Check this out.

Or better yet - can someone link this video?

http://medicine.arizona.edu/spotlight/learn-sarver-heart-centers-continuous-chest-compression-cpr

[video:youtube]http://www.youtube.com/watch?feature=player_embedded&v=EcbgpiKyUbs[/video]

Thanks for posting, I try to keep an eye on my dad when we are working very hard. He's had a few close calls with heart attacks in the past, this is a good refresher for what to do.

While the new standards for CPR are a great improvement, people need to know some important things.

You'll need help. 100 compression's a minute will wear anyone out in a couple or few minutes.

CPR in general doesn't work very well. Get 911 on the phone, and send people to find an AED.

I think the new standards are the result of the medical profession's realization that most people are not going to take the chance of putting their mouth on someone else's unless they REALLY care about them.

No, it's finding that the level of oxygen in the blood at the time of the MI is sufficient for the time CPR is effective.. Usually a few minutes...

All CPR does is it buys time until electricity (defib)and drugs arrive.

One of the Arizona professors who helped with the research on this new CPR protocol spoke at our Rotary Club. It's easier to perform than the older method and appears to be as efficient.

DF

You hit the point why they have so publically changed their tune. For trained responders they still expect rescue breaths, but they come after compressions. The old curriculum had the breaths occur first. There is little risk of catching a blood born pathogen from doing CPR (but there is a risk). Even if I didn't have my pocket mask, I'd generally give full CPR unless I saw something that gave me pause (lesions, jaundice ect) or there is blood involved.

+1

DF

I don't doubt that, but sometimes research and learning is an attempt to address a practical reality. I could be wrong about my hypothesis, but it is based on my own opinion and those I know who are similarly situated.

Nope. It is more because the studies prove that the blood has enough oxygen to make CPR effective for several minutes without the breathing, and, in reality, if you have not "fixed" the reason you have no pulse for several minutes, it doesn't matter anyhow. (Cold water drowning being a huge exception, but that is because of the hypothermic effect and the decreased oxygen demands)

FWIW, I am a rapid response team nurse at a 700 bed hospital in Minneapolis. Your mileage may vary, but my mileage includes doing CPR over 200 times.

If you can't shock them out of a lethal rhythm or pace them out of a symptomatic bradycardia, all the CPR in the world is just going to make you tired. They changed a lot more than the CPR with the last revision of ACLS......

I have performed CPR on MI Patients more than a thousand times in the last 30 plus years and it save patients about 50 % of the time if performed right. This new method looks to be better than nothing. The difference in saving someone or them expiring is how soon you start CPR after they have the MI. Time is the most important aspect whether they live or die.

goalie's right. Medical research won't give a lot of credence to personal feelings regarding CPR procol(s). It has to be based on research and data collected over a period of time, comparing methods. It's the data that dictate the final product, not concern about people not wanting to do mouth to mouth CPR.

DF

You may have had a 50% immediate survival rate, but do you know what your long-term (made it to discharge, home independently) rate was?

If I may ask, do you work in a cath-lab? When I worked cath-lab, it seemed like the survival was 10x better than even out in the ICU, let alone on a med-surg floor.

+10,000,000

I've never understood not shocking trauma.....that was our protocol.

Do any of your jurisdictions allow shocking trauma induced MIs?

Interesting..

Our AED's only shocked a convertable arrhythmia. I don't know if you'd find that in most trauma caused cardiac problems and/or interruptions.

Just a volly FF/EMT talking here.

Goalie's not really right. I'm not up on the current High School or Friends and Family curriculium, but the BLS HeartSaver and BLS Health Care version still train rescue breaths with compressions.

AHA has said It's better for someone who is not trained at all to at least give compression and no breaths than nothing at all. They believe that fear of mouth to mouth reduces the number of untrained people to give CPR. That's the original point brought up.

One other change in current training is to set the mask to the side when doing CPR when not doing breaths. During compressions there is some exchange of oxygen. Covering the mouth would reduce that exchange. Science is showing breathing to be less important than in the past, but it's still one of the main pillars of CPR.

I covered all the Codes in the Hospital and ER and i did the Intubations and CPR on most of the Cardiac Arrest patient and Drug Overdose. I was Day shift Supervisor in Cardiopulmonary at IPH Med Center. Most patients i worked with in ER had been in Cardiac Arrest for a while while being transported on EMS. I also did the Intubation in the Cath Lab if needed. I have done mouth to mouth on a few patients but most ambu bag after ET tube

Rancho---Our defibs were manual and semi. We never used AED's....I guess a little better control was what was desired in our SOP's.

I cover all the Codes in the Hospital and ER and i did the Intubations and CPR on most of the Cardiac Arrest patient and Drug Overdose. I was Day shift Supervisor in . Cardiopulmonary at IPH Med Center. Most patients i worked on in ER had been in Cardiac Arrest for a while while being transported on EMS. I also did the Intubation in the Cath Lab if needed. I have done mouth to mouth on a few patients but most ambu bag after ET tube [/quote]

That's pretty phenomenal to have a 50% SR given those challenges.

If it is still one of the main pillars, why, in ACLS, did they change the "best practice" of immediate intubation? Why do we use a different acronym instead of the ABC's now?

The bottom line is that if you cannot fix the actual cause, it all doesn't matter.

See my underlined part one more time please.

Again, was that 50% made it to discharge or just survived the immediate code? We can keep a turnip 'alive," but long term is a whole different ballgame. 50% to discharge and home would be the best in the world by far for true cardiac arrest Dr Blues involving compressions.

I don't need to. The studies support me.

BTW, how many times did you do CPR this week?

50% is just a guess and really never done the actual numbers. I worked 30 plus years in Critical Care before retiring. The majority of patients who came in with full blown cardiac arrest didn't survive and the ones who did usually had some brain damage.

Yes you do. You are arguing why CPR is effective, not why AHA has said to UNTRAINED people that compressions are better than nothing. You are absolutely correct on the efficacy of CPR, but that wasn't the point brought up in the first couple posts.

I didn't do CPR once this week. I trained two BLS classes and supervised a new trainer for another.

Those that can't do teach.....

Were you still around when we started doing "cool-it" patients? Inducing hypothermia in out-of-hospital arrests has been an interesting development.

They kind of skew the numbers though.

CPR is for short term survival , you have to fix the problem if you want long term. CPR just prolongs the patient so he can be treated for long term survival. Long term is a whole different ball game. they never did this procedure when i was working to the best of my knowledge. I have been retired 10 years or more. I haven't renewed my CPR or ACLS Credentials in years

No doubt you were born knowing CPR, but your reading comprehension is poor. Why are untrained people told compression only CPR is better than nothing?

It's only been used for a few years now, so you wouldn't have been doing it.

The cooling and subsequent warming has helped outcomes with out of hospital arrest, but there are some tricky parts to it. There are a lot of arrythmias when you warm up the patient again (think re-perfusion arrythmias x100), and it is difficult to assess neuro status, as you need to paralyze the patient when you cool him/her, so you obviously have to sedate quite heavily. We do baseline EEG testing when we are cooling them, but waking them up (if they wake up at all) is always interesting.

It's one of those things that usually goes either really, really well or really, really poorly.

Jeez, guys, let's cut out the pissin' match, OK?

Bottom line, ACLS now recommends chest compressions only. I have talked with some of the people who are "in the know", and the answer I got is that just about everybody who's weighed in on this thread are right:

1)evidence shows there's enough O2 in the bloodstream that you don't need positive pressure ventilations for a good 3-5 minutes;
2)evidence shows most people won't do effective mouth-to-mouth rescue breaths on a stranger
3)effective chest compressions are a LOT easier to teach than effective rescue breathing.

The bottom line is that only a tiny fraction of people who need CPR survive the initial event, let alone walk out of the hospital. Chest compressions buy you time until ACLS drugs and joules can be applied. If you don't get ACLS drugs and joules in a timely manner, CPR will not save you. It only saves 5-10% of patients who arrest in hospital (this doesn't include ICU/ER/OR saves, IIRC) so that gives you some idea of the low success rate in the field. Under 5% is the figure I read last.

Trained people are told it is what you do out of hospital. They are told that because it is effective.

Again, TRAINED people learn compression-only CPR. Wrap your little mind around that and get back to me after your EMT shift ok?

When you've got ACLS, BLS, PALS, and are CEN and CCRN certified, you tend to not suffer fools very well.

I'm one of those people you referred to who's "in the know."

You missed a part: the evidence collected from the above being true showed NO DIFFERENCE in outcomes between doing the mouth-to-mouth and doing compression-only CPR. Compression-only CPR is just as effective, regardless of training, location, or the freaking cycle of the moon.

sounds interesting. Medical Procedures improve every year. You are the care giver for a while and then as you become older you become the patient. So you new guys , get it right. We always believed if you are doing CPR right , the patient will have a few broken ribs. As far as rescue breathing if it was a woman i was more effective in my effort