CPR Not as Effective as Chest Compressions Alone

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.'"

Better links

[Captain Splendid (673276)]

Sarver Heart Center [arizona.edu]

Lancet article [thelancet.com] (login required)

Red Cross Changes

[dl107227 (632747)]

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

[Dunbal (464142)]

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.

Very old news

[brian0918 (638904)]

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:

[j-pimp (177072)]

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 Americ

Re:Very old news

[Dunbal (464142)]

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.

Ventilation still valid, I think.... ?

[bananaendian (928499)]

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:

[MyLongNickName (822545)]

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

[pavon (30274)]

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:

[Atlantis-Rising (857278)]

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:

[Wudbaer (48473)]

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,

Re:

[mgv (198488)]

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, eve

Re:

[dsanfte (443781)]

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.

Nonsense. Being obese is the key!

[ScentCone (795499)]

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

well

[mastershake_phd (1050150)]

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

Re:

[cheater512 (783349)]

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:

[compro01 (777531)]

that is the optimal, but you don't always have 2 people trained in 2-man CPR available.

since you don't have 2 people, you have to make do with one. the question that is coming up is how best to divide the efforts (ventilation vs. circulation) and it's looking like circulation is more important in the typical length of time you'd need to be using CPR.

when i did my CPR refresher a last year, the instructor (a former military medic) reccomended 80 compressions/2 breaths.

recent red cross cpr guidelines have improved

[MORTAR_COMBAT! (589963)]

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

Most effective *for cardiac arrest*

[6350' (936630)]

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:

[Dunbal (464142)]

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.

When to give breaths

[coleopterana (932651)]

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.

Terrible News

[iamdrscience (541136)]

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!

[thschmid (102849)]

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

[superid (46543)]

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.

[Werkhaus (549466)]

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

[dcemt (467776)]

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

[greg_barton (5551)]

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

[flyingfsck (986395)]

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.

Chest compression causes air movement...

[MMC Monster (602931)]

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.

I teach CPR

[doit3d (936293)]

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.

From my CPR course

[spaceyhackerlady (462530)]

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

[Masaq (732641)]

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:Wow

[Philip K Dickhead (906971)]

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

Re:

[Seumas (6865)]

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

Re:

[Sponge Bath (413667)]

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

[AuMatar (183847)]

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

Re:

[Sponge Bath (413667)]

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:

[CastrTroy (595695)]

I know when I took a first aid course, we were always supposed to ask the person if they needed help. Good Samaritan laws only kicked in if the person couldn't answer. In the majority of CPR cases, this would be true, however it's kind of an odd rule. And I live in Canada. If you saw someone with a gash to the head, and they were still conscious, then you were supposed to ask them if they needed help before applying pressure with a clean cloth. And if they refuse, you're supposed to just not do anything

Wow, I have no reading comprehension

[pavon (30274)]

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

[by Anonymous Coward]

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

Re:As a rescue technician

[gardyloo (512791)]

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

[mgv (198488)]

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

Not DUH

[Mr. Underbridge (666784)]

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

[CrazyJim1 (809850)]

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

[Mr. Underbridge (666784)]

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?

Had he made this statement BEFORE, and not AFTER the article came out, you might have a point. As it is, he's another guy who says 'oh, that's obvious' about research after it's done. And you missed my point that one could have said 'oh, that's obvious' in the other direction if it had turned out that the breathing part of CPR was critical.

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.

Don't get me started, they're definitely idiots. I correctly diagnosed myself with a disease I'd had for 8 years without a doctor even getting close. However, the unwashed masses are even dumber. And while medical education is sad, occasionally decent research is done. The original CPR method saved lives, that's not arguable. And the new research may help save more. So I think your rant is OT.

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

Scientists are wrong all the time, doesn't mean we stop doing science. And from the way you say you went to medical school, but don't say you're a doctor, I'm guessing you quit, so that doesn't make you the best source. What are you doing now? Doctor? Scientist? Pumping gas?

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.).

You seem to be good at armchair research, but your skills on actual research seem questionable. How do you set up such a study? Do you have a set of 1000 dying people on hand who need resuscutation? For christ's sake, at least think this shit through. Research on dying people is kind of hard to do for some obvious ethical reasons.

Oh, and just wondering, why the hell are you so angry? Go get laid.

A little reality please

[Simonetta (207550)]

'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:

[MikeyTheK (873329)]

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 d

Actually...

[Rob Carr (780861)]

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...

[mollymoo (202721)]

In the field and in the hospital, it's not uncommon for the person doing chest compressions to stop occasionally to perform an intervention.

I know addictions can be bad for your health, but decding to tackle them in the middle of a heart attack is a bit extreme.

Re:

[Dunbal (464142)]

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.