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.'"

Ventilation still valid, I think.... ?

[bananaendian]

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?

CPR Robot

[superid]

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 :(

Re:Ventilation still valid, I think.... ?

[Wudbaer]

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)).

Chest compression causes air movement...

[MMC Monster]

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:Wow

[MikeyTheK]

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:I teach CPR

[Anonymous Coward]

Most people forget what they were taught? As a non-professional who was confronted with the need to use my training a few minutes after entering my office last November, I can testify to that.

* I forgot everything, including the order of ABC.
* I was shaking so bad I *could not* open my non-latex gloves pack before removing the "emesis" (vomit) from his mouth.
* Once adrenaline kicked in, there was no hesitation from me and my cow-orkers to do compressions and breaths. No thought of lawsuits, contagious disease, or anything else - just doing what was needed to save a human life.
* Despite forgetting everything, we got air down his airway and chest pumps creating detectable circulation.
* Every time we stopped giving breaths, he turned very purple very quickly. This happened several times during the 15 or 20 minutes we did CPR until the paramedics found us (yes, it was a criminal amount of time). I'm not sure I buy into the idea that breaths aren't important.

In retrospect, it was a massive heart attack and he was really quite dead before we even started. Other than that I feel pretty good about what we were able to do, as well-trained but panic-stricken amateurs. But I won't soon forget the difference between how he looked with breaths in him and without.

Re:Wow

[CastrTroy]

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. Possibly wait for them to pass out and then help them. What a screwed up world we live in.

Re:Not DUH

[Mr. Underbridge]

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.