Hands only CPR recognized by AHA

[juno]

It does not apply to near drowning or similar situations, but there are a lot of people who collapse out of the water.

http://www.foxnews.com/story/0,2933,344212,00.html

You can skip the mouth-to-mouth breathing and just press on the chest to save a life. 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.

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.

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 outside hospitals or in emergency rooms. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get 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.

"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.

[stallbaum]

200 in 2 minutes compressions. than give a few breaths. Remember to check for a pulse. If an adult has a pulse they dont need compressions even if there not breathing they need breaths at 20 a minute.AED dont always indicate a shock so be prepared to go the distance. If you have an 02 kit use it too.

[patrick]

the aha quit using a pulse check. they just assume take the operator error out of the equation, and chest compressions, done properly, wont kill anyone. i can check my pulse just by holding my right thumb and forefinger together.. so theoretically in an emergency, i could be checking my own pulse and giving no cpr to a person w/o a heartbeat... thanks for the upd juno..

[stallbaum]

I understand. Bear in mind hands only cpr are is based on the fact that the people have enough o2 in there blood to keep vitals organs alive for a few minutes. THe instructions Im giving are to help you understand that. If your in a boat when something like that happens. Help will not be there in a few minutes it could be longer. In that case conventional cpr should be used. Your right though if you dont know how to accurately check a pulse just do hands off then. But if your confident in your pulse checking ability then check and they wont need compressions if the have a pulse. By the way your thumb has its own pulse so use your fingers. CPR breaks ribs when done correctly so be prepared for that also.

This hands only is most effective in a setting where the person is gonna collapse, someone calls 911, then help arrives shortly after including an aed and EMS. Out in a boat its better to know conventional cpr and be ready to go the distance.

[HurricaneBK]

cpr's whole purpose is to circulate oxygenated blood to the viatal organs (namely the brain) for drowning victims hands only isn't going to do much good because theyre out of oxygenated blood, where as cardiac arrest victims would still have some left. I think everyone who goes boating regularly should know cpr and other basic first aid. Even diving around a big city like miami, help is still at least 15-20 minutes away, and a lot can happen in that time.

[SpearMax]

Good move AHA!

I carry an automatic external defribullator on the boat and plenty of those mouth to mouth barrier masks.

[stallbaum]

Thats good guys. Thanks hurricane. THats what I was trying to let everyone know. Im a Fire Paramedic for 5 years so do I have some experience in this field. lol. Spearmax thats awesome your able to have an aed. But remember it does not always advise a shock. But hopefully in the case of drowning it will because you have a good chance of getting them back.

[Prater]

I worked as a tech in the ER for a year. Its hard work, but you never stop pumping until the Doc gives the order to stop. We check the pulse with a doppler and then start again if there is no pulse. I also have lots of time doing CPR and think the 200 pumps in a non drowning emergency is a good move.

[spearguam]

Some thought.
HurricaneBK gave some good information and i have to agree.

Stallbaum you are a Parramedic or EMT?
If a patient has a pulse but is not breathing don't you want to give him 1 breath every 5 seconds? This is called rescue breathing. Also CPR does not break ribs when done properly. Ribs CAN break even when CPR is done properly. This is common on older people who have brittle bones. The only reason people talk about this is because they want to encourage people to continue CPR even if they think they are hurting the victim. Its better to be alive with some broken ribs, than dead with ribs intact,

Folks don't forget the AHA is a business.... a very well run business. That's why their main office is in La Jolla, Ca; one of the most expensive places to live in the U.S.

They seem to come up with a new way to do CPR every couple years. This is how they sell books, videos and other material. They also keep there instructors and training centers having to constantly update their materials and instruction.

This new CPR is for the lay person. They don't want to confuse the average person with pulse checks, proper head position, cricoid pressure, etc. this new method is definitely the KISS method.

If you know what you are doing stick to regular CPR.

[stallbaum]

Interesting rescue breathing really? Whats that. Just kidding I know what rescue breathing is Im not say you break ribs every time you do cpr. But Im saying when your doing it right there gonna break It happens all the time. I know first hand. As for your question am I an emt or paramedic its very obvious that I wrote Im a paramedic. So anwser that one on your own.

And if a patient is not breathing. You first adjust the head make sure there is a patent airway and deliver 2 initial respirations. Then you begin your rescue breathing. 1 every 5 or 12-20 a minute.

When your out in a boat help can be a long way off. And hands only cpr aint gonna cut it. So do some research and learn real cpr. You owe to the people you dive with.

[jdnieman]

Interesting rescue breathing really? Whats that. Just kidding I know what rescue breathing is Im not say you break ribs every time you do cpr. But Im saying when your doing it right there gonna break It happens all the time. I know first hand. As for your question am I an emt or paramedic its very obvious that I wrote Im a paramedic. So anwser that one on your own.

And if a patient is not breathing. You first adjust the head make sure there is a patent airway and deliver 2 initial respirations. Then you begin your rescue breathing. 1 every 5 or 12-20 a minute.

When your out in a boat help can be a long way off. And hands only cpr aint gonna cut it. So do some research and learn real cpr. You owe to the people you dive with.

Yeah, I totally agree with the force of compressions. Effective CPR should have at least a femoral and carotid pulse, unless there is a massive saddle embolus (nothing to do with the so-called misnamed "embolus" that's really a pneumothorax) or they have bled out.

IMHO (an anesthesiologist who does trauma), AHA is selling out by recommending compression only CPR in a witnessed collapsed. They are always solid on using evidenced based approaches, but what I disagree with is their focus. If you can give breaths, give breaths!!!!! Why wouldn't you? The guidelines only show equal outcome (equally poor) in a very limited circumstance. Most of the time it falls outside of the parameters and as you said, help is far away. Why not use every tool in your arsenal. Probably the reason for equal outcomes is the lack of good compressions in both arms of their study. I can't tell you how many times I've been to codes and they won't turn the corner until you get good compressions AND good ventilations. Good of one or the other doesn't really matter because neither one do any good without the other! So is it surprising that the outcomes are equal if untrained people in the field don't do good compressions or ventilations? Of course...the outcome is dismal either way.

Kudos to all the brothers and sisters out there that know what to do and how to do it well. Take that rec of no compressions and throw it in the trash. Unfortunately, these recs make the paper, not recs on how to do effective ventilations or compressions. If you oxygen to the brain, just about everything else can be fixed to a great degree. The brain cannot.

If you want to know about my passion for this subject....I coded my Dad on the beach for unwitnessed arrest with effective CPR (good pulse with CPR and pinked up nicely) and arrival of paramedics in about 5 minutes...still brain dead. DO ALL YOU CAN, not the A.H.A. motto...(do the least you can and more people will do it).

[jdnieman]

ARrrrrggghhhh, i just read my post and I'm boiling! It really pisses me off. %^&% the AHA and their recommendation. dumb donkey butts!

[stallbaum]

I hear you jd. Your right man thats what im trying to tell everybody. Use every possible angle you can. It will only increase the chances of a better outcome.

[2fastlx]

First off, not looking for an arguement - just adding to the discussion.

I too am a paramedic, and have taken numerous classes by the University of Miami about this very subject. The theory of continuous chest compressions (also known as cardiocerebral recirculation) has been around long before the AHA ever got a hold of it. Doctors have developed and proven this method since the mid 90's and have seen drastic results, the University of Arizona's cardiac program has been working on this for a while as well as a few others I cant recall off hand. The whole thing about "they only did it so people would do cpr and not get freaked out about mouth to mouth" is nonsense. Yes, it is a theory about what may come out of it, but it is no where near the reason for the change. Studies have shown that out of all the cardiac arrest patients that enter the hospital - less than 3% will ever leave. With CCR, something like 26% (might not be 26, but its in the upper 20's for sure) of patients will leave the hospital - meaning they arent sitting on a vent in a vegetative state. The biggest reason for the change is this: when 30:2 cpr is performed, the pause between sets of compressions by people of the public averages over 15 seconds. During that time whatever perfusion pressure has been built up by the 30 compressions falls back to zero (or slightly above). The next 30 compressions are spent building the pressure back up, but only to be stopped again for another 15 seconds. In order to adequately perfuse the brain and heart, a blood pressure of 50mm/hg needs to be maintained, a level that 30:2 CPR cant reach long enough to be effective. Secondly, believe it or not, doing chest compressions (good ones) provides enough fluctuation of intrathoracic pressure to actually provide some natural ventilation. Check this out: cardiac arrest protocols at some departments in Arizona (I wanna say pheonix but not 100% sure) literally call for continuous chest compressions, with high flow O2 provided by a NON-REBREATHER MASK with no positive pressure ventilation. It sounds absolutely absurd to me too, but these departments are blowing away both FL and CA (the top 2 when it comes to EMS:thumps:) as well as the rest of this country when it comes to percentage of saves. They gotta be on to something with these kinds of results. My department just adopted these protocols less than one month ago (we still tube though - no nrb) and the first code since we had ROSC after the first epi. We ventilate simultaneously with compressions once every 5-7 seconds with a bvm, or once every 7-10 seconds with an advanced airway. Common sense (I hope) says that if there are 2 or more bystanders on scene of a cardiac arrest, one guy start CCC, and another guy ventilate, and switch off accordingly. The main emphasis is to keep compressions going to maintain that 50mm/hg of pressure, and dont stop for too long or you lose it. If anyone is interested in more info, or just clarification of what i have typed/jumbled together, I can provide literature or point you in the right direction.

[stallbaum]

I work in florida as a paramedic. Continues for how long with no o2 coming in what is the point I cant see a head flopping on the deck with nothing keeping the airway open or assisted taking in much o2. We all know that the chances of getting a TRUE code 99 back are very very slim our best bet is a v-fib code obviously. Thats all good info But if you can feel a pule immediately when beginning CPR compressions wouldnt that mean there is enough pressure to cause perfusion especially in organs.

[2fastlx]

Stallbaum,
Im with you 100% on the ventilations. Me or you working a code is one thing - of course we are gonna ventilate the patient. As for your average Joe - how many times do we role up on scene and CPR is being done poorly.....if at all. Ive seen compressions to the stomach, compressions 1/2 inch deep on a 200lb guy, and compressions being done on a patient that was semi-conscious (by a cop none the less - no offense to any leo's out there) One of the key points I learned in the classes from UM was that as long as the compressions are done effectively, and a good "BP" is maintained to provide perfusion to the brain and the heart through the coronary arteries, the heart will still be highly responsive to defibrillation. After 4 minutes of downtime with no perfusion, the heart is much less receptive to our electrical therapy.Of course this whole thing is banking on the patient being in VF or pulseless VT (we all know how the asystole codes turn out) As far as feeling a pulse during compressions, I asked the very same question in class. The answer I got was, yes if you feel a carotid and or a femoral you know you have over 60mm/hg, but that is in a big vessel running almost straight from the heart. To get the blood to all the smaller vessels that perfuse the vital organs, the blood needs to take all the much smaller pathways through the body and it takes around 15 good compressions to build the pressure up to your 50mm/hg in these vessels. Now that your pressure is good, we get 15 more seconds of compressions (perfusion) before the pause for ventilation - which coming from your average joe takes 16 seconds. During this pause our pressure is now lost, so we now have to do 15 more compressions to get the pressure again.So for every 10-15 seconds of perfusion we get, we end up losing it for around 30 more. I also asked about the ventilation part as well, and I was told that because we only use about 25% (dont quote me on that number, I cant remember the exact, but its close) the patient still has usable oxygen in their bloodstream at the time of the arrest, and if perfusion is taking place(compressions) that O2 will be used. The one thing I will try my hardest to find out for you is how long that remaining O2 will last, and how long natural ventilation can occur before either the decline in O2 or the increase in CO2 needs addressing. You are absolutely right about the airway not being secured and positioned though, which is another concern I have. You and I both know how to position, and how important an adjunct is at the very least, but we are talking about pre-ems here. The results of the new treatment definitely impress me though, you can read all about the success they are having in publications like JEMS.

[stallbaum]

JEMS NOOOOOOOOOO. LOL I would get punched in the face if I got caught reading jems. Lol That would be admitting I like ems. Were all fire medics who claim we hate ems and love fire when deep down we love both. You got a lot of real good information and It sounds like were on the same track. I think that your right the average joe cant do cpr correctly at all. But I think that is more of a reason to go ahead start rescue breathing as well. Cause if you have to half Arse techniques going its better then on half arse.

I think the moral is everybody out here diving should definately take a real cpr class learn as much as you can you never know when your buddy will need it.

[2fastlx]

Lol, I know exactly what you mean. As I always say, we are a fire dept that does EMS, but EMS accounts for 90% of our calls. You are right, the more people that actually get PROPERLY trained in good CPR techniques, the more people we are gonna save, its that simple - we can only get to a scene so fast.

[stallbaum]

Especialy when were waiting at the dock for them to come in. Keep it real man.

jon