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CPR Not as Effective as Chest Compressions Alone
patiwat writes "A Japanese study detailed in the New York Times has found that people suffering from cardiac arrest were more likely to recover without brain damage if rescuers focused on chest compressions rather than on rescue breaths. Some experts advised dropping the mouth-to-mouth part of CPR altogether. Interrupting chest compression to perform mouth-to-mouth ventilation might do more harm than good if blood flow to the heart was not properly re-established, a researcher from Tokyo's Surugadai Nihon University Hospital said. According to the article, 'More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital — partly because they do not get CPR.'"
So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit.
DUH!
Food not Bombs is a nice platitude but it breaks down when you notice that the Bombees are usually well fed
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Linux, you magnificent bastard, I read the fucking manual!
This year the Red Cross changed their standard from 2 rescue breaths every 15 compressions to 2 rescue breaths every 30 compressions (or that is what my yearly training reflected). They also removed abdominal thrusts for unconscious choking victims and basically made the care the same as for a heart attack (minus the AED). I had thought they were dumbing the program down (in the case of choking)so the average person who takes first aid/CPR wouldn't have too many things to remember. Now I see that rescue breaths are generally without merit. I wonder if my training next year will reflect this particular study.
I read about this back in November, and it was known even in 2005. How many people's lives were affected in the interim due to slow news sources?
The mouth-to-mouth ventilation part was always the tricky bit. To be effective you had to blow a large volume of air into the patient with a frequency that made you dizzy and tired quickly. But you also had to be careful not to blow too hard and get air into the stomach which would then blow out all the food out. Often members of the public were reluctant to engage in CPR because of the ventilation part (because of hygiene and sensitivity consideration) and many victims didn't get any CPR because of this. In many countries, including here in Finland, the directives for teaching non-professionals CPR have been changed years ago to teach only the compression part. But I see no reason here why the ventilation part would make CPR less effective when done properly and by professionals. Perhaps this study just shows the lack of skill in doing it properly. After all, what's the point of circulation, if there's no oxygen going in?
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No, it is true even if they have stopped breathing. Basically, it does no good to get more oxygen into the blood if it isn't being circulated, and it takes a lot of chest compressions to get it circulated properly. This is an issue that has been slowly unfolding over the last several years. The Red Cross already decreased the recommended number of breaths to chest compressions a couple years ago, and people are debating whether to get rid of the breathing altogether. One additional argument in favor of the breaths is that it allows the person giving CPR a small break, which is important if they are the only one around to provide CPR.
So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit. DUH!
It's not that much of a 'duh'. The idea originally behind CPR is that you manually perform the action of the heart through the chest compressions, and that the chest compressions don't do much good without some fresh O2 in there. As such, one could ask what good CPR is without the breathing part?
The research basically just shows that circulating the remaining O2 in the blood and stimulating the heart muscle is much more valuable than stopping occasionally to ensure the air is fresh, but that's not a determination you could make with no education, experience, or actually performing the research.
If you're going to call 'duh', you're asserting thay you know more about medicine than the medical professionals who created it and have practiced it all these years. I don't think that's the case, and as is usually the case, the facts are more complicated than it seems to laypeople.
If you really want to survive in emergency situations, just be wide enough to float.
Don't disappoint your bird dog. Go to the range.
What if one person gave chest compressions while another gave mouth to mouth.
Libertarian Leaning Political Discussion Forum.
IIRC, last time I had a CPR refresher, where they told us to increase compressions from 15 to 30, one of the things they mentioned is that the chest compressions themselves help to bring in a minimal amount of air, provided the air cavity is not blocked. Right now, it isn't a sure thing that the breathing should be gotten rid of entirely, but it definitely isn't as important as we once thought it was.
This is the first article which has had me think about my breathing.
I thought I was immune to the old trolls.
liqbase
He forgot to also mention its rare (if EVER!) that someone is breathing and their heart has stopped. Definately a not duh.
God spoke to me.
So, let me get this straight: It's better to focus on chest compressions, but only if you're doing the breath part wrong.
Duh!
Likewise, it's better to focus on standing in the shallow part of the pool if you are doing the swimming wrong, assuming you don't want to drown.
The real focus of the article is actually that the breath part is hard to do correctly, and apparently a lot of people get it wrong. Instead of a single person trying to do it all, someone should help by doing the breath (if they know how!) while the other works on compressions.
I've never been able to figure out why if there's a crowd of people there, 1 person ends up doing all of it while the others get in the way. One of those idiots standing their with their mouths open should bend down and help.
"If you make people think they're thinking, they'll love you; But if you really make them think, they'll hate you." - DM
a recent refresher course has really stressed chest compressions over air as well. 30 compressions per two breaths.
MORTAR COMBAT!
George Bush Sr. collapsed and was revived by his buddy. '"The ugliest part of what happened was that my (male) friend ... gave me mouth-to-mouth resuscitation," Bush said with a smile.'
/ elder-bush-collapses
http://www.huffingtonpost.com/huff-wires/20070312
A key caveat here is that the average joe will have great difficulty recognizing if a victim is suffering from cardiac arrest or respiratory failure: in this case, a combo is the safe approach that covers the most bases.
After each 1 minute of pumping someone's chest, i like to teabag the victim for about 30 seconds.
If I'm trying to revive one of these fine folks, I'm going to perform the chest compressions without skipping the mouth-to-mouth!
I will now volunteer to help them revise their video...
As emphasized by someone in the article, which I read when they published it (and I'm also a swim instructor, lifeguard, and first responder) it's VERY important to note that using only compressions is best and useful in the event of a dryland cardiac event. If someone has just been pulled from the water for instance and is not drowning, you need to give them AIR. Rehashing from the article: most people suffering from heart problems and fibrilliation have plenty of oxygen in their blood and it will remain that way for about 8 minutes. They are not generally in danger of losing oxygenated blood flow to their brain and dying that way. Thus, the exec that collapses in the stairmaster you can probably do just fine with giving compressions: and if you're the ONLY one there who can do that, you had probably better do that. Having actually given CPR for more than 2 minutes, it can literally cause you to pass out if you're the only one there: you have to combine forceful compressions (of breaking THROUGH the ribcage to the heart to get it going) with breathing into a person...and then there are people who might know CPR but, as the article points out, are afraid of catching something. In summary: don't forget to breath into the victim if they aren't breathing. Especially if they were drowning.
Could this be the end of being able to trick hot teenage lifeguards into making out with you?
This study refers to CPR in case of cardiac arrest only! You should still apply the 30:2 rule to patients that drowned, have airway obstructions or drug overdoses.
In any case, when you approach a patient, most of the time you will not know what the cause of collapse is, unless it is witnessed (someone choking in a lunch room, someone grabbing their chest in case of heart attack). So in this case you have to check for a good airway, by listening and feeling and sometimes by giving a breath mouth-to-mouth to see if the chest rises)
In any case, for people with first aid training i suggest carrying some kind of barrier device like a pocket mask to perform CPR. Some of the smaller device are really cheap and small (fit on your key ring).
I always carry my pocket mask and gloves with me, but then I am also obligated by law to help people because of my first aid ticket, and i want to play it safe.
Also, when i was tought in first aid class, we were specifically instructed never to give mouth-to-mouth unprotected, because the first rule in first aid is to watch out for your own safety!
Thomas Schmid athschmid@gmail.com Skype: athschmid
ianaEMT but I volunteer at our local ambulance service as the network admin. I heard about this study and others like it back in December. Due to the emphasis and effectivity of chest compressions, and the risk to the patient during the lapse of compressions when you are breathing, we looked at buying two of these units
:(
You strap the patient to the board and it will do regular chest compressions for you. It is nothing short of amazing and the medics tell me that it is very effective. You can't do either breathing OR compressions when you are hauling a gurney down 3 flights of stairs.
I wish I'd known this before Zoll stock went from 24 to 80
An easy way to remember the timing was shown to me by a paramedic and diving instructor.
30 compressions is the chorus of "Nellie The Elephant"
NELLie the ELephant PACKed her TRUNK and SAID goodBYE to the CIR - CUS,
OFF she WENT with a TRUMPety TRUMP, TRUMP, TRUMP TRUMP.
NELLie the ELephant PACKed her TRUNK and TRUNdled OFF to the JUN - GLE
OFF she WENT with a TRUMPety TRUMP, TRUMP, TRUMP TRUMP.
If you sing the Toy Dolls version
http://www.youtube.com/watch?v=otBWbVdvxLk
you'll even get the 100bpm about right.
Even the best CPR circulates only a fraction of oxygenated blood to the brain. This study was performed under the old guidelines of 15 compressions to 2 ventilations. A theory proposed by the researchers who did the study is that the delay in properly positioning the patient's airway to provide ventilation actually decreased the effectiveness of the compressions. By the time the rescuer got blood flow going, it was time to stop and ventilate again. Perhaps with the current 30 compressions to 2 ventilations as now taught would change the outcome of the study. In any event, everyone who experiences cardiac arrest who is not successfully resuscitated dies of the same thing, anoxia, or lack of oxygen to the brain. Many people in cardiac arrest vomit, sometimes profusely. Layperson CPR really does not allow such a person to be properly ventilated, as the ventilations would most likely cause aspiration (the vomit entering the lungs). By doing adequate and continuous chest compressions, life saving oxygenated blood is delivered to the brain. This can keep the patient viable until professional rescuers arrive on the scene and are able to provide advanced life support such as defibrillation, intubation and cardiac drugs. Studies have repeatedly shown that early access to CPR and defibrillation provide the best chance for surviving cardiac arrest. Also note thought that this study involved adult patients who usually experience cardiac arrest due to cardiac related events such as heart attacks or lethal disrhythmias. Children usually experience cardiac arrest due to airway problems such as choking. So it is vital that ventilation attempts be made on children to determine whether or not they have a patent airway. If not the Heimlich maneuver should be initiated immediately, as the child's best chance of survival is restoration of a patent airway.
A friend of mine works as a 911 operator. I remember her saying years ago that they were testing out new CPR directions to give to folks calling in. They were supposed to tell people to do 400 heart compressions to every breath, but they were losing count. (Panic situations, donchya know.) So they ended up telling them to do 100 compressions and then ask for what to do next. They'd just say, "keep going...."
As far as I know they adopted the new guidelines. It's just hard to spread the word that mouth to mouth isn't all that effective.
In my own humble experience, a person with heart failure will gasp and breathe as soon as blood flow is established.
With a drowning victim it is the other way around - their hearts are OK, but their lungs are full of water, so getting them to breathe/cough/drain is more important - their hearts will beat OK.
So, some intelligence is required. You have to analyze the situation, not just start full resussitation if you don't know what/why you are doing it.
Excuse me, but please get off my Pennisetum Clandestinum, eh!
More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital -- partly because they do not get CPR
;)
With roughly 3% of CPR actions actually doing anything useful, it's no wonder most cardiac arrest victims die. Even with CPR you're only going to save a tiny fraction of them.
Every once in while, CPR makes me think of all the half-hearted measures we introduce into our legal system - on the premise of "well, if it saves ONE life it's worth it". We spend an awful lot of time and money teaching CPR to people, and it almost never does any good. Thanks to TV and the movies, the average person actually thinks CPR is a fairly successful procedure - they get (sometimes violently) angry when you tell them the actual success rate.
Ah well, anything that improves it is a plus, I guess. Now only 8.88889 out of 10 cardiac arrest victims will die
Endless arguments over trivial contradictions in books written by ignorant savages to explain thunder in the dark.
'More than 300,000 Americans die from cardiac arrest each year. Roughly 9 out of 10 cardiac arrest victims die before they get to a hospital -- partly because they do not get CPR.'"
One less asshole: one more job opening.
I was just recently certified in CPR, and they told us the same thing here. Chest compressions are more important than rescue breaths. As they learn more over the years, CPR classes have changed as a result.
I didn't see any of the other comments mention this yet, but a number of researchers believe that adequate chest compressions will cause air to exit the lungs, and the moment of relaxation between compressions will allow some (adequate?) air entry.
Also, if not done by very well trained individuals, the time spent giving a breath to these individuals means time not engaged in chest compression, meaning the effective heart rate will decrease.
Help! I'm a slashdot refugee.
Just to be pedantic, as a paramedic, I watched a few people who were breathing while in cardiac arrest. It's not common, but it can happen. The thing is, they won't breathe for long while in cardiac arrest. One guy in a witnessed arrest for 5 minutes, no pulse, not breathing, v-fib on the monitor, grabbed me and screamed "NO!" when I tried to defibrillate him. I almost shocked both of us. After I got his hands pried off my collar, I sparked him and got him back into a decent rhythm. When he woke up a couple hours later, he didn't know why he screamed "NO!" I've always wondered what was going on in his mind.... The ability to move blood decreases dramatically with time when blood isn't flowing. This result may indicate that stopping compressions for anything short of a return of cardiac activity isn't worth it. In the field and in the hospital, it's not uncommon for the person doing chest compressions to stop occasionally to perform an intervention. This result may change how CPR is done by the medical professionals as well. On the other hand, if rescue breathing is being done poorly in the field, perhaps it's complications like air in the stomach that results in vomiting and thus aspiration pneumonia that's causing the problem. More work will definitely need to be done on this question.
This sig seemed like a good idea at the time....
Wouldn't the act of compressing the chest, also compress the lungs, causing a bit of fresh air flow in and out of them?
Love many, trust a few, do harm to none.
I teach CPR instructors for the layperson as well as for professionals. Yes, I do work in emergency medicine. Here is my take on the findings and from my experience.
First responders (people first on the scene, not medical professionals) historically tend to do a very poor job of ventilating a patient. Often times this renders the rescue breathing almost useless. This has been known about and debated for many years. The "something is better than nothing" attitude as prevailed through the years, even though the majority of the time "nothing" is exactly what the patient gets in terms of oxygen. They often also tend to perform very poor quality CPR compressions (not deep enough, not fast enough).
You are breathing 21% oxygen now. When you exhale into an individual, they are not receiving 21% for part of it was used by the rescuer. The patient is only receiving 16% oxygen. This is a drastic reduction, but it is far better than nothing.
When any patient is determined to not be breathing, there are 3 things a rescuer must remember:
ABC
Airway
It the airway is not clear and straight, no oxygen can get into the lungs.
Breathing
If a person is not breathing, you MUST breath for them or their heart will stop due to lack of oxygen.
Circulation
If a pulse is not detected, you must do proper CPR to circulate oxygenated blood.
These must be maintained in the order ABC. Maintaining circulation when there is no breathing or oxygen is bad.
CPR buys time until properly trained medical personnel arrive. It will not get the heart starting to beat again. You are simply trying to circulate oxygenated blood since the body is not capable of doing that on its own. When there is no pulse in the early stage of a heart attack you see, generally the heart is in an abnormal, but regular rhythm most of the time, but not always. It is basically beating so fast that it cannot circulate blood, and the rhythm at some point becomes very irregular. Defibrillation and cardiac drugs are needed for the heart to return to a normal rhythm. If there is electrical activity still in the heart there is a significantly greater chance of resuscitation. When the heart is in asystole, there is no electrical signal and it is game over. Circulating oxygen is key to survival.
It is also a known fact that most people who take a CPR class forget more than half of what they were taught the day before. As more time elapses, even more is forgotten. If I were having a heart attack, I would prefer that someone tried to give me rescue breaths, even though there is a chance they will do it wrong. It is better to have oxygenated blood circulated than deoxygenated blood. This is just my opinion.
"This is America... where the will of the few outweigh the outrage of the many..." - Unknown
..my dreams of rescuing and saving a hot babe on the beach using "mouth to mouth" are out the window?? *sniff*
My employers sent me on a CPR course. A while ago, but I remember it well.
Two things in particular that stuck with me:
1. Since you have your hands full, you must nominate somebody to call for help: YOU!!! Call an ambulance! Don't ask for volunteers.
2. Don't be afraid to lean in to it. Nobody ever died of cracked ribs.
I've never had to use what I learned. I hope I never do.
...laura
As a physician who deals with in-hospital cardiac arrests on a regular basis, and whom has RTFA, there are couple important points. First, this study really only looked at bystander-provided CPR. The paramedics/other trained professionals who arrived still intubated and ventilated these patients - as this is standard of care. The authors of the study say that the likely explanation for their finding is likely that bystanders interrupted chest compressions to give rescue breaths. So, we may need to change the training for the lay public regarding CPR, but professional responders will still need to give ventilations, and once an airway is secured simultaneous compression and ventilation can be given. If you don't breath - you don't live. Second, while this is likely one of the better studies that can be done on a topic like this, it was not randomized, it was not controlled, nor was it even comprehensive/population-based. There are multiple types of errors that can creep in and cause erroneous results in these types of studies. Finally, we need to keep results in perspective. While any improvement is important - and should be pursued - the overall statistics they report for outcomes are still pretty dismal. The overall survival rate for out of hospital arrest was 8-9%, and the number of people with only moderate/mild disability afterward (ie able to walk, talk, etc) was ~6% if you only got chest compressions, ~4% if you got compressions and rescue breaths. So, even with the "chest compressions only" strategy, the absolute difference is relatively small.
Thank you for RTFA and commenting from a professional point of view.
Given the people in my area, I'd be more than happy to skip the mouth-to-mouth thing. :|
One of the most important CPR facts is that it is only effective 5%-10% of the time! Many people who are trained in CPR and have actually had to perform it do not know this, and they suffer psychologically because they feel they performed it wrong and let/caused someone to die, when they probably did it right. Know this.
--<Mike>--
Disclaimer: IANAL. Get a CPR card if you want to practice CPR. Mine is out of date; work gave maintenance the CPR training, while I got the mandatory "confined spaces" training instead--it consisted entirely of looking at pictures of every last manhole around the plant, while being told "don't go in them." I wish I was making that up.
Back on topic, many places have "Good Samaritan" laws which protect people who try to help you from malpractice suits in situations like that. Might be worth looking up what, if any, such laws your state has if you're worried about that.
So... No tongue?
This research ruins half the "Becoming a hero by saving Lindsay Lohan" fantasy!
What a ridiculously backwards representation of the point the articles on this topic actually make. The title of this entry should be: Chest Compressions Alone Nearly Always as Effective as Full CPR
I read the script, and I think it would help my character's motivation if he was on fire. -Bender
I'm not implying that people shouldn't bother helping someone, of course they should, but I think too much hope is placed in the exercise, and too many hospital dramas make it look like a quick push against someone's chest will wake them up right away.
As a recently certified EMT, I find this both encouraging and disturbing.
The switch from 2 breaths/15 compressions to the 2/30 ratio made sense; the idea is to circulate oxygenated blood to the brain and heart. Oxygen in the lungs is useless if there is no circulation, ergo circulation is far more critical, even if blood oxygen saturation is relatively low.
This study disturbs me because it will cause me to doubt the efficacy of my patient care in the field. If working alone, should I forego rescue breaths and concentrate on chest compressions? Or should I follow the AHA recommendation of 2/30? Whichever route I choose, is it the best care for the patient?
I will no doubt take the CYA route and follow protocol, which is 2/30. Still, if a patient does not survive, I will wonder if perhaps they might have survived had I violated protocol.
Most unpleasant.
Ignorance is curable, stupid is forever.
I hope babelicious damsels in distress are not reading this.
For you ma'm, I'll CPR for free.
667 - one step ahead of the beast.
...the lack of people trained up on basic emergency life support (ELS) techniques. I'm an instructor for the HeartStart scheme (run by the BHF) in the UK, where general knowledge of ELS is pretty poor, hence the initiative I guess. Over in Canada things are so much more different to the USA, as most people are pretty clued up on the basics. Given the Western decline in healthy eating standards (especially over here, where things have really gone down the pan) this should be the sorta stuff we're teaching kids today. Doing something is better than doing nothing at all, which is a point a lot of people seem to miss.
Given a victim with an unobstructed airway (a case of cardiac arrest, for example), do chest compressions move any air into and out of the lungs as a side effect?
Have gnu, will travel.
In the paramedic course I did some years ago they told us, if someone doesn't know how to do the breathing just do the compression.
First of all the breathing is difficult to do right, especially in a stress situation. Also someone who doesn't breath will have heart problems soon and vice versa. There's also enough oxygen still in the blood for the next 10 minutes. And after 10 minutes the ambulance should arrive anyway.
Of course that's now what a paramedic on duty should do. But with an anesthesia bag it's also much easier. The rule is more for your typical first aider or if you don't have anything with you to avoid getting in direct contact with the sick person. Call 112 or 911 on concentrate on the compression.