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Biotech Science

CPR Not as Effective as Chest Compressions Alone 194

Posted by Zonk from the use-the-compressions-luke dept.
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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CPR Not as Effective as Chest Compressions Alone More

CPR Not as Effective as Chest Compressions Alone

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  • Better links (Score:5, Informative)

    by Captain Splendid ( 673276 ) <`capsplendid' `at' `gmail.com'> on Saturday March 17, 2007 @06:29PM (#18390297) Homepage Journal
    Sarver Heart Center [arizona.edu]

    Lancet article [thelancet.com] (login required)

  • Red Cross Changes (Score:5, Insightful)

    by dl107227 ( 632747 ) on Saturday March 17, 2007 @06:34PM (#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 (Score:5, Informative)

      by Dunbal ( 464142 ) on Saturday March 17, 2007 @08:07PM (#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.

    • 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 hav

    • Re: (Score:2)

      by s31523 ( 926314 )
      And lets remember 2-person CPR... I believe it's still 5 compressions, 1 breath. This would be the ideal method since the interruption of blood flow is smaller.

    • Re: (Score:2)

      by FroBugg ( 24957 )
      I'm a professional lifeguard and was just going through a review of all my certifications when I learned of these changes a few days ago. It struck me as interesting, especially since the new 30/2 pattern applies to everyone, including children and infants (who used to be 5 compressions to 1 one breath).

      I'd also thought it was just because they were worried that the previous set of guidelines confused some people, but maybe there's good science behind it.

      The loss of abdominal thrusts for a choking victim bo
  • 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: (Score:2)

      by 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 (Score:4, Insightful)

        by Dunbal ( 464142 ) on Saturday March 17, 2007 @08:02PM (#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.
        • 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

        • Re: (Score:2)

          by Joebert ( 946227 )

          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...

          • 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...
            Thank you for saving my husband!
            Oh, by the way, we're suing you. My husband suffered excess brain damage that we believe could have been prevented had you used the proper 30:1 ratio rather than 15:1.

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

    by bananaendian ( 928499 ) on Saturday March 17, 2007 @06:41PM (#18390355) Homepage Journal

    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?

    • 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.
      • 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.
    • 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: (Score:3, Interesting)

        by 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: (Score:3, Informative)

          by 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: (Score:2)

            by Wudbaer ( 48473 )
            Hm. I think you are right that there should indeed be a certain gas exchange, as the mechanical conditions are given - the bellows effect applies also to the chest, as it is elatic and will get back by itself into a semi-expanded state causing some inhalation. The expansion will not be that effective as if someone is actually actively breathing, but it is there.

            OTOH I think (but is really only a feeling, no data of any kind to support this) that the compression cycles in CPR are indeed too short to allow fo

    • Re: (Score:2)

      by 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.

    • Re: (Score:2, Insightful)

      by sherrysj ( 1077163 )
      > 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 c
    • "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 equip

    • Re: (Score:2)

      by matt me ( 850665 )
      Continued CPR requires at least two people, maybe someone could be performing chest compressions throughout?
  • If you really want to survive in emergency situations, just be wide enough [itv.com] to float.

  • well (Score:2, Insightful)

    by mastershake_phd ( 1050150 )
    What if one person gave chest compressions while another gave mouth to mouth.
    • 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.

    • 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.

    • Re: (Score:3, Informative)

      by 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 (Score:5, Informative)

    by MORTAR_COMBAT! ( 589963 ) on Saturday March 17, 2007 @07:01PM (#18390471)
    a recent refresher course has really stressed chest compressions over air as well. 30 compressions per two breaths.

  • Most effective *for cardiac arrest* (Score:5, Insightful)

    by 6350' ( 936630 ) on Saturday March 17, 2007 @07:05PM (#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: (Score:2)

      by 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.

    • Re: (Score:2)

      by 6350' ( 936630 )
      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 i

  • When to give breaths (Score:5, Informative)

    by coleopterana ( 932651 ) on Saturday March 17, 2007 @07:09PM (#18390551) Journal
    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.
    • 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.

  • Terrible News (Score:5, Funny)

    by iamdrscience ( 541136 ) on Saturday March 17, 2007 @07:29PM (#18390699) Homepage
    Could this be the end of being able to trick hot teenage lifeguards into making out with you?
  • 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 (Score:5, Interesting)

    by superid ( 46543 ) on Saturday March 17, 2007 @07:35PM (#18390735) Homepage
    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. (Score:4, Informative)

    by Werkhaus ( 549466 ) on Saturday March 17, 2007 @07:36PM (#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 (Score:4, Informative)

    by dcemt ( 467776 ) on Saturday March 17, 2007 @07:39PM (#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 (Score:3, Insightful)

    by greg_barton ( 5551 ) * <greg_barton&yahoo,com> on Saturday March 17, 2007 @07:45PM (#18390785) Homepage Journal
    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 (Score:5, Insightful)

    by flyingfsck ( 986395 ) on Saturday March 17, 2007 @07:49PM (#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.
  • 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

  • Chest compression causes air movement... (Score:3, Interesting)

    by MMC Monster ( 602931 ) on Saturday March 17, 2007 @08:59PM (#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.

  • O2 (Score:2)

    by PhotoGuy ( 189467 )
    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 (Score:5, Informative)

    by doit3d ( 936293 ) on Saturday March 17, 2007 @09:39PM (#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.

    • Re: (Score:2, Interesting)

      by 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 dis

      • 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.

        for 15-20 minutes ... yes, it would be important to do the breathing. The compression-only technique assumes that somoene with a defibrillator (the new automatic ones) will be arriving within a few minutes.

  • From my CPR course (Score:4, Informative)

    by spaceyhackerlady ( 462530 ) on Saturday March 17, 2007 @11:15PM (#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 (Score:5, Informative)

    by Masaq ( 732641 ) on Saturday March 17, 2007 @11:27PM (#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.
  • One of the most important CPR facts is that it is only effective 5%-10% of the time! Many people who are trained in CPR and have actually had to perform it do not know this, and they suffer psychologically because they feel they performed it wrong and let/caused someone to die, when they probably did it right. Know this.
    • They tell you this in training, but I believe they say more like 50%. Either way, you should know that it's a flip of the coin. Hey, this guy's DEAD, /maybe/ I can bring him back to life.
  • As a recently certified EMT, I find this both encouraging and disturbing.

    The switch from 2 breaths/15 compressions to the 2/30 ratio made sense; the idea is to circulate oxygenated blood to the brain and heart. Oxygen in the lungs is useless if there is no circulation, ergo circulation is far more critical, even if blood oxygen saturation is relatively low.

    This study disturbs me because it will cause me to doubt the efficacy of my patient care in the field. If working alone, should I forego rescue breaths a

    • Re: (Score:2)

      by erbmjw ( 903229 )

      TGFEditor this study was not looking at EMTs or any medical professionals it was evaluating average Joe/Jane who might have a CPR course but nothing better.

      This study should no direct bearing on your efforts - follow your training.

      The study does provide you with information on what we average Jane's & Joe's might be doing incorrectly when we are trying to perform CPR and rescue breathing.

      Search this thread for the "physician" comment - he explains the situation from a medical professionals persp

      • "This study should no direct bearing on your efforts - follow your training."

        Excellent advice. Thank you.

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