Fear Of Trying

 

 

Source American Heart Association

 

# 5961

 

 

A study just presented  at the American Heart Association’s annual Scientific Sessions held in Orlando, Florida over the weekend provides clues as to why only 30% of the lay public who witness a cardiac arrest attempt resuscitation.

 

The study, conducted by Perelman School of Medicine at the University of Pennsylvania found that among the people they interviewed, most lacked the skills and confidence to perform CPR - even when they had received CPR training in the past.

 

Nearly 3/4ths were unaware of the new `hands only’ method of CPR, although once instructed, most felt more confident in their ability to render aid during a cardiac arrest.

 

Excerpts from the press release follow, after which I’ll return with more.

 

University of Pennsylvania School of Medicine

Members of the public lack skills, confidence necessary to save lives with CPR, Penn research shows

Findings point to need for new training strategies, dissemination of information about latest CPR techniques and guidelines

ORLANDO – Even members of the lay public who have received CPR training are confused about how to perform the lifesaving skill and say they don't have confidence in their ability to do it properly, according to a study from the Perelman School of Medicine at the University of Pennsylvania which will be presented today at the American Heart Association's annual Scientific Sessions (Abstract #65).

 

"Despite hours spent in CPR training courses and passing an exam, our study shows that even people who have been trained in what to do during a cardiac arrest may ultimately be unable to recall when or how to perform the skill," said lead author Audrey Blewer, MPH, of the Penn Emergency Medicine Department's Center for Resuscitation Science. "We believe that new approaches to training members of the lay public, especially by providing more hands-on training time and information about the option to perform "hands-only" CPR can improve peoples' ability and willingness to respond to a cardiac arrest."

(continue. . . )

 

 

Witnessing a cardiac arrest, particularly of a loved-one, can be a terrifying and traumatic experience. Far too often, bystanders are paralyzed into doing nothing while they wait for rescuers to arrive.

 

As a paramedic, only rarely did I arrive on scene to find someone attempting to resuscitate a patient.

 

Almost inevitably, however, some kind soul had placed a pillow under the head of the victim to make them more `comfortable’, effectively closing off their airway.

 

Consequently, even with the advanced life support equipment we carried, our success rate in reviving these patients was dismally low.

 

The new hands only resuscitation method, which eliminates the need for mouth-to-mouth ventilation, makes doing CPR easier than ever before.

 

But hand’s on training is still important, if you expect to be able to react properly during an emergency. While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A CPR class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

NPM11: Early CPR Saves Lives

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

 

 

A final note.

 

One of the big contributors to sudden cardiac death at home is a failure to call 911 when coronary symptoms first appear. Often people will wait hours, hoping the chest pain will go away, before calling for help.

 

From the CDC’s Heart Attack Information page:

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

 

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

»» Read More

MMWR: Out-of-Hospital Cardiac Arrest Surveillance

 

 

# 5728

 

Over the years I’ve written often about the importance of learning CPR, and on occasion, of my own experiences as a paramedic and as an American Red Cross and American Heart Association CPR instructor.

 

The first four or five minutes of any cardiac arrest are the most critical. And resuscitation efforts that are started after that time period are less likely to produce a good outcome.

 

Quite simply, since EMS response times are often longer than 5 minutes - when someone suffers cardiac arrest outside of the hospital – the patient’s ultimate survival hinges greatly on whether bystander CPR is started before help arrives.

 

Last week the CDC’s  MMWR released a surveillance summary that illustrates this point with data gleaned over the past 5 years from 911 Call Centers, EMS services, and Hospitals on OHCA’s (Out Of Hospital Cardiac Arrests).

 

Out-of-Hospital Cardiac Arrest Surveillance --- Cardiac Arrest Registry to Enhance Survival (CARES), United States, October 1, 2005--December 31, 2010

Surveillance Summaries

July 29, 2011 / 60(SS08);1-19

Bryan McNally, MD, Rachel Robb, MMSc,Monica Mehta, MPH,Kimberly Vellano, MPH,Amy L. Valderrama, PhD, Paula W. Yoon, ScD, Comilla Sasson, MD, Allison Crouch, MPH, Amanda Bray Perez, BS, Robert Merritt, MA, Arthur Kellermann, MD

Abstract

Problem/Condition: Each year, approximately 300,000 persons in the United States experience an out-of-hospital cardiac arrest (OHCA); approximately 92% of persons who experience an OHCA event die. An OHCA is defined as cessation of cardiac mechanical activity that occurs outside of the hospital setting and is confirmed by the absence of signs of circulation. Whereas an OHCA can occur from noncardiac causes (i.e., trauma, drowning, overdose, asphyxia, electrocution, primary respiratory arrests, and other noncardiac etiologies), the majority (70%--85%) of such events have a cardiac cause.

 

The majority of persons who experience an OHCA event, irrespective of etiology, do not receive bystander-assisted cardiopulmonary resuscitation (CPR) or other timely interventions that are known to improve the likelihood of survival to hospital discharge (e.g., defibrillation). Because nearly half of cardiac arrest events are witnessed, efforts to increase survival rates should focus on timely and effective delivery of interventions by bystanders and emergency medical services (EMS) personnel. This is the first report to provide summary data from an OHCA surveillance registry in the United States.

(Continue . . . .)

 

The entire report is detail rich and worth reading, but briefly:

 

In 2004 the CDC, in collaboration with the Emergency Department at the Emory University School of Medicine, began a pilot program called the Cardiac Arrest Registry to Enhance Survival (CARES).

 

This registry – which has since expanded to include 46 EMS agencies in 36 communities in 20 states – evaluates patients who received resuscitative efforts, including CPR or defibrillation, outside of the hospital following a coronary related cardiac arrest.

 

In evaluating 31,689 OCHA events, the registry found that the mean patient age was 64, 61.1% were male, and nearly half (47.3%) were witnessed by a bystander or EMS personnel.  Two thirds occurred at a home or residence, 13.5% in a nursing home or assisted living facility, and roughly 20% in public locations.

 

Just over 20% were pronounced dead at the scene by EMS personnel, while 26.3% survived to be admitted to the hospital.

 

Overall, the survival rate to hospital discharge was 9.6%.

 

Although 36.7% of these cardiac arrests were witnessed by bystanders, less than half (43.8%) of those received bystander CPR, and only 3.7% of those were treated with an AED prior to the arrival of EMS.

 

Among those who received bystander CPR or AED treatment, the survival rate to hospital discharge was 11.2% as opposed to just 7% for those who received no CPR.  

 

A 60% improvement in the survival rate.

 

 

In conclusion, the authors write:

 

The data provided in this report indicate the need for prompt and effective resuscitation efforts. Provision of optimal care at the scene is essential to survival. If a pulse is not restored before EMS transport, additional efforts at the receiving hospital almost invariably fail (23).

 

Education of public officials and community members about the importance of increasing rates of bystander CPR far beyond the current 33.3% and promoting use of early defibrillation by lay and professional rescuers are critical to improving survival of OHCA events. CARES data can be used at the community level to target interventions (e.g., bystander CPR training and AED placement) and assess their effectiveness. CDC uses CARES data for cardiovascular surveillance efforts and makes data available to the public at http://apps.nccd.cdc.gov/NCVDSS_DTM. As statewide CARES registries become available, the data will be used for state-specific OHCA surveillance efforts.

 

With expansion to state-level surveillance, CARES will enable local and state public health departments and EMS agencies to better coordinate their efforts. Such coordination can improve the quality of EMS care and thus increase the proportion of persons who survive an OHCA event.

 

Luckily, today CPR is easier to do than ever.

 

Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.

 

This from the American Heart Association.

• Sudden cardiac arrest is a leading cause of death in the U.S.
• Everyone should know how to perform CPR in an emergency.
• Immediate, effective CPR could more than double a victim's chance of survival.
• Push on the chest at a rate of at least 100 beats per minute.
• Push to the beat of "Stayin' Alive" and you could save a life.
• Click here for more information on Hands-Only CPR.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A CPR class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

»» Read More

Study: Predictors Of Sudden Coronary Death

 

 

# 5714

 

 

According to The American Heart Association (data for 2009) every year an estimated 785,000 Americans experience their first heart attack, and another 470,000 suffer a recurrent heart attack. They also estimate another 195,000 `silent’ myocardial infarctions occur each year.

Making for just under 1.5 million coronary attacks a year (cite Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart Disease and Stroke Statistics—2010 Update. Circulation. 2010;121:e1-e170).

 

While many people survive their first heart attack, for far too many Americans, their first heart attack is also their last. 

 

Every year American EMS units respond to roughly 300,000 cardiac arrests, and the vast majority of those prove fatal (cite  AHA CPR Stats). Why some people survive their first heart attack, and others do not, has been a subject of considerable interest for many years. 

 

The BMJ journal HEART recently published an article that looks at ECG and clinical predictors of sudden cardiac death. 

 

Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease

Elsayed Z Soliman, Ronald J Prineas, L Douglas Case, Gregory Russell, Wayne Rosamond, Thomas Rea, Nona Sotoodehnia, Wendy S Post, David Siscovick, Bruce M Psaty, Gregory L Burke

 

 

While this study found many commonalities between those who suffer sudden cardiac death and those who survive their heart attacks, researchers found several risk factors that appear to suggest a higher risk of sudden death.

 

• Black race/ethnicity (compared to non-black)
• Hypertension and increased heart rates
• Extreme high or low body mass index

Additionally, ECG readings showing a prolongation of QT interval (QTc) and abnormally inverted T waves were seen as possibly being predictors of a higher risk of sudden cardiac death.

 

This research was conducted at the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

 

The authors conclude by stating that these results need to be validated in another cohort.

 

A press release, with more details, is available on the Wake Forest Medical Center Website.

 

 

Predictors of Dying Suddenly Versus Surviving Heart Attack Identified

WINSTON-SALEM, N.C. – July 25, 2011 – Is it possible to predict whether someone is likely to survive or die suddenly from a heart attack?

 

A new study by researchers at Wake Forest Baptist Medical Center has answered just that.

 

“For some people, the first heart attack is more likely to be their last,” said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author of the study. “For these people especially, it is important that we find ways to prevent that first heart attack from ever happening because their chances of living through it are not as good.”

(Continue . . . )

 

 

While preventing that first heart attack is a laudable goal, this is an excellent time to remind my readers of the importance of learning CPR. 

 

This from the American Heart Association.

 

• Sudden cardiac arrest is a leading cause of death in the U.S.
• Everyone should know how to perform CPR in an emergency.
• Immediate, effective CPR could more than double a victim's chance of survival.
• Push on the chest at a rate of at least 100 beats per minute.
• Push to the beat of "Stayin' Alive" and you could save a life.
• Click here for more information on Hands-Only CPR.

Today, CPR is easier to do than ever.

 

Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

»» Read More

CPR Week: Stayin’ Alive

 

 

# 5602

 

I lost count of how many times I’ve done CPR decades ago. Since I did nearly all of my paramedic work in three infamous cardiac cities (St. Petersburg, Phoenix, Bradenton) working codes (cardiac arrests) was pretty much a daily experience.

 

Even with our defibrillators, cardiac meds, and telemetry most of these attempts to resuscitate failed.  

 

It was simply a matter of timing.

 

Once the heart stops, the patient has maybe 4 to 6 minutes before irreparable damage occurs. Only rarely does an ambulance or rescue squad arrive within that window of opportunity.

 

There were some happy endings, of course.  Not as many as I’d have liked, but sometimes we got lucky.

 

And a lot of those `saves’ could be credited to quick acting bystanders who began CPR before we arrived. 

 

The American Heart Association reminds us that this is CPR WEEK, and that everyone should learn how to do Hands-Only CPR.

 

• Sudden cardiac arrest is a leading cause of death in the U.S.
• Everyone should know how to perform CPR in an emergency.
• Immediate, effective CPR could more than double a victim's chance of survival.
• Push on the chest at a rate of at least 100 beats per minute.
• Push to the beat of "Stayin' Alive" and you could save a life.

• Click here for more information on Hands-Only CPR.

 

Today, CPR is easier to do than ever.

 

 

Compression-only CPR is now the standard for laypeople, and so you don’t have to worry about doing mouth-to-mouth.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

For more on the recent changes to bystander CPR, you may wish to visit these recent blogs.

 

 

CPR As A Requirement For High School Graduation

AHA Unveils 2010 CPR Guidelines

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

»» Read More

A Bad Way To Start Your Day

 

 

 

# 5545

STEMI on EKG- credit Wikidoc.org 

 

Admittedly, there is no good time to have a heart attack, but new research is casting light on the fact that the time of day when a person has a myocardial infarction may affect its severity.

 

Last November (see A Different Kind Of Holiday Tradition) I wrote about the seasonality of heart attacks (they spike as much as 33% during the holiday season - between Thanksgiving and mid-January).

 

The reasons for this are not entirely clear, but may be due to a variety of factors:

 

Colder temperatures, increased respiratory infections, over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and the combined stressors of shopping, running up debt for gifts, traveling, meal preparation, and/or the stress that comes from dysfunctional family gatherings.

 

But as any paramedic will tell you, mornings are prime time for cardiac calls anytime of the year.

 

In fact studies have shown that people are 40% more likely to experience a heart attack between 4am-10am than any other time of the day (cite). 

 

But now there is growing evidence that myocardial infarctions that occur in the morning may cause more heart muscle damage than those that occur during other times of the day as well.

 

First the study which appears in the BMJ Heart Journal, then some discussion.

 

Heart doi:10.1136/hrt.2010.212621

Circadian variations of infarct size in acute myocardial infarction

Aida Suárez-Barrientos, Pedro López-Romero, David Vivas1,Francisco Castro-Ferreira, Ivan Núñez-Gil, Eduardo Franco, Borja Ruiz-Mateos, Juan Carlos García-Rubira, Antonio Fernández-Ortiz, Carlos Macaya, Borja Ibanez

Abstract

Background The circadian clock influences a number of cardiovascular (patho)physiological processes including the incidence of acute myocardial infarction. A circadian variation in infarct size has recently been shown in rodents, but there is no clinical evidence of this finding.

 

Objective To determine the impact of time-of-day onset of ST segment elevation myocardial infarction (STEMI) on infarct size.

 

<SNIP>

 

Conclusions Significant circadian oscillations in infarct size were found in patients according to time-of-day of STEMI onset. The infarct size was found to be significantly larger with STEMI onset in the dark-to-light transition period (6:00–noon). If confirmed, these results may have a significant impact on the interpretation of clinical trials of cardioprotective strategies in STEMI.

 

 

Essentially, researchers looked at cardiac enzyme levels of more than 800 patients in Madrid, Spain who were having an STEMI (ST segment elevation myocardial infarction).

 

STEMIs are serious heart attacks that affect a large portion of cardiac muscle and show up on EKGs (ST segment elevation) and produce a spike in cardiac enzymes (indicative of muscle damage).

 

The peak levels of cardiac enzymes released - Creatine kinase (CK) and troponin-I (TnI) – provide a good indication of the amount of coronary muscle damage.

 

By comparing peak enzyme levels in patients with their time of coronary onset, researchers were able to determine what time of day the most severe heart attacks occurred. 

 

And the results  showed that heart attacks that began during the dark-to-light transition period (6:00–noon), showed roughly 20% more tissue death, compared with heart attacks with onsets between 6pm and midnight.

 

The current theory as to why this might be is that the body’s circadian rhythm influences the production of cardio-protective proteins called salvage kinases, which are released in greater quantities later in the day.

 

The hope is that this kind of research will eventually lead to new therapies and treatments which might reduce the amount of muscle damage during heart attacks.

 

For now, the best defense is to remember to take your prescribed medications and to pay attention to the signs and symptoms of a heart attack, and not delay calling 9-1-1.

 

From the CDC’s Heart Attack Information page:

Symptoms of a Heart Attack

The five major symptoms of a heart attack are—

• Pain or discomfort in the jaw, neck, or back.
• Feeling weak, light-headed, or faint.
• Chest pain or discomfort.
• Pain or discomfort in arms or shoulder.
• Shortness of breath.

If you think that you or someone you know is having a heart attack, you should call 9–1–1 immediately.

 

And while you are thinking about gifts for your family and friends this year, one gift you can give them is to take a CPR course – so you can help save their life if their heart should stop due to a heart attack, electrocution, anaphylactic reaction or drowning.

 

Compression-only CPR is now the standard for laypeople, and is easier to do than the old way.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

 

A class only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

»» Read More

CPR As A Requirement For High School Graduation

 

 

# 5240

 

Last week the American Heart Association, along with the American Academy of Pediatrics, and the American College of Emergency Physicians, the National Association of School Nurses and the Society of State Directors of Health, Physical Education and Recreation came out in favor of CPR and AED training for all High school students in the the United States. 

 

Regular readers of this blog are aware that as a paramedic I was heavily involved in the teaching of CPR to high school students back in the 1970s, and I am a big supporter of the concept.

 

The recent elimination of the rescue breathing (mouth-to-mouth) component in bystander CPR makes it easier to teach, and to learn, than ever.

 

I’ve written about that experience several times over the years, including as far back as 2007 when I was part of the National Pandemic Leadership Blog sponsored by the HHS (see To Dream The Impossible Meme Redux.)

 

I’ve some excerpts from the American Heart Association press release, followed by the link to the journal article published in Circulation.

 

But whether offered by your child’s school or not, CPR training is something every family should take seriously, and find ways to implement.

 

 

Secondary students should be required to receive CPR training

American Heart Association Science Advisory

Advisory Highlights:

• CPR training and an overview of automated external defibrillators should be required for high school graduation, according to an American Heart Association advisory.
• Such mandatory training would rapidly increase the number of people ready to respond to sudden cardiac arrest, a leading cause of death in the United States.

DALLAS, Jan. 10, 2011 — All secondary school students should be required to be trained in cardiopulmonary resuscitation (CPR) and receive an overview of automated external defibrillators (AEDs), according to an American Heart Association science advisory.

 

The advisory, published in Circulation: Journal of the American Heart Association, calls for state legislatures to mandate that CPR and AED training be required for graduation, and to provide funding and other support to ensure the educational standard is met.

 

Last school year, 36 states had a law or curriculum standard encouraging CPR training in schools, according to the advisory. School districts have developed various models for providing and paying for the training and equipment, including using volunteer instructors or video-based programs, and drawing support from businesses, foundations, civic organizations and public agencies.

 

Challenges include finding time in the curriculum to teach the courses and providing and maintaining CPR manikins, which are vital for training. Schools can keep reusable manikins, replacing key parts for sanitary reasons, or can work with a local agency that provides manikins and training. Some schools provide personal training kits that include DVD-based instructions and an inflatable, reusable manikin.

 

The statement authors report that the benefits far outweigh the costs. “Training of all secondary education students will add a million trained rescuers to the population every few years,” said Mary Fran Hazinski, R.N., M.S.N., co-author of the advisory and professor at Vanderbilt University School of Nursing in Nashville, Tenn. “Those students will be ready, willing and able to act for many years to come, whenever they witness an emergency within the community.”

Students trained as rescuers might help save lives at home, where most sudden cardiac arrests occur. Trained students could also respond to cardiac arrests at school and at public places such as malls, health clubs, or swimming pools, or at events such as family reunions.

 

(Continue . . . )

 

Importance and Implementation of Training in Cardiopulmonary Resuscitation and  Automated External Defibrillation in Schools

Diana M. Cave, RN, MSN, CEN, Chair; Tom P. Aufderheide, MD, FAHA; Jeff Beeson, MD; Alison Ellison, BSN; Andrew Gregory, MD; Mary Fran Hazinski, RN, MSN, FAHA; Loren F. Hiratzka, MD, FAHA; Keith G. Lurie, MD; Laurie J. Morrison, MD, MSc; Vincent N. Mosesso, Jr, MD; Vinay Nadkarni, MD, FAHA; Jerald Potts, PhD, FAHA;
Ricardo A. Samson, MD; Michael R. Sayre, MD, FAHA; Stephen M. Schexnayder, MD

 

 

Other recent CPR-centric AFD blogs of note include:

 

A Different Kind Of Holiday Tradition

AHA Unveils 2010 CPR Guidelines 

JAMA: Compression Only CPR

MMWR: Sudden Cardiac Arrest Awareness Month

»» Read More

AHA Unveils 2010 CPR Guidelines

 

 

 

# 4989

 

 

 

Just 8 hours post-embargo, we’ve got the new American Heart Association 2010 CPR Guidelines, including the media kit with a ton of supporting information, and a terrific new video.

 

As a former AHA CPR Instructor (as not to play favorites, I was also an American Red Cross Instructor), these new guidelines are of particular interest to me.   Much has changed since I taught the class, based on research that I’ve covered in this blog in the recent past.

 

JAMA: Compression Only CPR

Results Of CPR Without Rescue Breathing

 

 

Excerpts from the press release, followed by a couple of the promotional aids, and finally the 3 minute video. 

 

 

A New Order for CPR, Spelled C-A-B

Statement Highlights:

- The 2010 AHA Guidelines for CPR and ECC update the 2005 guidelines.

- When administering CPR, immediate chest compressions should be done first.

- Untrained lay people are urged to administer Hands-Only CPR (chest compressions only).

 

DALLAS, Oct. 18 /PRNewswire-USNewswire/ -- The American Heart Association is re-arranging the ABCs of cardiopulmonary resuscitation (CPR) in its 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, published in Circulation: Journal of the American Heart Association.

 

Recommending that chest compressions be the first step for lay and professional rescuers to revive victims of sudden cardiac arrest, the association said the A-B-Cs (Airway-Breathing-Compressions) of CPR should now be changed to C-A-B (Compressions-Airway-Breathing).

 

<SNIP>

 

All victims in cardiac arrest need chest compressions. In the first few minutes of a cardiac arrest, victims will have oxygen remaining in their lungs and bloodstream, so starting CPR with chest compressions can pump that blood to the victim's brain and heart sooner. Research shows that rescuers who started CPR with opening the airway took 30 critical seconds longer to begin chest compressions than rescuers who began CPR with chest compressions.

 

The change in the CPR sequence applies to adults, children and infants, but excludes newborns.

 

Other recommendations, based mainly on research published since the last AHA resuscitation guidelines in 2005:

• During CPR, rescuers should give chest compressions a little faster, at a rate of at least 100 times a minute.
• Rescuers should push deeper on the chest, compressing at least two inches in adults and children and 1.5 inches in infants.
• Between each compression, rescuers should avoid leaning on the chest to allow it to return to its starting position.
• Rescuers should avoid stopping chest compressions and avoid excessive ventilation.
• All 9-1-1 centers should assertively provide instructions over the telephone to get chest compressions started when cardiac arrest is suspected.

 

 

 

 

Given the changes in how CPR is performed, and that this is Sudden Cardiac Awareness Month (see MMWR: Sudden Cardiac Arrest Awareness Month) wouldn’t this be a good time to take (or re-take) a CPR training class?

 

It only takes a few hours, and it could end up helping you save the life of someone you love.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

»» Read More

Results Of CPR Without Rescue Breathing

 

 

# 4766

 

 

Having performed CPR in excess of 500 times over the years, and since I was an American Heart Association and an American Red Cross CPR instructor in my distant past, I’ve watched the adoption of a `compression only’ method of CPR for laypeople over the past couple of years with considerable interest.

 

Admittedly, the removal of rescue breathing from the protocol seemed a bit counterintuitive to me.   Airway management and proper ventilation were a huge part of my EMT and Paramedic training.

 

But I understand the reluctance of bystanders to do mouth-to-mouth – particularly on strangers (which is why I  own two Ambu-bags - one for each of my first aid kits).

Despite my initial skepticism, the NEJM has published the results of a comparative study of CPR outcomes with, and without, rescue breathing that support the notion of doing compression-only CPR. 

 

At least among those who have little or no CPR training. 

 

This study was conducted in Sweden, and researchers found that the 30-day survival rate was 8.7% in the compression-only group and 7.0% in the group receiving standard CPR.

 

Excerpts from the abstract follow.

 

CPR with Chest Compression Alone or with Rescue Breathing

Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H. and Mickey S. Eisenberg, M.D., Ph.D.

N Engl J Med 2010; 363:423-433July 29, 2010

Background

The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.

Methods

We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.

 

<BIG SNIP>

 

Conclusions

Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing.

 

(Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)

 

 

Doing 1-man CPR, even for a trained responder, can be difficult and quickly exhausting.  For a layperson, changing from compressions to rescue breaths and back again to compressions  can be awkward and ultimately inefficient.

 

The end result is often poor ventilation and poor circulation. 

 

Rescue breathing and trying to maintain a proper airway complicates CPR considerably, but emergency dispatchers can coach untrained bystanders to do chest compressions relatively easily. 

 

By concentrating on chest compressions alone, the layperson can keep a little oxygenated blood flowing to the brain while waiting for medics to arrive. 

 

This can help stave off brain death, which is the primary goal of bystander CPR.

 

I would urge everyone to take a CPR course, and follow up with refresher courses every few years.  Contact your local Red Cross Chapter or the American Heart Association  for training options.

 

You should be warned, however, that the `miraculous saves’ shown on many dramatic TV shows - where the CPR success rate is usually over 50% – aren’t very realistic.  

 

CPR can, and does, save lives. 

 

But the rate of success is usually 10%-15%, even under the best of circumstances.  For a sobering, but realistic appraisal of CPR’s effectiveness you might wish to read:

 

CPR: Less Effective Than You Might Think

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