A lot of hoo-ha in the press over this in the last few days. There is a lot of evidence - of varying levels of quality it must be said - that suggests that doing chest compressions alone is better than alternating between chest compressions and ventilation (rescue breaths to you and me) at the current rate of 30:2.
The thinking is that there is enough oxygen in your lungs and in your system to sustain you if adequate mechanical compression of the heart takes place (i.e. chest compressions): well, certainly for the first six or seven minutes.
An American group published a position paper (expert opinion, NOT new research) that appears in the journal Circulation, and this has prompted a response from the UK and European Resuscitation Councils (see links below). For the time being, the status quo is being maintained:
If you have no idea how to do CPR and someone collapses in front of you in the street, CALL AN AMBULANCE NOW. The experienced and calm operative at the end of the phone will likely instruct you how to determine whether the patient is breathing or not, and will then tell you to perform chest compression-only CPR. We do recognise that laying your lips on some dodgy looking old man in the street is not your idea of a good time, and also that you will not be able to do it well for the first time in a real life-or-death situation. In truth, most trained medics don’t do a stunningly good job at rescue breathing either. So, do compressions only. They are far more important than ventilations, and far easier to do. Continue this until you are relieved by the paramedics. WARNING: it is extremely hard work, get someone to take over from you after a couple of minutes if you can or the quality of your compressions will deteriorate rapidly.
Times when it is still (probably) better to combine compressions with ventilations are: unwitnessed arrests (you find someone and have no idea how long they have been not breathing for and, as such, they have a more urgent need for oxygen); children (in adults, it is usually that the heart stops, and the breathing stops secondary to this, but in children primary breathing problems are the usual cause of collapse and subsequent cardiac arrest); drowning (again, a primary breathing problem).
Trained rescuers and in-hospital CPR will still combine compressions and ventilations. For now…
Some things to chew on:
1) Survival rates from CPR are largely unchanged in the 40 years that we have been using these techniques. Only with recent research may this begin to change.
2) If you have a cardiac arrest out of hospital, your chance of surviving is around 1 in 50 (2%). In hospital it is still only in the order of 15%. YOU CAN DO SOMETHING TO IMPROVE THESE ODDS:
3) DOING SOMETHING IS BETTER THAN DOING NOTHING. Please, call the ambulance early, start chest compressions early. Survival relies on early intervention.
Many public areas now have automated debrillators. These are machines than can be operated by members of the public who have had just basic training (for example, nominated persons in shopping centres or train stations), and allow electrical shocks to be given to patients far more quickly. Such devices will save lives.
Some links:
The statement in Circulation journal: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380v1
The official response from Resuscitation Council (UK): http://www.resus.org.uk/pages/compCPRs.htm
Basic Life Support and Automated External Defibrillation:
http://www.hmc.org.qa/qmj/nov2005/images/pg4_imga.jpg (BLS sequence)
I also found an excellent site from a course run from the University of Birmingham: NOTE THIS COURSE IS NOT AVAILABLE TO THE PUBLIC, BUT THE WEBSITE IS FREELY AVAILABLE AND HAS EXCELLENT INSTRUCTIONS AND PHOTOS DEMONSTRATING THE RELEVANT SKILLS. www.rmdbirmingham.org
Resuscitation Courses:
www.lifesavers.org.uk (Royal Life Saving Society)
www.sja.org.uk (St John’s Ambulance)
www.redcross.org.uk (Red Cross)
There is a ‘Chain of Survival’, which summises that EARLY intervention at a number of stages is required for survival from cardiac arrest: http://kingmagic.files.wordpress.com/2007/01/chain.jpg
And a song, of course:
Have been singing loudly, and unashamedly tunelessly, in the car to ‘She Makes my Day’ by Robert Palmer. And all the rest don’t bother me…
Well, except one thing. If anyone knows how I can get my links to open in a new page, please leave a comment and let me know.
Posted in Resuscitation | Tagged CPR, Resuscitation | No Comments »
