Slashdot Mirror
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.'"
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.
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.
What if one person gave chest compressions while another gave mouth to mouth.
Libertarian Leaning Political Discussion Forum.
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.
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!
Personally, if someone next to me went into cardiac arrest right now, I would do as my training said and do the 15 to 1 ratio. If I could verify that the American Red Cross teaches otherwise in the Adult CPR course, I would follow those new procedures. However, if the adult CPR course said 15 to one and the CPR for the professional rescuer said 30 to one I would do 15 to mone because I never took a CPR for the professional rescuer course.
This is the reason your CPR card has an expiry date. If you don't stay current and perform an inadequate CPR technique, technically you are liable (although it's unlikely you'd be sued). I renewed my ACLS certificate a few months ago and can confirm the new 30:2 ratio is endorsed by the American Heart Association. Other changes were made to airway obstructions, too.
If you want to do CPR I suggest you take a refresher course. Cracking ribs is lots of fun (I've personally reanimated hundreds of people and it's nice when it works), but you have to do it properly if you want to give the patient his best chance at living again.
Seven puppies were harmed during the making of this post.
> After all, what's the point of circulation, if there's no oxygen going in?
Short answer: There's already a bit of oxygen in your lungs.
Long answer: You can think of the airways in your lungs as a binary tree. Generations 17-23 are the respiratory unit, where gas exchange takes place; generations 0-16 are the conducting zone, which move air to the respiratory unit, but don't factor into gas exchange. An average lung with a volume of about 5 L has a respiratory unit with a volume of ~2.75 L, leaving a conducting zone volume of 2.25 L of air yet to be breathed. At 21% atmospheric O2, you've got about 0.47 L O2 in that 2.25 L of air, not including extra, yet-to-be-used O2 in your blood. Don't forget that Reinhold Messner summited Mount Everest breathing atmospheric air and with only about 53 ppm O2 (~1/3 sea level atmospheric O2 of 160 ppm); hemoglobin only needs about 80 ppm O2 to fully saturate. At 53 ppm, Reinhold was probably kicking it with ~80% hemoglobin O2 saturation.
How?
Your body has compensation mechanisms to deal with lower than ideal O2. The Bohr effect (Christian, not Neils), causes hemoglobin to loose affinity for oxygen in high CO2 environments, resulting in higher O2 delivery to metabolizing tissues. O2 diffuses from your lungs passively to your blood in 250 msec and your blood goes through your lungs (when your heart is working) for about 750 msec, so your lungs are seriously overspec'ed for the amount of O2 you need at rest (or unconscious) and are about the surface area of a tennis court!
You're touching the crux of the problem there - people won't perform first aid on others, especially here in the US, where, if the person dies or doesn't recover 100% without a medical bill, you'll get sued, because there's a slim possibility that your actions caused more harm than good, and that the person potentially could have recovered on his own. By helping others, you become liable.
Heck, even doctors and nurses walk away here out of fear of litigation, unless they're on duty or their assistance have been requested by someone else.
Teaching people about CPR here in the US should be followed by laws like they have other places, where it's a felony to not assist a fellow in life threatening situations, and where you can not get sued for results of actions obviously intended to assist someone in dire need. Unless the laws are changed, CPR will almost exclusively be performed by ambulance personnel, hospital staff, and very close family.
One less buyer of my plumeting stock :(
Priorities man, its America!
http://www.rense.com/general79/wdx1.htm