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CPR Not as Effective as Chest Compressions Alone

Zonk posted more than 7 years ago | from the use-the-compressions-luke dept.

Biotech 194

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.'"

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Wow (0, Flamebait)

stanmann (602645) | more than 7 years ago | (#18390247)

So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit.

DUH!

Re:Wow (4, Funny)

Philip K Dickhead (906971) | more than 7 years ago | (#18390301)

Good! There's soooo many more lives that I'd save, without the mouth part!

Re:Wow (2, Funny)

Seumas (6865) | more than 7 years ago | (#18390321)

Yeah. That was my first thought, too. Great way to get herpes or something. Gross.

Re:Wow (2, Funny)

Sponge Bath (413667) | more than 7 years ago | (#18390439)

There's soooo many more lives that I'd save...

Scenario: Darl McBride on the ground clutching his chest in pain.
Well? Your move. No lip locking required.

Re:Wow (3, Funny)

AuMatar (183847) | more than 7 years ago | (#18390507)

Kicking him while he's down is allowed, right?

Re:Wow (1)

Sponge Bath (413667) | more than 7 years ago | (#18390753)

Kicking him while he's down is allowed, right?

Hell yeah! But since it's St Patrick's day, you have to get drunk first.
Cheers!

Re:Wow (1)

arodland (127775) | more than 7 years ago | (#18391647)

Kick 'em when they're up
Kick 'em when they're down
Kick 'em when they're up
Kick 'em all 'round

Dirty little secrets
Dirty little lies
We've got our fingers in everybody's pies
We love to cut you down to size
We love dirty laundry!

Re:Wow (0)

Anonymous Coward | more than 7 years ago | (#18390983)

I save his life, but make him agree to a $699 "service contract" first.

Re:Wow (0)

Anonymous Coward | more than 7 years ago | (#18390991)

Save him, so that he can live to face federal pound-me-in-the-ass prison.

Re:Wow (1, Insightful)

arth1 (260657) | more than 7 years ago | (#18391617)

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.

Re:Wow (1)

Puff of Logic (895805) | more than 7 years ago | (#18391951)

This isn't true is many instances. While I don't know if it applies at a national level, I know that many states have "good samaritan" laws that provide a legal shield against being sued for rendering assistance in good faith. Such laws are there precisely due to the concern you detail: that no-one would render assistance for fear of litigation.

As far as doctors and nurses walking away, they'd better hope that no-one sees them do so. I recall from my Maryland EMT training that trained professionals (i.e. from EMTs all the way up to doctors) have a duty to render assistance in such situations. Indeed, I think it's far more reasonable to hold a doctor negligible for not rendering assistance since a duty of care exists by virtue of his profession. Of course, talk to me once I'm done with medical school and perhaps I'll have a somewhat less idealistic view, but I sure hope not.

Re:Wow (1)

cashman73 (855518) | more than 7 years ago | (#18392151)

Actually, the real reason a lot of people don't want to do mouth-to-mouth probably has more to do with not being certain if the person is HIV positive or not and the fear of potentially becoming infected should you perform mouth-to-mouth on them.

But the bottom line, if it comes down to doing CPR, the person's most likely going to die anyway. If you do see someone that looks like they're in cardiac arrest, you're first instinct should be to look for the automatic defibrillator device if one's available. CPR should be a last resort after that.

Re:Wow (1)

Moose,The (971845) | more than 7 years ago | (#18392213)

You may want to check your facts on HIV. The chances of spreading the virus via saliva alone are extremely slim.

Re:Wow (1)

cashman73 (855518) | more than 7 years ago | (#18392299)

True. But do you think most Americans know that? Most Americans can't even find Iraq on a globe! If you read my post again, you'll see I said they just feared catching HIV from it.

Re:Wow (1)

aveldina (938862) | more than 7 years ago | (#18390313)

If that person is in the state that they require CPR and their heart has failed then they are probably not breathing. You might want to consider reading the article again because it's pointing out that if one has to give CPR to a person with heart failure, it will be more effective if they concentrate on doing the chest compressions rather then also having to get air to person at the same time. (This makes sense after all.)

Re:Wow (0)

Anonymous Coward | more than 7 years ago | (#18390371)

This is very bad for geeks everywhere, now we shall all have to hope for a hot girl to be dared to kiss us, rather then hoping they need CPR when we are around, or by faking no breathing in front of a hot girl... This is very, very, very sad news.

Re:Wow (0)

Anonymous Coward | more than 7 years ago | (#18390423)

Two words for you, my friend: Al Cohol.

Wow, I have no reading comprehension (4, Informative)

pavon (30274) | more than 7 years ago | (#18390391)

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.

As a rescue technician (5, Funny)

Anonymous Coward | more than 7 years ago | (#18390527)

After each 1 minute of pumping someone's chest, i like to teabag the victim for about 30 seconds.

Re:As a rescue technician (4, Funny)

gardyloo (512791) | more than 7 years ago | (#18390803)

I think that, by definition, anyone even approached by you is a victim, whether their heart has stopped yet or not.

Re:Wow, I have no reading comprehension (3, Informative)

mgv (198488) | more than 7 years ago | (#18391919)

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

The reasoning is as follows:
1. You don't need much oxygen to stay alive
2. Chest compressions by themselves may cause some air to flow in and out.

As for how much oxygen you need:
At rest you consume about 250 ml/min of oxygen. In a cardiac arrest you probably could keep your heart and brain alive on half that as other organs can tolerate hypoxia for at least 30 minutes.

You have about 2.2 litres of air in your lungs if you breathe out passively. Of this 21% is oxygen, which means you have around 400 ml of oxygen in there. Even if you aren't moving 500 ml of air a minute in an out whilst jostling the person around doing chest compressions, you are probably moving enough to keep the person going for 10 minutes or so.

Of course, if you want to keep someone alive for a longer period of time then you really need to do full CPR. But your chance of survival goes down dramatically after about 10 minutes of CPR anyway.

At the end of the day, there are no technologies for keeping someone alive without a functioning heart (that can be done quickly enough to matter) to make CPR anything more than a stop gap.

Survival is dependent on fixing the underlying problem. The most common fixable problem is a heart attack where the person tries to die not from a large loss of heart muscle, but rather a smaller heart attack complicated by the sudden onset of a heart rhythm that is too fast or slow for the remaining muscle to work properly. This is essentially an electrical problem and the solutions that will fix it are electrical - Defibrillation or Pacing. CPR simply buys you time till this happens.

Michael

Re:Wow, I have no reading comprehension (1)

MichaelSmith (789609) | more than 7 years ago | (#18392057)

Thanks for posting. I learnt CPR at high school, 20-30 years ago. As I and the people I associate with increase in age the probability that I will have to give someone first aid is increasing, so its good to get up to date information.

What you say makes sense.

Re:Wow, I have no reading comprehension (1)

gwbennett (988163) | more than 7 years ago | (#18391957)

At 911, we do 400 compressions over the phone before the first set of 2 breaths, then 100 compressions in between breaths, except when the patient has been electrocuted, drowned, or is under 18. There are a few reasons for this, one that applies specifically in over the phone instruction is that it takes longer to explain where to put the hands and the more often/the sooner the caller has to leave that position to do something else, the more likely they are not to be as effective in subsequent pumping.

Not DUH (5, Insightful)

Mr. Underbridge (666784) | more than 7 years ago | (#18390407)

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.

mod parent up (2, Informative)

CrazyJim1 (809850) | more than 7 years ago | (#18390459)

He forgot to also mention its rare (if EVER!) that someone is breathing and their heart has stopped. Definately a not duh.

Re:Not DUH (0)

Anonymous Coward | more than 7 years ago | (#18391779)

"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."

And you overlook the fact that despite his hand-waving and joking statement, he ended up being more right than all those professionals and practicioners that have generally at least 7 years of medical to practioner based education. Oh, I guess if you call them professionals, they know what they are doing and are experts, right?

You know shit about what goes on in medical education. Little has to do with coming up with new things; the profession is mainly about learning about learning mass of material (rote), and getting it beat into you to do what is the accepted since usually doing something outside the norm harms people (another form of rote). You want to know why doctors are suckers to the pharm salesrep? Because they are too stupid to do the analysis themselves.

btw, yes, I do assert. For one, I went to medical school. For two, they've been practicing CPR a certain way for years...and WERE WRONG. You really don't get it do you? All they freaking had to do was check oxygen levels on blood cycling to central organs and systems and compare to known physiological data for failure, for starters. Fact is, no one really bothered to check what was best, otherwise it would have been revealed earlier, not after decades. This is basic science. Several elements in CPR, the two main ones being breaths and compressions. What happens if you do one or the other? Damn people, even the basic science people should be pissed; at the very least, one or the other should have been some of the basic variables (or glorified control, depending on how you approach things) in the experiments (i.e. do nothing (control), flip to back only, flip to stomach, breaths only, compressions only, breaths to compressions, etc.).

After all, they CAME UP with a breath:compression ratio in the first place and determined that, didn't they? Or was that also BS from these "professionals"?

A little reality please (2, Funny)

Simonetta (207550) | more than 7 years ago | (#18390937)

'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.

Re:Wow (0)

Anonymous Coward | more than 7 years ago | (#18391019)

So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit.

DUH!
Actually, you're not going to still be breathing if the heart has stopped.

The point here is that the partial pressure of oxygen in your lungs is far more than what you need to do adequate diffusion of the oxygen into the bloodstream, so you can go quite a long time on a single breath. (Think of those divers that stay underwater for a minute or more! And they're not even unconscious.) They're not saying that the breaths are useless, just that the person giving CPR has higher priorities. You'll notice that when the professionals arrive on the scene they have 2 people doing CPR, one on compressions and one bagging, so that compressions are continuous.

Actually... (5, Informative)

Rob Carr (780861) | more than 7 years ago | (#18391299)

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.

Re:Actually... (1)

AshtangiMan (684031) | more than 7 years ago | (#18391763)

I always thought that the compressions alone would cause some air exchange in the lungs, minute perhaps, but probably enough to sustain an unconcious person for several minutes without worrying about any kind of oxygen depravation. When I meditate I suspend breathing, and notice that if I do so without bearing down or cutting off the air flow it seems like the air exchange continues without any muscular action. Of course after a few minutes I have to breathe normally again. But this convinces me too that simply compressing someones chest will cause a breathing action.

Re:Wow (1)

rogue780 (1077155) | more than 7 years ago | (#18391115)

Just wanted to point out that if your heart has stopped beating it is impossible to breathe...so anyway what you said was kind of idiotic.

Re:Wow (1)

Tsu Dho Nimh (663417) | more than 7 years ago | (#18391269)

"So if the person is still breathing but their heart has stopped, rescue breaths provide no benefit. DUH!"

RTFA ... if they are NOT breathing, and had a cardiac arrest, DON'T WASTE TIME WITH THE RESCUE BREATHING! Just call for help and do the chest compressions. In an urban emergency, you can keep them going until the EMT's get there with the defib and O2.

Re:Wow (3, Interesting)

MikeyTheK (873329) | more than 7 years ago | (#18391447)

Um. I think you misunderstand the meaning of Cardiac Arrest, and I can tell you didn't RTFA. When an individual is in respiratory arrest such as when they are suffering from anaphylactic shock, they have stopped breathing, but their heart is still pumping. If they are in cardiac arrest then they have both stopped breathing and their heart is in an unsustainable rhythm, e.g. asystole (flatline), or ventricular fibrillation.

There is no such thing as cardiac arrest with continued respirations.

The study discusses many different reasons why lay persons should focus on chest compressions alone if a victim is in cardiac arrest. One of the most important reasons is that lay people avoid providing chest compressions (felt to be the most important part of CPR for the first few minutes) because they don't want to give rescue breaths.

The protocol for lay people has already been changed to reduce the number of rescue breaths given, and the duration at which they are given.

There are also contraindications to full rescue breaths for emergency responders, such as asthma-induced respiratory (and then later cardiac) arrest, COPD, etc. It was also noted by the study that "saves" (conversions, survivors, whatever you want to call them) tend to suffer from less brain damage if they are not given rescue breaths, but the mechanism for such a claim is unclear to me.

For the time being, professional rescuers will continue to follow the newest protocols for CPR, which involves chest compressions, rescue breaths via BVM or advanced airways (ET tubes), and AED application ASAP.

I'm not sure why this is even much of a topic for discussion anyway. AED is the tool that actually saves lives. CPR is generally not effective except in witnessed arrests, and even then the probability of a save is frequently low. Speaking from personal experience, I've performed CPR 20+ times, and have yet to get a save. Even though I get recertified every year, you should expect your experience to be about the same. You need paramedics with drug bags, and defibrillation, and you need them yesterday. The rest of us are just trying to buy time.

Re:Wow (1)

stanmann (602645) | more than 7 years ago | (#18391539)

Actually if you've had Red cross training, you'd know that cardiac arrest does NOT necessarily mean respiratory failure.

The Old way
1, check pulse.
2 check breathing
3 perform appropriate parts of CPR

New way
1 Check pulse
2. perform chest compressions

Re:Wow (1)

ampmouse (761827) | more than 7 years ago | (#18391999)

No, It's the other way around. Here are the old steps for Adult CPR:

1. Check Scene Safety
2. Obtain Concent/Check for Consciousness
3. Send someone to call 911, apply protection
4. Check for Breathing if not breathing continue else goto 16
5. Open airway and give Rescue Breath if success goto 8
6. Readjust airway and give Rescue Breath if success goto 8
7. Five Stomach Pumps, Sweep Throat with Index Finger, goto 5
8. Check for Pulse, if no pulse continue, else goto 12
9. Fifteen chest compressions
10. Open airway and give two breaths, goto 6 on failure
11. Repeat step 9 and 10 for about one minute, then goto 8
12. Give a slow breath
13. Count to five
14. Repeat steps 12 and 13 for about one minute
15. Check for breathing, if not breathing goto 8
16. Continue to monitor for changes, treat other issues, if not breathing goto 5

Changes:
Step 9 is now Thirty chest compressions
Steps 4-8 optional for untrained persons
Disclamer: IANAD (I am not a doctor or CPR trainer) this is not medical advice.

Re:Wow (1)

UncleTogie (1004853) | more than 7 years ago | (#18391773)

AED is the tool that actually saves lives.

While I was working at that medical facility, I took the opportunity to recertify with the office. We covered AEDs in addition to the normal compression/breathing routine. Someone mentioned only medical professionals get this training, and my card DOES say "Healthcare Professional" on it as well as specifically mentioning AEDs. Is the AED training available to the public yet, or will I lose my certification at some point? Anyone?

Red Cross Changes (5, Insightful)

dl107227 (632747) | more than 7 years ago | (#18390323)

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.

Re:Red Cross Changes (4, Informative)

Dunbal (464142) | more than 7 years ago | (#18390925)

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.

      Actually the real reason is that too many patients were surviving their airway obstruction only to die from intraabdominal bleeding due to lacerated livers and spleens. The average joe gets carried away in a panic situation and would put a bit too much energy into those abdominal thrusts. Chest compressions are approximately as effective, and reduce the risk of intraabdominal trauma. Plus as you say, it has the advantage of making this simpler for Joe. Cheers.

Re:Red Cross Changes (1)

Jack Taylor (829836) | more than 7 years ago | (#18391469)

I did a training course with the St. John's Ambulance in the UK back in May last year. The new guidelines had already come into effect then. The most interesting thing I found was that now the rescue breaths are now optional. Apparently, chest compressions are not only good at keeping the blood flowing round the body; the air that is displaced and replaced from the lungs by the action of the chest compressions alone is enough to have new oxygen enter the blood stream.

Of course, the best solution is to have one person do chest compressions and another do rescue breaths at the same time, as some others have mentioned already. Then you can swap over when one person gets tired - 100 compressions every minute is hard work! (Especially if the ambulance takes a long time to arrive...)

Re:Red Cross Changes (0)

Anonymous Coward | more than 7 years ago | (#18392275)

I *just* completed a Senior First Aid course today with Red Cross (Australia), and the recommendation now is 2 rescue breaths with 30 chest compressions, 3 cycles per minute (which is pretty damn fast).

The course this year was much simpler and easier than it was three years ago.

Before anyone comments on this article, they should go and redo a first aid course with their local Red Cross or equivalent organisation!

Very old news (1)

brian0918 (638904) | more than 7 years ago | (#18390327)

I read about this back in November [eurekalert.org] , and it was known even in 2005 [eurekalert.org] . How many people's lives were affected in the interim due to slow news sources?

Re:Very old news (1)

j-pimp (177072) | more than 7 years ago | (#18390695)

I read about this back in November [eurekalert.org] , and it was known even in 2005 [eurekalert.org] . How many people's lives were affected in the interim due to slow news sources?


Did you ever think the red cross was deciding whether or not this study had merit. The people that take CPR have a minimal of medical training. Literally, a couple of hours. They,including myself, should probably due as their training said and stick to the 15 to 1 comporession to breathing ratio or the 30 to 1 that apparently is taught these days. 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.

Re:Very old news (3, Insightful)

Dunbal (464142) | more than 7 years ago | (#18390895)

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.

Re:Very old news (1)

Firethorn (177587) | more than 7 years ago | (#18391053)

I think that the expiration date on the CPR cards is more to protect the Red Cross than to protect the performer.

Most areas have good samaritan laws that protect you even if you do something wrong, as you're the best resource available. IE even though I'm current on my CPR, it's still only a two hour class held once every year or so. I might forget something, I almost certainly won't have as good of a technique as a paramedic would. But if I'm doing it, it's because a paramed isn't available. If my CPR training has expired because my employer doesn't cover it and I forgot, it's likely my older technique is still better than nothing. This holds true through any form of emergency first aid.

Heck, there's the possibility that I'll simply forget the new 30:2 ratio in favor of the 15:2 ratio because that's what I learned in the eight or so classes before the new one.

Re:Very old news (1)

Joebert (946227) | more than 7 years ago | (#18391077)

If you don't stay current and perform an inadequate CPR technique

Maam, my certification expired last year & they've updated the technique, I could actually end up killing your husband.

*SLAP*

Sorry maam, don't know what I was thinking.
one 1000, two...

Ventilation still valid, I think.... ? (5, Interesting)

bananaendian (928499) | more than 7 years ago | (#18390355)

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?

Re:Ventilation still valid, I think.... ? (1)

MyLongNickName (822545) | more than 7 years ago | (#18390409)

There is still several minutes worth of oxygen supply in the blood. CPR is a stopgap method. If you are just trying to keep someone alive for a few minutes until the ambulance arrives, then simply circulating the blood is enough. I agree, however, that getting more oxygen into the blood is going to be helpful if you have to keep the person going for a more extended period.

In addition (1)

pavon (30274) | more than 7 years ago | (#18390437)

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.

Re:Ventilation still valid, I think.... ? (1)

Atlantis-Rising (857278) | more than 7 years ago | (#18390415)

IANAMP (Medical Professional) but presumably the chest-compressions function similarly to the iron lung, forcing air into and out of the lungs via pressure differentials?

Re:Ventilation still valid, I think.... ? (2, Interesting)

Wudbaer (48473) | more than 7 years ago | (#18390799)

No. There might be a slight effect like that, but for air circulation and oxygenation you do the mouth-to-mouth part. The compressions are used to manually provide some kind of heart function by compressing and releasing the heart muscle indirectly through chest compressions, thus keeping some basic blood circulation going to oxygenize the brain and other vital organs (one can also compress the heart directly, but this for obvious reasons is normally only used in an OR setting, never try this at home, kids, even if you got Mom's new bread knife handy !). The idea is the same like those bellows you use for pumping up kids' rubber boats (very very simplified). (IAAMDBTEIIDCN (I am an MD by training even if I do computers now)).

Re:Ventilation still valid, I think.... ? (2, Informative)

mgv (198488) | more than 7 years ago | (#18392073)

There might be a slight effect like that, but for air circulation and oxygenation you do the mouth-to-mouth part. The compressions are used to manually provide some kind of heart function by compressing and releasing the heart muscle indirectly through chest compressions, thus keeping some basic blood circulation going to oxygenize the brain and other vital organs (one can also compress the heart directly, but this for obvious reasons is normally only used in an OR setting, never try this at home, kids, even if you got Mom's new bread knife handy !).

Its actually quite substantial if the chest compressions are done properly. You can get a blood pressure of 120/80 (measured directly on an arterial pressure line) with CPR (+ adrenaline to vasoconstrict although endogenous adrenaline may well keep the BP up much the same). In the process of restoring a normal blood pressure, you will shift a fair bit of gas. However, I have observed this mainly in people who have an endo-tracheal tube in place, as its hard to measure otherwise. In the absence of this the airway may well obstruct such that no gas exchange may occur. Although if you are doing good CPR the brainstem will probably have some function and the airway may have some patency, depending on the individual.

Anyway, I can see the rationale for leaving out the expired air ventilation, but it would probably only be good for a short resusicitation. As I have posted earlier, they are the ones that you will probably be able to save anyway.

Michael

Re:Ventilation still valid, I think.... ? (1)

dsanfte (443781) | more than 7 years ago | (#18390417)

Can't you just ventilate by gently compressing the diaphragm anyways? People who are unconcious don't need a huge volume of oxygen to survive. Watch your breathing as you're falling asleep sometime. It's extremely shallow, or at least is for me, but I run a lot.

Re:Ventilation still valid, I think.... ? (1)

dl107227 (632747) | more than 7 years ago | (#18390515)

The point of this may be that the first people to respond to heart attack victim are those who are not first responders or medical professionals. Those who are casually trained in CPR (such as myself and many other people who get a yearly refresher course) are often those who start CPR. We may not have the experience to know if rescue breaths are effective. Since blood circulation seems to be the most important it makes sense to abandon ventillation until medical help arrives.

Re:Ventilation still valid, I think.... ? (2, Insightful)

sherrysj (1077163) | more than 7 years ago | (#18391305)

> 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!

Re:Ventilation still valid, I think.... ? (0)

Anonymous Coward | more than 7 years ago | (#18392211)

As intelligent that post was, you spelled 'lose' wrong. May want to get that right.

Re:Ventilation still valid, I think.... ? (1)

Tsu Dho Nimh (663417) | more than 7 years ago | (#18391323)

"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?"

The chest compressions are only intended to keep the person going until the ambulance Apparently the residual O2 in the blood is enough. When the pros get there, they have pure O2, ventilator bags, defibrillators and all sorts of nifty equipment.

But without the mouth-to-mouth... (1)

gsonic (885510) | more than 7 years ago | (#18390365)

What would be the point of having a hot lifeguard give you CPR? ;-)

BLS course (1)

p51d007 (656414) | more than 7 years ago | (#18390393)

Last time I took an ARC BLS course, 2 years ago, they were mentioning that they might be changing their procedures. Looks like the rescue breathing isn't that important as it once was. If you think about it, kind of makes sense. The blood cells already have "some" oxygen, so keeping blood flow to the brain sounds like a good idea, as long as you get their heart started again. I know a lot of police cars, buses, wreckers, utility trucks are starting to carry on board AED's, but it's a shame more people don't take at least a BLS course.

Nonsense. Being obese is the key! (1)

ScentCone (795499) | more than 7 years ago | (#18390425)

If you really want to survive in emergency situations, just be wide enough [itv.com] to float.

well (2, Insightful)

mastershake_phd (1050150) | more than 7 years ago | (#18390435)

What if one person gave chest compressions while another gave mouth to mouth.

Re:well (1)

cheater512 (783349) | more than 7 years ago | (#18390761)

Then they'd be getting too much air. AFAIK someone doesnt need *that* much breathing.
Its probably better just to take turns doing the compressions since it gets tiring.

Re:well (1, Informative)

Anonymous Coward | more than 7 years ago | (#18391003)

I've been a life saver for many years. This year we changed our training to reflect the same idea. The reasoning behind it is that 15 compressions was not enough time to raise the blood pressure to a stable level and allow it to deliver oxygen into the body (the lack of which causes the brain damage over prolonged resuscitation attempts).

The new 30 compressions maintain blood pressure and allows proper delivery of the oxygen. Two exhaled breaths contain over twice the oxygen required during inhalation and the improvised circulatory drive (eg compressions) lowers the amount required due to it's inefficiency (compared to the norm).

Re:well (1)

Nymz (905908) | more than 7 years ago | (#18391327)

What if one person gave chest compressions while another gave mouth to mouth.

If you have two people then one person continues non-stop on compressions, while the second does breaths and monitors for breathing and pulse.

Re:well (1)

Tsu Dho Nimh (663417) | more than 7 years ago | (#18391333)

What if one person gave chest compressions while another gave mouth to mouth.

That's the 2-rescuer approach ... the tricky part is the timing so the one doing the compressions doesn't have to stop for long whil you give 2 short blasts of air.

Thanks slash (0, Offtopic)

LiquidCoooled (634315) | more than 7 years ago | (#18390451)

This is the first article which has had me think about my breathing.

I thought I was immune to the old trolls.

Do it right! (0, Troll)

Aladrin (926209) | more than 7 years ago | (#18390465)

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.

Re:Do it right! (1, Informative)

Anonymous Coward | more than 7 years ago | (#18390569)

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.

"As two-person CPR requires a degree of synchronized technique, it is usually more effective for first aid providers to perform individual CPR, and change operators after ten minutes or so." - http://www.fortunecity.com/campus/springbank/973/f irstaid/cpr.htm [fortunecity.com]

Re:Do it right! (1)

Dunbal (464142) | more than 7 years ago | (#18390845)

and change operators after ten minutes or so

      I take my hat off to anyone who can do effective chest compressions for 10 minutes. If you have the manpower you want to be swapping much sooner than that.

recent red cross cpr guidelines have improved (4, Informative)

MORTAR_COMBAT! (589963) | more than 7 years ago | (#18390471)

a recent refresher course has really stressed chest compressions over air as well. 30 compressions per two breaths.

Now they tell us. (0)

Anonymous Coward | more than 7 years ago | (#18390497)

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.'

http://www.huffingtonpost.com/huff-wires/20070312/ elder-bush-collapses [huffingtonpost.com]

Most effective *for cardiac arrest* (4, Insightful)

6350' (936630) | more than 7 years ago | (#18390513)

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.

Re:Most effective *for cardiac arrest* (1)

Dunbal (464142) | more than 7 years ago | (#18390831)

in this case, a combo is the safe approach that covers the most bases.


    No - that's the whole point. A "combo" does worse than chest compressions alone because you are a) ventilating a corpse and b) not generating enough circulation. The layman will only do chest compressions if there is no pulse. A and B come first. You can ventilate a pulseless patient all day and I swear you're not going to get him back no matter WHAT the cause. More chest compressions, less ventilation.

Re:Most effective *for cardiac arrest* (1)

6350' (936630) | more than 7 years ago | (#18391107)

Double "No", double "That's the whole point" :P

If the rescuer is certain that the rescue-ee is suffering from cardiac arrest, then yes: skip the ventilation. However, the layperson may not always be able to determine if the victim is suffering from cardiac arrest vs. respiratory failure. In this case, the caveat, again, is that for those who don't know, the "combo" is the safe choice.

Envision a messy scene in the middle of the highway, with rain beating down, sirens blaring in the distance, and noisey intrusive confusion all around: the average Joe (like me) would quite possibly have extreme difficulty identifying if the victim is borderline slipping away from respiratory failure, or instead suffering from cardiac arrest - ie, has no pulse or a faint on-deaths-door pulse. In these real-world situations, the layperson might definitely feel safest sticking with a combo that covers the most bases.

In some cases mouth-to-mouth is MANDATORY! (0)

Anonymous Coward | more than 7 years ago | (#18390539)

If I'm trying to revive one of these fine folks [frenchmaidtv.com] , I'm going to perform the chest compressions without skipping the mouth-to-mouth!
I will now volunteer to help them revise their video...

When to give breaths (5, Informative)

coleopterana (932651) | more than 7 years ago | (#18390551)

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.

Re:When to give breaths (1)

flyingfsck (986395) | more than 7 years ago | (#18390869)

My experience with cardiac arrest is that the victim will gasp for air as soon as blood flow is re-established. So just focusing on compressions is probably good enough for people collapsing on dry land - they will breathe on their own every once in a while. Drowning is different - you have to get air in and water out and usually drowning victims are young and have good hearts - old people don't usually go swimming.

Re:When to give breaths (1)

coleopterana (932651) | more than 7 years ago | (#18390939)

I wish! Every person I ever pulled out of a YMCA pool had at LEAST 65 years to their name! Water helps joints and improves mobility while decreasing pain (such as from arthritis) (to get offtopic here) so I've generally seen quite a majority of the elderly in pools when working there. Every age group has their own risks, though.

Terrible News (5, Funny)

iamdrscience (541136) | more than 7 years ago | (#18390699)

Could this be the end of being able to trick hot teenage lifeguards into making out with you?

still give mouth-to-mouth but with protection! (4, Informative)

thschmid (102849) | more than 7 years ago | (#18390727)

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!

CPR Robot (4, Interesting)

superid (46543) | more than 7 years ago | (#18390735)

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 [zoll.com]

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 :(

CPR timing. (4, Informative)

Werkhaus (549466) | more than 7 years ago | (#18390741)

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 [youtube.com]
you'll even get the 100bpm about right.

CPR (4, Informative)

dcemt (467776) | more than 7 years ago | (#18390755)

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.

This has been known for some time (2, Insightful)

greg_barton (5551) | more than 7 years ago | (#18390785)

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.

Heart failure = erratic breathing (4, Insightful)

flyingfsck (986395) | more than 7 years ago | (#18390815)

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.

CPR success rates can't get much worse (1)

freeweed (309734) | more than 7 years ago | (#18390919)

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 ;)

Re:CPR success rates can't get much worse (1)

maxume (22995) | more than 7 years ago | (#18391173)

I think maybe the best way to look at it is that it doesn't hurt the people that are already dead.

Re:CPR success rates can't get much worse (0)

Anonymous Coward | more than 7 years ago | (#18391361)

You're one cynical bastard aren't you? Should people who know CPR just stand there when someone is flailing on the ground in cardiac arrest, thinking "well on 3% of people given CPR survive, so I might as well just not bother"?

Re:CPR success rates can't get much worse (1)

tjasond (680156) | more than 7 years ago | (#18391521)

"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."

Couldn't agree more, and to add to that I think TV shoes and movies do an even greater disservice - anytime someone is unconscious in a scene, they immediately go for the chest compressions, often without even checking the vital signs first (pulse and breaths), and the victim magically gains conciousness. I think that this goes beyond misinformation and has potential to actually risk lives; in reality, if you're doing chest compressions (or just breaths for that matter), the victim is most often not going to regain conciousness very quickly, if at all. If it's only breaths that are required (they have a pulse), then there may be a chance, but by no means should one expect a victim to magically come to conciousness within minutes, let alone before emergency personel arrive, like the televison and movies would have you believe.

In contrast to what should be done, even if done slightly incorrectly (but correct enough to keep someone alive until emergency workers arrive), Hollywood would lead the average untrained person to believe that in most cases, simply pounding on someone's chest should do the trick within seconds, regardless of what their vital signs may be.

Re:CPR success rates can't get much worse (0)

Anonymous Coward | more than 7 years ago | (#18391607)

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".

I agree with this for many measures, but CPR seems to be worth it. It takes me a one-day refresher course every two years - about 0.2% of my productive time. Say that you train about 5% of the population - you're using 0.01% of their productivity.

300,000 Americans per year is about 0.1% of the population. 3% of them are saved by CPR, or 0.003% of the population. If a saved individual, on average, lives another 20 years, you've saved the equivalent of 0.06% of the population for one year, at the cost of (from the previous paragraph) 0.01% of the population's productivity.

Obviously, these numbers are pretty crude - but at a first glance, it looks like CPR is useful enough to pay for itself.

Re:CPR success rates can't get much worse (1)

flyingfsck (986395) | more than 7 years ago | (#18391687)

Hmm, well, I have done it once and it worked - so 100% success rate in my experience...

CPR classes already say the same (1)

Dr. Cogent (1017990) | more than 7 years ago | (#18391151)

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.

Chest compression causes air movement... (2, Interesting)

MMC Monster (602931) | more than 7 years ago | (#18391295)

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.

Re:Chest compression causes air movement... (1)

reddn (910451) | more than 7 years ago | (#18391421)

yes, proper chest compressions could cause air movement, might i re affirm COULD. Now, how could it cause air movement, because you are not only compressing the sternum, but bending the anterior ribs(that 'was' attached to the sternum, before you broke it) down, causing a slight compression of the thoracic cavity, which when you compress that you are causing a positive pressure in the lungs, which once you recoil the compression, the ribs return to where they started(less the fractured sternum) which causes negitive pressure in the lungs, causing air to come in. BUT, more so of the reason they removed ventilations from the normal 'lay person' is for two reasons: 1, people might discouraged by the complete cpr process, more so they kiss of life(mouth to mouth resusitation) 2, in the majority of cardiac arrest in adults its not the problem of the lungs oxygenating the blood, its the person/patient had a heart attack, and part of the heart is becoming ichemic and irritated, which could cause the hard(in the lesser of the actual process) to go into a(n) irregular or absent heart rhythem(it usually stays in a vfib, vtach rhythem until it uses up all of the oxygen and atp in the heart), now, you must remember, the heart can not get its oxygen/atp(energy) from the blood inside of its chambers, but the vessels on its exterior(coronary arteries), so you have oxygenated blood, with atp in it, inside of the heart, but the heart can't use it, because it needs to be pumped out of the heart, to the aorta, where the coronary arteries are connected, then the heart could have a chance, so, i must not say that i apologize but i did not read most of these comments, this might have already been posted, but here it is again further more, revivant (a part of zoll) has a cpr machine out, called the 'auto pulse', instead of using cpr(pushing on the chest, with a palm) it is a flat board that as a compression strap, that encompasses the patient, and actually squeezes the chest to compress the heart. i can go on and on about the multitude of studies on the subject, email me if you would like some more -thomas

O2 (1)

PhotoGuy (189467) | more than 7 years ago | (#18391399)

Wouldn't the act of compressing the chest, also compress the lungs, causing a bit of fresh air flow in and out of them?

I teach CPR (5, Informative)

doit3d (936293) | more than 7 years ago | (#18391475)

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.

so.. (0)

Anonymous Coward | more than 7 years ago | (#18391707)

..my dreams of rescuing and saving a hot babe on the beach using "mouth to mouth" are out the window?? *sniff*

From my CPR course (3, Informative)

spaceyhackerlady (462530) | more than 7 years ago | (#18391937)

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

A couple comments on the study (5, Informative)

Masaq (732641) | more than 7 years ago | (#18391995)

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.

Re:A couple comments on the study - MOD UP (1)

erbmjw (903229) | more than 7 years ago | (#18392165)

Thank you for RTFA and commenting from a professional point of view.
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