Hands Only CPR

[All Ryle Dup]

None of the companies/agencies I teach with sell hands only CPR as primary for any level of samaritan or responder.

They have ads on the radio...

Advocating and instructing hands only CPR in California.
For the layperson; not first responders.

 

[Jim37F]

They have ads on the radio...

Advocating and instructing hands only CPR in California.
For the layperson; not first responders.

LA County Fire has been doing "sidewalk CPR" for teaching people on the street compression only CPR

 

[mycrofft]

They have ads on the radio...

Advocating and instructing hands only CPR in California.
For the layperson; not first responders.

They have ads for Indian casino gambling, payday loans and liposuction too.:glare:

I'm just saying I have three different employers/sponsors and none feature hands only CPR as the preferred method. Not strictly taught, just mentioned. I use it as a trick question, what's do you do after thirty compressions with hands-only...

 

[Akulahawk]

They have ads for Indian casino gambling, payday loans and liposuction too.:glare:

I'm just saying I have three different employers/sponsors and none feature hands only CPR as the preferred method. Not strictly taught, just mentioned. I use it as a trick question, what's do you do after thirty compressions with hands-only...

Because you're now exhausted doing the hands-only compressions, you switch over to the boot-method and keep going while you sip your latte. Priorities, you know?

 

[DrParasite]

An EMS agency in Ga that my buddy teaches for is doing hands only CPR as well.... no more intubations or BVM on a cardiac arrest, just a NRB at 15 lpm and chest compressions w/ ACLS until you get pulses back or they get pronounced.

 

[MarkusEMS]

The American Heart Association is promoting hands only CPR where the rescuer only does compressions until EMS has arrived and taken over. The theory is that there still oxygen in the patients blood, enough to be circulated throughout the body. In addition they are promoting this to try and get more of the public trained in CPR since now they don't have to worry about bodily fluid transfers.

I find this interesting and wonder what you all think about hands only CPR.

adds a new "responsiblity" to the star of life response network ey?
Seriously, the American Red Cross promotes it heavily, too - there's what they call the annual "save-a-life Saturday" or disaster prepardness, other public events where they educate interested public and explain the very same aka get that remaining O2 get to the brain and other vital organs - it's always fun for me to teach people this skill and see how determined people are, young and old and leave with a smile in their face, proudly announcing I can help out now

 

[Brandon O]

I'm just saying I have three different employers/sponsors and none feature hands only CPR as the preferred method.

Perhaps they should.

Although I've wondered for a while now whether there may be financial DISincentive for many training organizations and even bodies like the ARC (we'll leave out the AHA to avoid getting too close to the stove) to promote simplified, hands-only, PSA-style concepts, on the basis that they'll lose dollars from the certification money mill. I thought perhaps not, since most healthcare providers (of all stripes) usually still need to be certified, but the possibility is there.

 

[mycrofft]

Parse down the questions and try to link it to actual real world results.

I think this is a pivotal issue, but needs subdivision to maintain focus and answer instead of begging questions.

1. All this "unused oxygen in circulation"...does it constitute a medically meaningful fraction and partial pressure, especially versus CO2, vis a vis actually maintaining life as we know it? Does CO2 build up in that fraction when the pt isn't EX-haling too? (Remember, CO2 isn't just a suffocator, it is a toxic waste product as well).

2. What is sold to otherwise untrained bystanders, or trained first-aiders, first responders, EMTs and so forth do not all equate because of differing training in airways, means of inflation, drugs, monitoring, use of laryngoscopy and suction and such. Apples to oranges, or at least plums to pluots.

Example: we regularly teach laypersons to extend the neck by raising the chin to open an airway (which can cause a lethal cervical dislocation), but teach professionals and first responders the jaw thrust (when that can exacerbate facial trauma and thus lose airway), EMT-Bs get supralaryngeal airways (which can tamp airway obstructors into the larynx), paramedics to to intubate, etc. They do not equate. We will accept a degree of mortality and morbidity when to do so will pose risk acceptable due to the alternative (hands-only and without resuscitation, versus none at all).

3. The free oxygen radical injury, has it been clinically tested? Just as betadine and peroxide, known to harm tissues in vitro and with overuse, can prevent or reverse important infections, can it be that oxygen, may in vitro or with overuse cause damage (to what degree?) later, but immediately provides the chance of there being a "later"?

While I agree that "Kompression is King", I still believe judicious scientific airway and oxygenation are potential tools, and they are tie-breakers in the small percentage of cases where field resuscitation is actually going to work (i.e., cases without irreversibly lethal infarct, traumatic asystole, or prolonged periods without respiration/circulation before discovery possibly excepting hypothermia/mammalian diving reflex cases) .

The inaugural hallmark of the EMT-P or A, the spine board, was inflated into a harmful panacea without or despite real clinical results, then demonized the same way. One aspect of the mind of a technician is to try to over-simplify expansion or retraction of the uses of his permitted tools.

 

[mycrofft]

Ps

Just because some renegade instructor or service decides to start teaching something, it doesn't necessarily mean they are right. I remember the EMT instructor who told his students to carry a towel clamp to subdue patients through intranasal pinching...h34r:

 

[Brandon O]

1. All this "unused oxygen in circulation"...does it constitute a medically meaningful fraction and partial pressure, especially versus CO2, vis a vis actually maintaining life as we know it? Does CO2 build up in that fraction when the pt isn't EX-haling too? (Remember, CO2 isn't just a suffocator, it is a toxic waste product as well).

...

While I agree that "Kompression is King", I still believe judicious scientific airway and oxygenation are potential tools, and they are tie-breakers in the small percentage of cases where field resuscitation is actually going to work (i.e., cases without irreversibly lethal infarct, traumatic asystole, or prolonged periods without respiration/circulation before discovery possibly excepting hypothermia/mammalian diving reflex cases) .

Over the initial minutes of arrest, the basic cardiopulmonary physiology would suggest that oxygen tension remains reasonable and CO2 does not elevate profoundly. (Just try holding your breath for a while.) The more important question is whether you'd rather trade a few points on both sides for the periods of zero perfusion produced by pauses in compressions.

But this is just theorizing. If you're asking about outcome-based evidence, what's clear is that (both experimentally and in vivo, both anecdotally and in large implementations) greater emphasis on compressions has resulted in better survival, whereas there's been almost no benefit of any kind demonstrated from ventilations.

We presume there may be at least a couple subsets who benefit: those who receive a really optimal cocktail where ventilations are added with minimal compromise of circulatory support, and those whose arrest is primarily respiratory in nature. That's why it hasn't been thrown out yet. But again, if you're asking about the real effects on the ground, the evidence across the board has been for compressions. If there's a conceptual "reach" based on physiology but no evidence, it's in continuing to believe that we need to breathe for these people.

I'm not saying we need to put our foot down definitively on this topic. But if we're listening to the evidence, which is fairly strong here, we could do nothing but compressions and defibrillation and be on the side of the angels. The reason for doing, or thinking about doing, anything else is because it seems to make sense, and increasingly that's the side that needs to come up with support for its beliefs.

 

[Tigger]

I think this is a pivotal issue, but needs subdivision to maintain focus and answer instead of begging questions.

1. All this "unused oxygen in circulation"...does it constitute a medically meaningful fraction and partial pressure, especially versus CO2, vis a vis actually maintaining life as we know it? Does CO2 build up in that fraction when the pt isn't EX-haling too? (Remember, CO2 isn't just a suffocator, it is a toxic waste product as well).

2. What is sold to otherwise untrained bystanders, or trained first-aiders, first responders, EMTs and so forth do not all equate because of differing training in airways, means of inflation, drugs, monitoring, use of laryngoscopy and suction and such. Apples to oranges, or at least plums to pluots.

Example: we regularly teach laypersons to extend the neck by raising the chin to open an airway (which can cause a lethal cervical dislocation), but teach professionals and first responders the jaw thrust (when that can exacerbate facial trauma and thus lose airway), EMT-Bs get supralaryngeal airways (which can tamp airway obstructors into the larynx), paramedics to to intubate, etc. They do not equate. We will accept a degree of mortality and morbidity when to do so will pose risk acceptable due to the alternative (hands-only and without resuscitation, versus none at all).

3. The free oxygen radical injury, has it been clinically tested? Just as betadine and peroxide, known to harm tissues in vitro and with overuse, can prevent or reverse important infections, can it be that oxygen, may in vitro or with overuse cause damage (to what degree?) later, but immediately provides the chance of there being a "later"?

While I agree that "Kompression is King", I still believe judicious scientific airway and oxygenation are potential tools, and they are tie-breakers in the small percentage of cases where field resuscitation is actually going to work (i.e., cases without irreversibly lethal infarct, traumatic asystole, or prolonged periods without respiration/circulation before discovery possibly excepting hypothermia/mammalian diving reflex cases) .

The inaugural hallmark of the EMT-P or A, the spine board, was inflated into a harmful panacea without or despite real clinical results, then demonized the same way. One aspect of the mind of a technician is to try to over-simplify expansion or retraction of the uses of his permitted tools.

While we are all entitled to opinions, the outcomes disagree. If you can't back your opinion with actual science, then it has no business in your practice.