no more kiss of life

[Rad]

No mouth-to-mouth required in new CPR rules.

 

.............

 

A close friend of mine did CPR, with breathing, on a drowning victim for 45 minutes until paramedics arrived. The man never revived. It was a disturbing experience, with unearthly gurgling sounds from dead lungs and a crowd of family and relatives looking on. It could easily have been me in his shoes given the situation near the camp where we were working.

 

............. Article below:

 

Just press on the chest of adult victims till help arrives, heart group urges.

 

In a major change, the American Heart Association said Monday that hands-only CPR — rapid, deep presses on the victim’s chest until help arrives — works just as well as standard CPR for sudden cardiac arrest in adults.

 

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

 

 

“You only have to do two things. Call 911 and push hard and fast on the middle of the person’s chest,” said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

 

Hands-only CPR calls for uninterrupted chest presses — 100 a minute — until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

 

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest — the heart suddenly stops — which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.

 

A child who collapses is more likely to primarily have breathing problems — and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

 

'Better than nothing' But in either case, “Something is better than nothing,” Sayre said.

 

The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those “unable or unwilling” to do the breaths could do presses alone.

 

Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it. Hands-only CPR

The American Heart Association says bystanders who witness an adult's* sudden cardiac arrest can opt to perform hands-only CPR and skip mouth-to-mouth breathing. If someone collapses, stops normal breathing and is unresponsive to shaking:

 

First, have someone call 911, or call yourself.

 

Put the victim on the floor, face up.

 

Put one hand on top of the other in the middle of the victim's chest.

 

Push hard and fast, 100 presses a minute.

 

If there's another bystander, take turns.

 

Continue until paramedics take over.

 

Use an automated external defibrillator if available.

 

* Children and drowning victims still need mouth-to-mouth.

 

 

Source: University of Arizona Sarver Heart Center

 

 

Sayre said the association took the unusual step of making the changes now — the next update wasn’t due until 2010 — because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.

 

An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get hands-only CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.

 

Dr. Gordon Ewy, who’s been pushing for hands-only CPR for 15 years, said he was “dancing in the streets” over the heart association’s change even though he doesn’t think it goes far enough. Ewy (pronounced AY-vee) is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.

 

Ewy said there’s no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths — 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.

 

Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.

 

“When people are honest, they’re not going to do it,” he said. “It’s not only the yuck factor.”

 

In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.

 

Easier and more reliable

“They love it. It’s less complicated and the outcomes are better,” said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.

 

One person who’s been spreading the word about hands-only CPR is Temecula, Calif., chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California

 

Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad’s 15-year-old son Josh called 911 in the meantime.

 

Hjelmstad said he pumped on Goodall’s chest for more than 12 minutes — encouraged by Goodall’s intermittent gasps — until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.

 

On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.

 

“After this whole thing happened, I was on cloud nine,” said Hjelmstad. “I was just fortunate enough to be there.”

 

Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there’d been no hint that he had clogged heart arteries.

 

“I was lucky,” he said. Had the situation been reversed, “I wouldn’t have known what to do.”

 

“It’s a second lease on life,” he added.

 

[Norman_Clyde]

This is a fascinating change in our understanding of how CPR saves lives. A few more details are worth knowing:

 

In the case of adults with cardiac arrest, the organ that most needs to maintain circulation in the first critical minutes is not the brain, but the heart. Oxygen utilization by other tissues drops to a relative minimum--but the heart, though not "beating" per se, is most often in ventricular fibrillation, which means that the muscle fibers are contracting away in an ucoordinated fashion; thus the heart's oxygen demand in the average sudden death patient actually goes up at time of arrest.

 

Chest compressions do not immediately produce a functional blood pressure. It takes something like 10 to 20 compressions before the blood pressure is high enough to lead to coronary artery (i.e. heart muscle) perfusion. Whenever chest compression is interrupted-- say to give artificial respiration in the field, or even to check the heart rhythm in an emergency department setting--coronary perfusion is halted, and it will take extra compressions to get it started again.

 

Effective chest compressions without breathing will not keep the entire body alive for prolonged periods. However, they appear to be the best way to keep the heart alive until a defibrillator can be applied to the patient to (one hopes)restore a perfusing rhythm. Because an adequately perfused heart has a greater chance than a compromised heart of returning to normal sinus rhythm after defibrillation, no-breath CPR makes the heart better able to defibrillate, which saves lives.

 

[The above is a paraphrasing of my latest ACLS course and has not been vetted for perfect accuracy.]

[dmuja]

 

 

They can have my mouth to mouth when they pry it from my cold dead lips...

[marylou]

So Mr. Clyde, great info on a domestic situation. That and the above is really promising. Chest compressions are easy as hell, even if the ick factor is not so bad....

 

In the backcountry, is there really anything we can do except make our climbing partner feel comfortable in a similar situation?

[dmuja]

 

 

I also have maybe another (but related) question(s)...

 

Can chest compressions help to restart a heart that is in ventricular fibrillation or cardiac arrest?

 

In a remote setting where help is hours/days away, what is the benefit of chest compressions on lets say a "fall victim" whos heart is in ventricular fibrillation or cardiac arrest? Could the heart restart on its own?

[Dechristo]

 

A close friend of mine did CPR, with breathing, on a drowning victim for 45 minutes until paramedics arrived. The man never revived. It was a disturbing experience, with unearthly gurgling sounds from dead lungs and a crowd of family and relatives looking on.

 

I had a very similar experience, but the pt was a newborn.

 

Good info.

[Doug]

It is fascinating to know that I can probably remove that extra couple of ounces of mouthshield out of my first aid kit now. It has long been my understanding that in the backcountry its a let your conscience be your guide regarding CPR. Fact is if the PT doesn't revive within 15 - 20 minutes the prognosis is grim even if ALS shows up. In the backcountry that usually means a helo.

 

We had a situation on Mailbox (hardly "backcountry") about 5 years ago where a guy went into cardiac arrest and his hiking partner gave him CPR for something along the line of 90 minutes. A helo from NAS Whidbey was able to get there by then but taht was only to assist in the recovery of the subject's body. I really felt for the guy who gave it his all for 90 minutes against all hope.

[Off_White]

Doug, it was probably better for the guy to make the effort and have it not work out than to just give up and feel guilty over whether you should have tried.

[G-spotter]

That CPR is now done without mouth to mouth was news last year. Just take your refresher?

[Doug]

Its just that we wanted to try the new method on Canadians before using it here. I guess it must be news to you that you are our lab rats!!!

 

My refresher comes up this year.

 

OW, I commend the guy and find no fault in it. I would have done the same.

[robpatterson5]

As I remember it the backcountry standard is 30 minuets then stop, as thats on the far side of statistically survivable and most people who will revive from chest compressions will do so in that time. Obviously you do what you can beyond the minimum, or what you feel that you have to do. Also if you know that the defib is 15 minuets away at that point, lol, I'd keep going.

 

When I did my training the instructor recommended walloping the victim in the heart two-handed, esp. for lightning strike victims. Aperintly, it compresses the muscle tissue and creates a small electric current - so sometimes a really hard hit there can restart the heart if all it needs is a kickstart. Pretty desperate, but so is having a heart attack in the backcountry; Or getting first aid advice online!

Edited April 1, 2008 by robpatterson5

[dmuja]

 

So, I know there are doctors who frequent this site, (don't mean to whip a dead... nevermind) my question isn't so much about "how long" to continue chest compressions, but more precisely, what are the actual benefits of compressions in the FAR back country (say remote BC or AK or China or Tibet) to a patient in ventricular fibrillation or cardiac arrest?

 

I know that cc assists in blood/O2 circulation (thus staving off possible brain damage for a time) and according to Mr Clyde specifically "coronary artery (i.e. heart muscle) perfusion" thus staving off heart muscle damage due to lack of blood/O2. But the question I am asking is more about re-starting a heart and will chest compressions POSSIBLY lead to this outcome (a heart re-starting) WITHOUT the assistance of electrical shock/de-fib devices.

 

btw, 30 mins is what I have been taught in my firstaid/cpr coarses every 2 years.

[Clarence]

what are the actual benefits of compressions in the FAR back country (say remote BC or AK or China or Tibet) to a patient in ventricular fibrillation or cardiac arrest?

 

will chest compressions POSSIBLY lead to this outcome (a heart re-starting) WITHOUT the assistance of electrical shock/de-fib devices.

 

I just had MOFA training this weekend with the Everett Mounties, Red Cross and SAR folks. They were saying that Even in the near backcountry the chance of CPR working for a cardiac arrest is slim to none...

 

The SAR folks said that the biggest benefit of CPR is to ease your own mind (and the minds of the victims relatives) after the fact, knowing that you at least tried.

However, CPR is apparently very effective in near drowning cases.

[alpineyeti]

That CPR is now done without mouth to mouth was news last year. Just take your refresher?

 

Hmmm, just took my refesher a month or so ago and this was not mentioned at all... Refresher course was put on by American Red Cross..... Just when I thought I was getting up to date info....

Edited April 1, 2008 by alpineyeti

[NateF]

just to restate what the article says: perfom rescue breathing in cases of drowning, the new recommendation applies only to adult cardiac victims. i wonder how much the "ick factor" played into the change.

 

i've also heard of anecdotal cases of chest thumps restoring normal rhythm. based on that and norman's information, maybe the best thing for a cardiac victim would be a few quick hard thumps, then chest compressions for some amount of time, eventually adding ventilation to reoxygenate the blood. how long can you do compressions before you're just pumping oxygen depleted blood around in a circle? anyone know?

 

my guess is that they don't bother complicating standard protocol by recommending this because the assumption is that ALS is nearby, or the answer to the above question is "a long long time". But it may be helpful information in cases where ALS is, say 30-60min out?

 

 

Edited April 1, 2008 by NateF

[tanstaafl]

If your course was from the Red Cross, it's not too surprising that it wouldn't use new American Heart Association guidelines. Even the conventional CPR is taught slightly differently by the two agencies.

 

Note that hands-only CPR is recommended only in cases of *witnessed* collapse of an adult. Children, infants, and adults you didn't actually see keel over still get conventional CPR.

 

 

[Pandora]

This research makes clear that chest compressions are the most important component of CPR and are more effective when done properly. The instructors for the EMT course I just finished placed great emphasis on doing them perfectly. The key is to make sure you take all your weight off the chest between presses so the heart has time to refill. If you are doing them properly, chest compressions are not "easy as hell"; you will get tired and begin to unconsciously lean on the patient. Rotate every few minutes with another rescuer if at all possible.

[rbw1966]

Chest thumps should only be given to someone you actually witness going into cardiac arrest. I know of at least one occasion when a patient was complaining of chest pain and was hooked up to a defbrillator and started to be packaged up when she went into cardiac arrest. A direct thump brought her out of cardiac arrest briefly then she went back into cardiac arrest. A second thump brought her back and they administered IV meds which stabilized her. She did not end up needing a shock.

 

Her words after being thumped the first time "why did you hit me?"

[sklag]

ah, the good ole precordial wallup! It was a Wham, Bam, Thank you ma'am ,er sir, situation.

[Norman_Clyde]

what are the actual benefits of compressions in the FAR back country (say remote BC or AK or China or Tibet) to a patient in ventricular fibrillation or cardiac arrest?

 

will chest compressions POSSIBLY lead to this outcome (a heart re-starting) WITHOUT the assistance of electrical shock/de-fib devices.

Benefits are probably zero, because the heart does not restart itself on its own. Heart muscle fibers have a natural rhythm that is built in and, under normal conditions, happens automatically. In the most common cardiac arrest scenario, namely ventricular fibrillation, the heart muscle fibers are not "stopped", but each is contracting independently of the others a totally chaotic fashion, meaning the heart is not beating. Strangely enough, defibrillation works by stopping the heart, which can then return to a normal coordinated rhythm.

[Norman_Clyde]

The key is to make sure you take all your weight off the chest between presses so the heart has time to refill. If you are doing them properly, chest compressions are not "easy as hell"; you will get tired and begin to unconsciously lean on the patient. Rotate every few minutes with another rescuer if at all possible.

This is true. Also, it saves effort if you keep your elbows locked and use your weight to generate the compression.