

Personally, Id rather do cpr for 20 minutes than walk into a room full of the guys family and say "Yup, he's dead" and walk out.

CPR is not zero risk.

 

[EpiEMS]

CPR is not zero risk.

Assuming the scene is safe, the provider is suitably PPE'd, and there is a patient who is actually in need of CPR, then where's the risk (beyond any other EMS activity)?

 

[Dwindlin]

Assuming the scene is safe, the provider is suitably PPE'd, and there is a patient who is actually in need of CPR, then where's the risk (beyond any other EMS activity)?

I'm not talking risk to me, I read his comment as risk to patient. CPR is not zero risk, does risk outweigh benefits? Yeah, but to say zero risk is untrue.

 

[bahnrokt]

I'm not talking risk to me, I read his comment as risk to patient. CPR is not zero risok, does risk outweigh benefits? Yeah, but to say zero risk is untrue.

So what are these hidden risks that are worse than death?

 

[AnthonyM83]

As I've said before, however, I think many of the CPR survivors either had an undetectable pulse (we don't even teach taking pulses to laypersons), or had a transient cause for apparent clinical death.

Why CPR fails: done wrong, but since each new iteration makes the last one "wrong", this is only part of it. If the heart or whatever organ failed so badly as to cause loss of resp and pulse, there is an excellent chance it is lethal and irreversible.

Absolutely. I have no doubt that many of my cardiac arrests who regained pulses still had a non-detectible heartbeat...but CPR is for people with heartbeats too (since the criteria is no caratoid/femoral pulse). So, you could see yourself as having saved them from death by not intervening with compressions....


As far as the new science proving the old science wrong....I've always accepted that's how it works. I hate when people get pissed off about the new updates...aren't they used to it already? Don't know they you gotta be trying different things out in order to narrow in on the things that work better and better? It doesn't make CPR wrong....just helps refine it each time.

When you work up your next cardiac arrest patient, you might not be doing it for him...you might be doing it for the guy ten years from now...

 

[Dwindlin]

So what are these hidden risks that are worse than death?

I already said the benefits outweigh the risks, again, only pointing out that CPR is not without risk to the patient (e.g. cardiac contusion, sternal fracture, punctured lung, spleen, liver, etc).

Again, not suggesting CPR shouldn't be started, simply clearing up that CPR is in fact not without risk, and should the patient survive may have real consequence to deal with as a direct result of the CPR.

 

[Farmer2DO]

Why not put everyone that codes on ECMO?

This is certainly becoming more in vogue.

There are 2 forms: veno-venous ECMO (V/V) and veno-arterial ECMO (V/A). V/V requires cannulation of 2 large central veins, while V/A requires venous and arterial cannulation. V/V performs only the work of the lungs, and requires a heart that is pumping and not in failure. V/A is essentially cardio-pulmonary bypass, and also performs the pumping of the heart.

There are 3 big limitations, from my experience:

1. The ability of someone to quickly and efficiently cannulate 2 large vessels: a central vein and an artery. This is usually a surgeon, an anesthesiologist, or an intensivist. These providers aren't always just hanging around a hospital, and when you need them, you need them NOW. So this will predispose the larger hospitals, tertiary care centers, trauma centers, and academic centers to be able to do this.

2. The cost to keep the equipment around is likely prohibitive. Usually your hospitals that perform open heart surgery are most likely to have it.

3. The people to maintain the therapy once started. Generally this is a cardiovascular ICU with a perfusionist on staff. We have 2 large medical centers in town; one is university based and is a major transplant center. They put in VADs all the time. They are comfortable using ECMO. The other one is a large hospital, licensed for around 550 beds, an ED that sees over 100K patients a year, and does about 3X the cardiac work (caths and CABGs) that the university medical center does. They will occasionally put it in, but they transfer them across town, to the University hospital, because they just don't do it that often, and don't feel comfortable managing them.

They're a good idea, but they take a lot to initiate in reality.

 

[mycrofft]

Anthony, the latest revisions seem tone the most science-orioented ones yet. Many prior iterations seemed to be General Custer polishing his saddles. (Rearranging deck chairs on the Titanic?), an excuse to make updates and refreshers and separating the ARC "brand" from the AHA one.

 

[shiroun]

Assuming the scene is safe, the provider is suitably PPE'd, and there is a patient who is actually in need of CPR, then where's the risk (beyond any other EMS activity)?

I'm not talking risk to me, I read his comment as risk to patient. CPR is not zero risk, does risk outweigh benefits? Yeah, but to say zero risk is untrue.

Dwindlin is right. It IS NOT zero risk. If you break a rib, and keep going, it can puncture the pleura space, causing a collapsed lung.

 

[leoemt]

Hi, I've been lurking on this site for about 6 months, figured now that I am an official EMT it was time to join. What better topic for a first post than one that is dear to me as CPR.

Even though I am a new EMT I am in no way a stranger to trauma and medical emergencies. I have been a cop and have worked security for Boeing.

When I was a cop, I never once performed CPR. Had a couple of people die infront of me but never did CPR. When I was with Boeing though, I performed CPR 5 times. Of those 5 patients, 3 were brought back by the time they were loaded into the medic unit. Whether they made it out of the hospital or not I don't know as I wasn't privy to that info.

CPR saves lives, and AED saves lives. Here in WA State we are very proactive with our EMS and health systems. At Boeing every patrol car, fire truck, aid unit, and support vehicle had an AED. Thats not including the AED's spread throughout the buildings. At the Everett site where I worked, a person experiencing a cardiac event can have an AED on them within approximately 30 seconds in most instances. Security had a less than 2 minute response time and our fire department wasn't much longer. About 80% of the 60,000 employees at the site were first aid / CPR trained.

Having a trained populous willing to perform compression only CPR at a minimum will drastically increase survival rates in sudden cardiac arrest events. We are fortunate here to have such a large populous of trained people thanks in part to Boeing, Microsoft, and the Military which routinely put their employees through this training.

I can't comment on the EMS side yet as I haven't started my ambulance job yet. However, if I ever saw someone who was in need of CPR I would jump in and do it. Not because I'm an EMT, but because it is the right thing to do. As previous posters stated, you have nothing to lose.

 

[Veneficus]

So what are these hidden risks that are worse than death?

Keep in mind death is not always the enemy to be conquered.

There are many patients where a peaceful end is better than a thrashing and being turned into Frankenstein's monster.

 

[OIFXGunner]

Keep in mind death is not always the enemy to be conquered.

There are many patients where a peaceful end is better than a thrashing and being turned into Frankenstein's monster.

Which is what a dnr is for. Without a dnr, we have to assume that they would like to become the Frankenstein monster, so death is still the enemy.

 

[Veneficus]

Which is what a dnr is for. Without a dnr, we have to assume that they would like to become the Frankenstein monster, so death is still the enemy.

That is what a phone call to medical control is for.