Heart-attack CPR response a bad move

[SouthernDZ]

Chest compressions without mouth-to-mouth: the coming thing in UK/France



http://www.thestandard.com.hk/news_detail.asp?we_cat=6&art_id=40340&sid=12702463&con_type=1&d_str=20070317


Heart-attack CPR response a bad move
London Standard Marlowe Hood

Friday, March 16, 2007

The chances of surviving a heart attack outside a hospital are doubled if someone performs chest compressions but omits mouth-to-mouth resuscitation, according to a new study.

Nearly everyone has witnessed the scene many times on television, and perhaps a time or two in real life: a take- charge passerby pinches the victim's nose and begins mouth-to-mouth resuscitation, alternating with pushing repeatedly and vigorously on the chest.

But there is something wrong with this sort of cardio-pulmonary resuscitation, according to the study published in the British journal The Lancet: it does more harm than good.

There is "no evidence for any benefit from the addition of mouth-to- mouth ventilation," writes Ken Nagao, a doctor at Tokyo's Nihon University Hospital who led the study of more than 4,000 heart-arrest cases.

And the chances of surviving with a "favorable neurological outcome" are twice as high when would-be rescuers skip the mouth-to-mouth and focus exclusively on trying to revive the heart by rhythmic chest-compressions.

The finding should mean "a prompt interim revision of the guidelines for out-of-hospital cardiac arrest," wrote Gordon Ewy of the University of Arizona's heart center.

The purpose of pushing air into a heart attack victim's lungs is to oxygenate the blood, while massaging the chest aims to restart the heart. But this first large-scale comparison of survival rates puts the lie to standard CPR, which has been taught to millions of people.

The survival rate is higher even when the blood has less oxygen content but is moved through the body by chest compressions, Ewy noted.

If results of the study are used to revise guidelines, it could mean more people will try to help. Of 4,068 adults who had heart attacks witnessed by strangers, 439 received cardiac-only resuscitation and 712 conventional CPR. But 2,917 had to fend for themselves.

Studies have shown because CPR guidelines call for mouth-to-mouth ventilation, a majority of people would not perform CPR on a stranger, said Ewy.
AGENCE FRANCE-PRESSE

[Monsoon65]

The time I came across a heart attack victim, I remember the diphibulator kit said to give "X" number breaths.

I wonder if this is something that will catch on. I can see them changing it if it pans out. How many of us were taught "Two man CPR" during Buddy Care and that changed.

Interesting article.

[jasonglh]

How much farther do we have to dumb down cpr for the public to understand? :rolleyes:

[soldierdoc_2005]

Chest compressions without mouth-to-mouth: the coming thing in UK/France


AGENCE FRANCE-PRESSE

The new ALS standard in Arizona is 200 compressions without any breaths.

A Paramedic buddy of mine told me he did 600 compressions on a guy....and was thoroughly smoked.

The best thing for a heart attack is and always will be:

a) prevention

b) early defib

Clinically, CPR is about 33% effective in the first minute in a clinical setting. After 2 minutes, the effectiveness drops waaay off.

As we all know, according to TC3, CPR is generally not considered in a field environment.

~E

[SeanBaker]

Does anyone here have access to fulltext on the Lancet article who can ring in on whether this study was based on the pre- or post- 2005 CPR protocol? Lancet's not on the available list here.

It'd be easy to assume that this study was based on the newer standard, but I've actually met very few outside of the medical community who are aware of the changes, much less certified to practice it.

The clinical experiments (pigs, I think) which led to implementation of the revised standard would seem explain the increased survival of compression-only victims if it was pre-2005. [The first ~10 compressions are ineffective d/t inertia of the blood].

[soldierdoc_2005]

Does anyone here have access to fulltext on the Lancet article who can ring in on whether this study was based on the pre- or post- 2005 CPR protocol? Lancet's not on the available list here.

It'd be easy to assume that this study was based on the newer standard, but I've actually met very few outside of the medical community who are aware of the changes, much less certified to practice it.

The clinical experiments (pigs, I think) which led to implementation of the revised standard would seem explain the increased survival of compression-only victims if it was pre-2005. [The first ~10 compressions are ineffective d/t inertia of the blood].

This may help:

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-12

[Radar Rider]

I'm always prepared to conduct CPR when need be. If I have to avoid rescue breathing, then that is what I'll do. If chest compressions are enough, then so be it.

[82ndtrooper]

Perhaps a bit off topic, but one ER doc told me that he compressed for over an hour on an air lift transport and had bloody palms. :eek:

He then explained that the cartilegenous tissue between the body of of the sternum and the true ribs actually comes through the chest wall and spikes the palms of the hands.

Is this caused from excess compressions or is it fairly standard to experience this ?

[Monsoon65]

My experience was at Black Water Falls in WV. Gent was in his late 80s and collapsed on a trail. One of his party (they were all in their 70s-80s) got to the ranger station just as my girlfriend and I were returning from dinner.

She was telling what happened, but they seemed to be dragging their feet. I told my girlfriend, "This isn't moving fast enough" and volunteered to go with the ranger and help out.

We got the the trail head where another member of his party was waiting. I found out where he was and ran up the trail (about a mile). The ranger followed behind (he was in his 60's).

When I got there, his wife was there and crying. He was flat on his back. I checked vitals and when I did, I hadn't realised how cold a body gets when dead. I took pulse, checked breathing and heart. Nada.

The ranger came with the kit and we started CPR. I did the breathing. To this day, I can't deal with the smell of sour milk because of what I was smelling (and a sign I wasn't getting air into his lungs. The trail was very cramped and I couldn't get him flat enough on his back).

Around 20 minutes or more after that, the EMTs arrived. They did their thing and got a doc on the line to declare him after a bit.

I was kicking myself in the ass for not being quick enough, but the EMTs said they figured he was dead by the time he hit the ground. His wife was thankful that I volunteered to help (found out they were from Mechanicsburg, about 15-20 minutes from where I live in PA!).

They had hiked out to an overlook to watch the sun go down, and his last words were, "Well, that was worth the trip."

Sorry for the long post.

[NousDefionsDoc]

The Lancet is not what what I consider a reliable source.

[soldierdoc_2005]

The ALS protocol was stated to me by a paramedic working in the field.

As for my statement about CPR in a tactical environment, I stand behind it. The TC3 manual does state that CPR is generally not considered in a tactical field environment. Note I stated "generally". One should be prepared to provide whatever life support is needed if the situation permits it.
My intent is not to diminish the fine efforts of the Doc you sited, or anyone else, it is merely to illustrate the difficulty of CPR in any environment.

Respectfully,

~E

[SouthernDZ]

....about CPR in a tactical environment, I stand behind it. The TC3 manual does state that CPR is generally not considered in a tactical field environment. Note I stated "generally".

EDIT: as requested

[24601]

How much farther do we have to dumb down cpr for the public to understand? :rolleyes:

Oh, keep going. 18 months after first learning it, a girl in my paramedic class still "didn't get it".

[The Reaper]

Yet again, I find myself having to intrude into another heated discussion among QPs.;)

When I have to be the voice of reason, things must really be screwed up.:D

I believe that we can have people of differing opinions present their cases here and they can be expressed and discussed rationally without coming to blows.

The silly part is that you guys are generally agreeing.

I am not a medical professional, but I recently stayed in a Holiday Inn Express.

If I have five men down from an IED, and a single remaining operational individual with medical training has to treat them, first, we have to be sure that we are as best prepared to defend ourselves as we can be, returning fire if fire is received. Next, someone has to call in the contact. Then I think that the primary survey and triage has to be completed on ALL patients before we have the luxury of CPRing any single patient. Clearly, if you have a second person with CPR training and the area is secure, he can assist with CPR as needed. If everyone is GTG with whatever you do for them following the primary survey, then you can spend all of the time you have left doing CPR. Again, this is in a field environment. In a clinical setting, with plenty of resources and trained individuals, you can CPR, entubate, defib, or whatever COA you wish till the physician pronounces or the patient recovers.

In summary, the books do not always agree. Books are merely guidelines and rarely are all-emcpmpassing. We each have to do the best we can, given the METT-TC and our own limitations and knowledge.

I suspect that were I in San Francisco, Miami, or with a patient of uncertain origin, I would do compressions only as well. If it is one of my fellow soldiers or a family member, they are getting the full CPR gig till I am relieved, or I drop.

Just my .02, YMMV. And like Rodney said, "Cain't we all jest get along?"

You gentlemen drive on with your bad selves.

TR

[SouthernDZ]

Yet again, I find myself having to intrude into another heated discussion among QPs.;)

When I have to be the voice of reason, things must really be screwed up.:D

I believe that we can have people of differing opinions present their cases here and they can be expressed and discussed rationally without coming to blows.

The silly part is that you guys are generally agreeing.

I am not a medical professional, but I recently stayed in a Holiday Inn Express.

If I have five men down from an IED, and a single remaining operational individual with medical training has to treat them, first, we have to be sure that we are as best prepared to defend ourselves as we can be, returning fire if fire is received. Next, someone has to call in the contact. Then I think that the primary survey and triage has to be completed on ALL patients before we have the luxury of CPRing any single patient. Clearly, if you have a second person with CPR training and the area is secure, he can assist with CPR as needed. If everyone is GTG with whatever you do for them following the primary survey, then you can spend all of the time you have left doing CPR. Again, this is in a field environment. In a clinical setting, with plenty of resources and trained individuals, you can CPR, entubate, defib, or whatever COA you wish till the physician pronounces or the patient recovers.

In summary, the books do not always agree. Books are merely guidelines and rarely are all-emcpmpassing. We each have to do the best we can, given the METT-TC and our own limitations and knowledge.

I suspect that were I in San Francisco, Miami, or with a patient of uncertain origin, I would do compressions only as well. If it is one of my fellow soldiers or a family member, they are getting the full CPR gig till I am relieved, or I drop.

Just my .02, YMMV. And like Rodney said, "Cain't we all jest get along?"

You gentlemen drive on with your bad selves.

TR


EDIT: As requested

[adal]

In regards to the 200 compressions. As a paramedic in AZ. Some agencies have signed on to be part of a "DEMONSTRATION", not a study (implies consent which you can't get in a code situation). It is called CCR -cardiocerebral resuscitation. It is in conjunction with the SHARE guys in Tucson. All of this has been approved by AZ medical control, AZ DHX and our BEMS.

Here's the basic premise. 911 call, operator can tell caller to start compressions W/O breaths. This can be done in less than 30 seconds as opposed to the 2-3 minutes required to teach CPR over the phone. (They have also been teaching it at Cardinals football games.)

IF GOOD compressions are being done when first responders arrive, we continue with defib, and 200 more compressions. We do this for 4-5 cycles. The idea is that there is enough lung residual to oxygenate the body for that amount of time. We do put on a non-rebreather mask at 15 LPM also.
After our 4-5 cycles (approx 6-10 min) we then switch to AHA ACLS guidelines.

This protocol is being used for Adult Sudden Cardiac arrest only. Overdose, drowning, trauma arrest, etc are still being done by their individual protocols.

The main reason behind the 200 compressions before a defib is to get coranary artery PRESSURE UP and as high as we can for a longer period of time before the defib, and then 200 more compressions. We are finding that if we jump start the heart with good pressure we are having a MUCH greater success rate.

Already have 4 saves here in Flagstaff attributed to CCR and many, many more with the other agencies in the state as a result of the CCR protocol.

Hope that sheds some light on it. adal

[The Reaper]

For the second time, sorry about ruffling feathers; I'll stick to the humor section. :)

I can live with it if you can.:D

TR