The new, better CPR. Please share this.

[trof]

The CCC gets rid of the 'yuck' factor of CPR.
I did CPR on a guy when I was a lifeguard (MANY years ago) and he threw up in my mouth.
Then we were both barfing.
Double yuck.
He survived.
I barely did.

Please keep this kicked.
trof


ScienceDaily (Nov. 15, 2009) — The chance of surviving a cardiac arrest outside a hospital was found to be twice as high when bystanders performed continuous chest compressions without mouth-to-mouth breathing than when bystanders performed standard CPR. These are the latest findings reported by the Resuscitation Research Group at the University of Arizona Sarver Heart Center and the SHARE Program (Save Hearts in Arizona Research and Education) at the Arizona Department of Health Services.

Only 5 percent of cardiac arrest victims survived if nobody performed CPR. In those receiving standard CPR (alternating between 30 compressions and 2 breaths), survival was marginally higher at 6 percent. In contrast, 11 percent survived if bystanders kept pumping on their chest and did not stop for mouth-to-mouth breaths until emergency medical services arrived. These trends were even more pronounced in those patients facing the highest survival chance to begin with due to the specific nature of their cardiac arrest, namely those whose collapse was witnessed and whose heart was in a rhythm that is most likely to respond to a shock from a defibrillator. In those, the survival rate was 17 percent without bystander CPR, 19 percent with standard CPR and 32 percent with continuous chest compressions.

The analysis also showed that while the percentage of bystanders administering CPR increased only slightly over the past four years, of those that did choose to help, 77 percent opted for chest compressions without mouth-to-mouth breathing instead of standard CPR. Before, that number was only 16 percent.

The results of the analysis, which included 4,850 out-of-hospital cardiac arrests in Arizona that occurred from 2005 and 2009, was presented by Gordon A. Ewy, MD, director of the UA Sarver Heart Center at the "Best of the Best" abstract session of the American Heart Association's Resuscitation Symposium in Orlando, Fla., on Nov. 15.

"Over the course of three days, out-of-hospital cardiac arrest claims as many lives in the U.S. as the September 11 attacks," Dr. Ewy said. "This study is the first to show that bystanders can raise the odds of survival by giving continuous chest compressions rather than the type of CPR they are being taught in most certification classes. If we can get more people to act, more patients who were on the brink of death will be walking out of the hospital neurologically intact."

Bentley J. Bobrow, MD, medical director of the Bureau of Emergency Medical Services & Trauma System at the Arizona Department of Health Services, said: "All previously published reports only showed that bystander CPR was better than not doing any CPR until the paramedics arrive, and that early CPR resulted in better survival than late CPR. Our statewide efforts promoting Compression-Only CPR have resulted in significantly improved survival rates for patients in out-of-hospital cardiac arrest."

Here's a video showing you how to do it. It's pretty simple.

http://www.youtube.com/watch?v=E5huVSebZpM

[Greyskye]

1. Maybe this will encourage more people to get certified

:kick:

[strategery blunder]

2. Makes sense.

I never quite understood the mouth-to-mouth breathing part of CPR, given that the breath exhaled into the recipient's mouth would be depleted of oxygen and relatively rich in carbon dioxide. :shrug:

[Heddi]

7. because it's not ALL CO2, and the smallest bit of oxygen can be beneficial

to the brain.

Now with the new regulations of fast-hard-good compressions, they are going with the knowledge that it is blood flow (which will have partially oxygenated blood in it) is more important than o2 alone. Also the fast-hard-good compressions keeps up the negative pressure in the chest and keeps the BP up, which means good blood flow to the vital organs - brain & kidneys, mainly. The researchers also found that when you stop to give rescue breaths, the negative pressure in the chest that was just built up over the previous 2 minutes of compressions pretty much goes to shit prety quickly, and it takes nearly 1/2 the time of the next 2 minutes of compressions to build that pressure back up. They found that when the rescue breaths were eliminated, and CPR was just focused on fast-hard-good compressions, the pts had better outcome b/c they had a continuous "good" blood pressure, which meant more blood to the vitals, which meant a better outcome.

One of the hospitals I worked at was part of the American Heart Association clinical trials regarding the new CPR guidelines. They actually had to cut the research study short because the outcome was so much better in compression only than in compression-stop-breath-compression CPR, that it was considered inhumane to continue to do the compression-stop-breath-compression on patients that needed cpr.

A good song to sing to yourself while doing CPR compressions is either "Staying Alive" or "Another One Bites The Dust". They both give a cadence that equals about 100 compressions a minute---the ideal number of compressions we want to do on someone who needs CPR> Personally, I think "Staying ALive" has a bit more of an upbeat message than "Another One Bites The Dust"....

Heddi
Emergency Room RN

[uppityperson]

10. k&r and those are good songs to sing but darn you

Now I have "another one bites the dust" going through my brain.

[Heddi]

23. dun dun dun anotheronebitesthedust dun dun dun anotheronebitesthedust

and another one's gone and another one's gone anotheronebitesthedust

[nadinbrzezinski]

27. Oh god, now that will be hard to get out of my mind

:-)

It sounds like I will have to go get recert for the fun of it soon.

Now just to date myself... when I first learned CPR, remember the good ol' Precordial Thump in un-witnessed arrest?

[Geoff R. Casavant]

21. Thanks for the rules of thumb Heddi!

Just curious though -- did the study discuss survival rates when a patient received CPR from two people, with one doing the compressions and the other doing the breathing?

[Heddi]

22. They may have, I'm not sure....

Most of the research was done in the field with paramedics and EMTs with just a small bit of the research being done on pts in the ER...most CPR starts "in the field"---at the scene of an accident, far away from the hospital

...now that I think about it, they must have done some kind of study (although I don't know what the results were) because the overwhelming conclusion that fast-hard-good CPR had a better outcome regardless of who was doing it (professional, layperson). Generally a professional CPR situation would generally (generally) involve 2 people--one either doing the breathing or bagging if they have a bag-valve-mask and the other doing compressions.

Forget the hokey pokey---fast, hard, and good compressions are what it's all about.

THe thing that people have to get over is that when we think we're pushing deep enough, we really *aren't*. It's an odd feeling to have ribs cracking and breaking beneath your hands. It's odd to feel the broken ribs moving, cracking, snapping beneath your hands. That's how deep CPR is supposed to be done...not the mamby-pamby chest massage they show on TV. 1 1/2 to 2 inches deep is how deep. The ribs and sternum are very strong. Pushing down 1.5-2 inches REPEATEDLY, especially on a larger person, is very difficult. Fatigue sets in immediately...>I've been in the ER, start doing compressions and I"m like "When the hell is 3 minutes up???" and my co-workers are like 'Um, you've done 2 compressions, dear....". Great abdominal workout, by the way. I always feel the burn when I'm done compressing...

[nadinbrzezinski]

28. I broken my share of ribs

and yes, after done with CPR I was ALWAYS drenched... no matter what the weather was.

Oy the shoulder, and upper arm pain next day is something YOU NEVER FORGET... yes, it is that bad.

[Canuckistanian]

8. It's not really THAT depleted of Oxygen

You lungs are not capable of absorbing 100% of the oxygen that you inhale.

Normal atmospheric air contains approximately 21% oxygen when created in. After gaseous exchange has taken place in the lungs, with waste products (notably carbon dioxide) moved from the bloodstream to the lungs, the air being exhaled by humans normally contains around 17% oxygen. This means that the human body utilises only around 19% of the oxygen inhaled, leaving over 80% of the oxygen available in the exhalatory breath.

http://en.wikipedia.org/wiki/Artificial_respiration#Efficiency_of_mouth_to_patient_insufflation

[strategery blunder]

17. Bad phrasing on my part

I knew the body doesn't use every bit of oxygen it takes in, but I thought it was more than 20%. I should've said "oxygen-depleted" (which is true, though not quite to the extent I thought) rather than "depleted of oxygen"--the latter more easily implies 100%.

I always wondered about that, and one of the wonderful things about DU is ignorance does not go uncorrected for long! :)

[nadinbrzezinski]

26. Because the Oxygen you breaht in is about 20% Oxygen

and the one you exhale is 16% which leaves plenty for the other person...

That said, this is not the reason why this is now changed. It has since it is far more effective to get into rhythm and stay in it.

Over twenty years ago I asked that question on the efficiency point... for rhythm.

Of course they looked at me as you nuts?

[liberal N proud]

3. I took the training one time in college

But they never gave anyone who took the class certification. I have not done anything since then but surrounded by many that are.

[trof]

4. WHERE'S SKITTLES!? I want this post's ASS KICKED!!!!!!

[Uncle Joe]

5. Kicked and recommended.

Thanks for the thread, trof.:thumbsup:

[BrklynLiberal]

6. K&R

[Luciferous]

9. Good to know. K&R

[Warpy]

11. Right, I no longer keep a valve mask with me to do the breathing

if somebody drops in front of me. All the CPR I've done has been in the hospital, though, where they were intubated quickly.

They do always barf, too. Barfing is part of cardiac arrest. The lower survival rate with mouth to mouth is undoubtedly due in part to some of the gastric contents being forced down into the lungs.

[pipoman]

12. Wow, I didn't know the stats on survival

I have done CPR 2 times, once in a convenience store parking lot, once at a postcard show, both people lived, sounds like I have beat the odds. Also did Heimlich once, she survived too.

[nutsnberries]

13. kickin' -nt

[CaliforniaPeggy]

14. Good to know! Thank you, my dear trof...

K&R

[Delphinus]

15. I got trained in this

a few years ago. Thankfully, I've not had to use it, but I know how if necessary.

[Indy Lurker]

16. children and infants should still get mouth-to-mouth

Most adults who go into cardiac arrest do so for circulation issues.

Most children and infants who go into cardiac arrest do so for breathing issues.

Adults who you suspect of drowning should also get mouth-to-mouth.

CPR Tip: For those of you who remember the song "Stayin' Alive" by the Bee Gees, you can think of it when your doing chest compressions, the rhythm is about 100 beats per minutes, the recommended rate for chest compressions.

[Hawaii Hiker]

18. Question re: CPR

I don't know if this is Hollywood or real, but sometimes in a movie/TV show when a victim suffers caradic arrest, (V-FIB), you'll see an emergency worker hit a person REALLY hard in the chest, practically a full force punch, before doing the normal compressions...Do they really do that??....

[nadinbrzezinski]

29. That is a precordial thump

and depending on the year the program is set what the protocol calls for.

When I first learned CPR in the Antedeluvian Period, we used to do it to EVERYBODY... last time I looked at Advanced Life Support Protocols they still had it for a certain rhythm on the monitor. I have not looked at any of them protocols recently, mostly I don't do it anymore, but that's what you are describing.

So if you see this on the TV for CPR done on or around the 1970s and early 80s, you will see it on just 'bout everybody.

The History of CPR and procedures is actually fascinating, since it took a while for the procedure (back in the early 1970s) to enter general practice in the US... hell the Heimeich Maneuver is even more fascinating.

[unc70]

19. A relative went over 10 minutes without pulse last year -- OK now

Sudden cardiac event -- probably electrical -- no pulse. Chest compressions for over 10 minutes until EMS, then a large number of attempts before heart restarted. Hypothermia coma, slow recovery. OK now. A miracle.

[davsand]

20. Everybody needs to know this!

This is potentially gonna save a life, and too few people have been willing to learn how.

As our population ages we are gonna see more and more need for emergency response to cardiac events. Emergency Responders can't be everywhere 24/7, so we ALL need to be able to react correctly.




Laura

[Ignis]

24. K&R. Spread the word, not the lips.

:D

[trof]

25. Wow! 49 recs. Nice goin', guys.

[Ignis]

30. Needs another kick to be seen over the HCR fiasco, though.

:kick: