question regarding CPR / saves ALS or BLS

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I was told by my instructors that generally patients do not become responsive in the field, even with ALS, meds, etc....

And very rarely, if ever does BLS CPR get patients breathing and a pulse.

At best, I was told, CPR sustains people to get to hospital, and they get a pulse, breathing, become responsive at the hospital.

There was an article I found which made stats on saves on TV/Movies and saves in the real life field.....and the point was saves rarely happen. Please do not get me wrong, I believe if CPR only saved 1 out of 1 million people it is worth doing for that one person.

Yet, I have read posts here and elsewhere about a CPR save when the person literally gets up and walks away...

I have no intention to start a flame war, I would just like to here first hand stories.

Thank you.
 
In the specific context of cardiac arrest, no CPR is not a definitive treatment. The only proven treatment for cardiac arrest is defibrillation.

The goal of CPR is to circulate some blood (and thereby oxygen and nutrients) to the brain and heart so that we avoid brain death that when we do defibrllate whatever pacemaker site in the heart we jumpstart is not acidotic and hypothermic.

Drugs (adrenaline, amiodarone, atropine, lignocaine/lidocaine, bretylium, magnesium etc) have long proven to be ineffective and just change the environment in order to make defibrillation more effective. Some adrenaline and a bolus of amiodarone fall into the "can't hurt" category really.

In reality we should not be transporting non-ROSC primary cardiac arrests, we've been calling it quits in the field for at least twenty years. There is nothing the hospital can do that Ambulance Officers cannot do in the field.

As far as CPR goes the only time you would get somebody "back" with it alone would be secondary to hypoxaemia that is not caused by cardiac arrest so a choking or drowning something like that. Even then its more the ventilatory aspect than chest compressions.

Which reminds me, stupid bloody evidence based medicine is telling us to no longer to the abdo thrusts for choking because there is "no evidence" they work; absence of evidence does not constitute evidence of absence.

So to simply answer your question; will somebody in VF or puseless VT get up and walk away after a bit of a thump on the chest, no, they need to be defibrillated.
 
MrBrown said:
So to simply answer your question; will somebody in VF or puseless VT get up and walk away after a bit of a thump on the chest, no, they need to be defibrillated.
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Precordial thump anyone?

I don't know if I can agree that defibrillation is the ONLY way to get ROSC, as I've had ROSC happen in patients in PEA or Asystole after medication administration (and yes it really was PEA). In one case we shocked the guy into PEA, and then after 3? (maybe 4) rounds of CPR he had ROSC without a change in the EKG morphology.
 
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I have twice seen someone go from pulseless and apneic to conscious in the field.

One was a BLS obstructed airway, and the other was a witnessed V-fib arrest, defibrillated and back to perfusing within 3-4 minutes.

It happens. Not very likely, but it happens.

In the hospital, I saw it at least 10 times in a year in a busy ICU.

ETA: All of these were basically witnessed arrests...best possible scenario.
 
That's not necessarilly true.

For a start, defibrilation is often only a short term solution - something caused them to enter VF, you need to fix that as well as cardioverting them.

Remember the 4Hs and 4Ts. You can decompress a tension pneumo, you can relieve a tamponade, you can give toxin antidotes, you can warm a hypothermic, you can thrombolise, you can fill someone who is intravacularly deplete, you can correct a metabolic disturbance, you can create an airway and oxygenate. That is how you get patients back.

However, the trick in any of the above involves recognising the problem early enough and effectively reversing it whilst maintaining coronary circulation. Whats more, a lot of it is well out of the scope of EMTs and paramedics.

Remember that the evidence shows that around 75% of arrests in hospital are preventable (!!!), pre-hospital is different because you guys don't sit and watch these people go downhill for three or four hours before doing anything about it.
 
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CPR doesn't save lives. Defibrillation saves lives. CPR just extends the time you have to let defibrillation possibly work, however the survival chance is still minimal.


The times you hear of people "regaining consciousness and walking away" aren't patients who were in any sort of sustained cardiac arrest, but most likely went in to a dysrhythmia right in front of the Paramedic and was promptly shocked back in to a normal rhythm (like, less then 30 seconds).
 
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LondonMedic said:
However, the trick in any of the above involves recognising the problem early enough and effectively reversing it whilst maintaining coronary circulation. Whats more, a lot of it is well out of the scope of EMTs and paramedics.
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Speak for the UK, not the US.
 
I think it's somewhere between 2-5% of all Cardiac arrests that CPR works on. That 2-5% is good enough to make me do it. Defibrillator is your best bet. I always look for the closest one when I walk into a sports arena, mall, etc. Especially when I play beer league, in case something happens I always know where it is.
 
LondonMedic said:
However, the trick in any of the above involves recognising the problem early enough and effectively reversing it whilst maintaining coronary circulation. Whats more, a lot of it is well out of the scope of EMTs and paramedics.
Click to expand...

Add on the fact that cardiac arrest is the time sensitive emergency and by the time EMS arrives for witnessed arrests we're already severely behind the eight ball, especially if there isn't any bystander CPR, and unwitnessed arrests are essentially futile. No amount of drugs or compressions is going to bring back the patient who was last seen 4 hours ago, unless they entered arrest a minute or less before being found.
 
Linuss said:
Speak for the UK, not the US.
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Bollocks.

While paramedics in the US do have access to more treatments than in the UK, they still don't have ABGs and can't effectively treat tamponade (or really tension).
 
Some places allow Paramedics to do pericardiocentesis, and whilst I agree needle decompressions isn't fantastic, I doubt you, or many doctors, are lining up to allow chest tubes in the field, and a 14g is better then nothing.
 
Linuss said:
Some places allow Paramedics to do pericardiocentesis, and whilst I agree needle decompressions isn't fantastic, I doubt you, or many doctors, are lining up to allow chest tubes in the field, and a 14g is better then nothing.
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Chest tubes? Too much like hard work - have a thoracostomy instead.

As for pericardiocentesis. :lol:
 
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*Correction... HEMS has chest tubes, I was speaking more for the average 911 ALS truck.
 
Linuss said:
*Correction... HEMS has chest tubes, I was speaking more for the average 911 ALS truck.
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Absolutely, none of our paras or EMTs do, but we do have doctors available throughout many regions and are working on making it nationwide.
 
LondonMedic said:
Chest tubes? Too much like hard work - have a thoracostomy instead.

As for pericardiocentesis. :lol:
Click to expand...

HMMM Needle and chest tubes are both considered thoracostomy.
 
LondonMedic said:
Absolutely, none of our paras or EMTs do, but we do have doctors available throughout many regions and are working on making it nationwide.
Click to expand...

Don't know why it is so easy you could teach a fire monkey to do.
 
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