Been holding your breath for an easier way to do CPR?

[Desertdog]

Been holding your breath for an easier way to do CPR?

Home URL of Sarver Heart Center
http://www.heart.arizona.edu/

URL for new CPR video instructions.
http://www.heart.arizona.edu/publiced/lifesaver.htm

CPR Research at UA Sarver Heart Center

Doctors and researchers at the UA Sarver Heart Center have been active in CPR research for more than 30 years and have earned an international reputation for their findings and recommendations, many of which were incorporated in the American Heart Association's 2000 CPR Guidelines.

Significant research findings that have surfaced in the past few years have convinced the Sarver Heart Center of the need to immediately apply new techniques that have been proven to save more lives.

The Sarver Heart Center's efforts have evolved into three components. The first, begun in fall 2001, is the Sarver Heart Auomated External Defibrillator Registry (SHARE). The program helps Arizona businesses and organizations obtain automated external defibrillators and learn how to use them. AEDs are used to restore a normal rhythm in hearts after cardiac arrest by delivering an electric shock.

Several businesses and organizations have joined the registry, including Tucson Electric Power, the University of Arizona and Pima County Community College District and the Maric opa County Community College District.

The second component is a partnership that the Sarver Heart Center has formed with the Tucson Fire Department called the SHC/TFD CPR Initiative. Under the guidance of the Sarver Heart Center, TFD has made important modifications to the procedures that its firefighters and paramedics follow when responding to sudden cardiac arrest calls. The primary change is an increase in the number of chest compressions administered to victims and a decrease in the amount of time spent on steps that require interruptions in chest compressions.

The Sarver Heart Center and TFD -- a nationally-recognized pioneer in emergency pre-hospital patient care -- believe the changes will significantly improve the survival rates for out-of-hospital sudden cardiac arrest.

The final component is a city-wide effort to educate the general public about a new and easier way to do CPR, called Continuous Chest Compression CPR. Heart Center researchers discovered years ago that overwhelming numbers of people will not perform CPR because they do not want to do mouth-to-mouth breathing. More recent research has found that stopping for mouth-to-mouth breathing is more harmful than helpful. Standard CPR, which calls for two mouth-to-mouth breaths after every 15 compressions, leads to a dire consequence: When chest compressions are stopped, none of the body's organs are receiving any oxygenated blood.

With CCC-CPR, there not only is a better chance of bystander participation, but a much greater chance that the victim will survive.

[SomeKid]

*Sigh*

If all you do is pump blood then your going to run out of oxygenated blood in moments. Unless you want to pump the blood in a corpse, you have to do mouth to mouth sooner or later. Now, if you only need to pump blood for a minute before an ambulance arrives, then maybe that will work.

Oh, and the article is wrong. It is now 30 compressions then break for spit swapping.

[Desertdog]

The way I figure it, as you do the compressions you are actually compressing the lungs also, which should move some air.

Research the complete web site and watch the video.  The compressions shown on the video look identical to the compressions I took in CPR class, with the exception of faster pace and no stopping for breathing.

It's the claims of the Sarver Heat Center, not mine, that I am passing on.

[MechAg94]

Our last CPR instructor mentioned that you can get those little plastic barriers with the filter pretty cheaply.  You can also get the mouthpiece with the one-way valve.  I haven't actually tried to get it, but I plan to.

[AmbulanceDriver]

I just finished upgrading my dispatcher certification a few weeks ago.  We are now giving instrucitons that include compressions first CPR for certain instances.  However, we are still giving instructions for breaths between rounds of compressions.  However, if the person refuses to give mouth to mouth, we will still give them instructions for continuous chest compressions until responders arrive.

Here is some of the physiology behind the continuous compressions CPR as I understand it.

First, compressions only is better than nothing.  Better partially oxygenated blood continues to circulate than no circulation at all, accumulating toxins at the cellular level.  Hypoxia is only part of the problem, excess CO2 *must* be removed from the cells otherwise they're just as dead as from hypoxia.  Also, chest compressions do create a minimal amout of air movement, so there is at least a minimal amout of air exchange going on.   Maybe not enough to get above 90% O2 saturation, but it's better than nothing.  Finally, there is the residual oxygenated air in the lungs from the moment of collapse, which will provide some oxygenation to the blood. 

[SomeKid]

DD, allow me to clarify. I was not attacking you, I know it was the claims of someone else.

Mech, you can buy them very cheaply from many places. I myself do not have one, but then, even though I am certified and a nursing student, I probably wouldn't give CPR to a total stranger. Too many diseases. A good rule for whenever helping someone else: Don't turn yourself into another casualty. (That isn't to say I wouldn't assist, but I refuse to put myself in danger stupidly.)

AD,

Don't get me wrong, compressions beat nothing. Just not by much.

As told to me by my CPR instructor, the idea behind continuous compression was that it takes x number of compressions to get blood flowing adequatly to the brain. When you stop to breathe into them, you start over. More compressions between stopping = more blood flow. Another interesting tidbit, who makes the CPR giudelines? Heart doctors...guess which gets more emphasis, blood for or O2 levels? CPR is good, but it is not the end all be all. I would take a defibrillator over CPR any day of the week. Too bad more people/places don't have those things.

chest compressions do create a minimal amout of air movement

I would use the word negligible in place of minimal, but there is probably a bit of movement, which might help a little bit. Keep in mind, the compressions are located over the heart.

Maybe not enough to get above 90% O2 saturation

I am a totally healthy 22yo wm. My O2 sat tends to hover around 95-97. (I checked at clinicals last week.) I would be rather shocked if my O2 stayed above 80 after not breathing for 5 minutes, even with continuous chest compressions. Although, next time I am at clinicals I am going to hold my breath and see how much it goes down over that lone minute. Should be interesting.

[Desertdog]

Another story from their web site
http://www.heart.arizona.edu/news-info/Paramedicssavemoreliveswhentheydontfollowtherules.htm

Study: Paramedics Save More Lives When They Don't Follow the Rules
 
 

Survival rates following the most common form of cardiac arrest increased three-fold when emergency medical personnel used a new form of CPR developed at The University of Arizona Sarver Heart Center. The new approach, called Cardiocerebral Resuscitation, is dramatically different from guideline-directed CPR procedures.

Because of its importance, the editors of the American Journal of Medicine chose to publish the report online in advance of the journals April print issue.

Cardiocerebral Resuscitation eliminates certain previously recommended procedures and reprioritizes the order of actions the emergency medical services deliver, said Michael J. Kellum, MD, leading author of the study report.

Under the new approach, first responders skipped the first steps of the standard protocol: intubating the patient for ventilation and delivering a shock using a defibrillator. While still attaching the victim to a defibrillator, they did not wait for the device to analyze the patients heart rhythm, but started fast, forceful chest compressions.

Intubating the patient and waiting for the defibrillator to do its analysis takes time  time a cardiac arrest victim doesnt have, said Gordon A. Ewy, MD, director of the Sarver Heart Center and co-author of the study. I am convinced that Cardiocerebral Resuscitation will have a world-wide impact.

In laboratory experiments, we found that the most important factor of survival is to keep the blood moving through the body by continuous chest compressions, said Dr. Ewy, who pioneered the CPR Research Group at the Sarver Heart Center.

Stopping chest compressions for ventilations was far more harmful than helpful. Excessive ventilations during chest compression turned out to be harmful, too.

First responders applying the new protocol were able to resuscitate the majority (58 percent) of out-of-hospital witnessed cardiac arrest victims, provided they had a shockable initial heart rhythm. Shockable describes a condition in which the heart quivers rather than beats but can be shocked back into normal beat with a defibrillator. In contrast, the survival rate was only 20 percent in the 3 years before, when the standard CPR protocol was used.

The current study, which involved 125 patients, reports the experiences after the revised protocol was implemented in two Wisconsin counties in a collaboration between the CPR Research Group at the University of Arizonas Sarver Heart Center and the Mercy Health System in Wisconsin.

We think one of the reasons that CPR as directed by international guidelines has not worked well is because it is designed for two entirely different conditions: cardiac arrest and respiratory arrest, said Dr. Ewy.  What is good for one may not be good for the other.  Cardiocerebral Resuscitation is designed for cardiac arrest.  Sudden unexpected collapse in an adult is almost always due to cardiac arrest. The new approach is not recommended for respiratory arrest, a much less common situation following, for example, drowning or drug overdose.

As a cause of death, out-of-hospital cardiac arrest is second only to all cancer deaths combined, taking the lives of 490,000 Americans every year. Unlike the impression created by TV shows such as E.R., the chance of surviving an out-of-hospital cardiac arrest is usually much less than 10 percent. In spite of periodic updates of standardized international guidelines, survival rates have remained more or less unchanged over the last couple of decades. Survival rates are better only if an automated external defibrillator (AED) is available and is used soon after the cardiac arrest.

Reference:

Michael J. Kellum, MD, Kevin W. Kennedy, MS, and Gordon A. Ewy, MD. Cardiocerebral Resuscitation Improves Survival of Patients with Out-of-Hospital Cardiac Arrest. The American Journal of Medicine (2006) 119, 335-340.

 

For more information and to obtain a copy of the report, please contact:

Gordon A. Ewy, MD, Director, Sarver Heart Center, gaewy@aol.com

Daniel Stolte, Office of Communications, Sarver Heart Center, Phone 520-626-4083, stolte@email.arizona.edu

Michael E. Kellum, MD, Phone 262-949-2270, mkellum@mhsjvl.org
 

[AmbulanceDriver]

SomeKid, I would agree with you.  I'm also an EMT-Intermediate, so I have experience on the other side of the radio as well.  And in my opinion, perfect CPR involves an intubated patient so you don't have to stop compressions to give a breath.  It also involves said chest compressions happening between rounds of drugs and defibrillatory shocks.   

However, until we get on scene, I'll take plain old CPR (compressions and rescue breathing, whether done at 30/4 or 15/2 or 5/1) over nothing.   And if they're not willing to do rescue breathing, I'll gladly take compressions only CPR. 

BTW, I recently had kidney stones.   They somewhat over-medicated me in the ER (15 mg total of Morphine over about 2 hours, Toradol,  and then another 2mg of Dilaudid.  Which was technically a significant overdose) and knocked my respiratory drive partway out.  I didn't pass out until my O2 sats dropped to about 75%, and that wasn't enough to knock me all the way out, the alarms going off over my head (low o2, high heart rate, apnea) woke me right back up.....

Let's just say that I never want dilaudid again.....

[Sergeant Bob]

BTW, I recently had kidney stones.   They somewhat over-medicated me in the ER (15 mg total of Morphine over about 2 hours, Toradol,  and then another 2mg of Dilaudid.  Which was technically a significant overdose) and knocked my respiratory drive partway out.  I didn't pass out until my O2 sats dropped to about 75%, and that wasn't enough to knock me all the way out, the alarms going off over my head (low o2, high heart rate, apnea) woke me right back up.....

Let's just say that I never want dilaudid again.....

I recently had a kidney stone attack also (wow, talk about pain!) and was given only dilauded (don't know how much) and it worked great for me. About 15 minutes and the pain was completely gone, with no significant side effects, other than a good buzz.
Perhaps your experience would have been better if you had only been given dilauded?
Unless you're just being sarcastic e.i., "I drank a fifth of whiskey then drank a beer and I got really sick. Shouldn't have had that beer!

[AmbulanceDriver]

Seargent Bob, the "normal" starting dose for dilaudid is in the 1.0 to 1.5 mg range.  That's for patients without any other narcotics on board.  By itself, the dilaudid was an overdose, and combined with the residual effects of the morphine, it knocked me for a loop.

[SomeKid]

AD,

Actually, the morphine was what knocked your resp system out of whack. One of the side-effects of morphine is reduced respiration.

I'll gladly take compressions only CPR.

Again, I agree. Some CPR beats no CPR.

[AmbulanceDriver]

Actually, that's a side effect for any (true, i.e. opioid) narcotic.  And dilaudid is a morphine derivative (hydromorphone).  So the combination definitely did me under....

But I was glad they didn't break out the narcan either.....

[Sergeant Bob]

Seargent Bob, the "normal" starting dose for dilaudid is in the 1.0 to 1.5 mg range.  That's for patients without any other narcotics on board.  By itself, the dilaudid was an overdose, and combined with the residual effects of the morphine, it knocked me for a loop.

Wow! Sounds like they did all they could to knock you off. Glad you're alright.