Doctor sparks debate over CPR

[jagfish]

A few more points to ponder. Does everyone remember the "old" method of drowning revival? You put the victim face down, pulled on the arms like chicken wings and then pushed on the back. Now certainly some of these victims were in respiratory arrest but some had to be dead. It turns out that the movements would both ventilate and compress...perhaps not very effectively but it could work, people were saved. Then they came up with a "new way"...rescue breathng and chest compressions. Do you think the rescuers of the time thought the new was was stupid? What do YOU think of the old technique now?

Interesting you bring up this technique...it might be making a comeback...or not...

At the Heimlick Institute, there are some interesting statistics (factual, I have no idea) about how ineffective MtM is if the lungs are still full of water. HI advocates enptying the lungs of water and claim that in about 80% of the cases, the victim/patient starts to breath spontaneously (if memeory serves).

The link is here...

http://www.heimlichinstitute.org/drowningart.html

 

[HammerNoMore]

Also consider that CPR is a "first responder" training. At it's basis is the assumption that you don't really know what you are doing. This is the reason that teaching the precordial thump is absolutly forbidden. Here we have a simple proceedure that can actually restart a heart (unlike CPR) but it is shunned because most laypeople (and most medical professionals) do it wrong...

 

[TheAvatar]

However, if one is expecting chest compressions to be the mechanism behind ventilation during CCC CPR, it seems airway control still needs to be stressed even if it is just a head til-chin lift for lay rescuers. Chest compressions aren't going to ventilate if the airways is blocked and the lay rescuer isn't going to be watching for chest rise because they aren't rescue beathing.

In rural areas or remote areas, is bystander CCC CPR going to keep the pt at all oxygenated for 5 or 10 minutes if the airway closes?

ABC is apparently too much... Just the C or maybe AC?

As explained during our re-certs this year, the blood carries enough oxygen to do some good for several minutes, even without breaths. And apparently the heart is more likely to successfully 'reset' if it's own tissues have been oxygenated. So one rescuer now does 2 minutes of compressions only at 100 per minute while the other sets up the equipment, inserts the OPA, etc. followed by 1 minute of two person, 15:1 CPR before the SAED is fired up. (as always, there are certain exeptions to the protocol)

Of course, I am speaking as a professional firefighter working at the direction of a base hospital physician. This is not to say that the protocol for the general public has or will change. You should do CPR however you were taught.

That is almost exactly the scuttlebutt I've been hearing as the new protocol for CPR-PR and CPR-HCP.

 

[ParamedicDiver1]

A couple of local agencies here in Houston are doing the Chest Compression as well. A couple of things to consider, generally this is for laypeople only, once licensed personnel are on scene, the patient is given Advanced Cardiac Life Support. This includes Defib, Intubation, and Medication administration. I do not believe that anyone is advocating that Paramedics continue the chest compression only style once on scene. (Could be wrong though) AHA and ARC will not change it's standards until the new process has undergone the complete scientific process and review, but I believe that if it proves to be effective they will modify their stance (they always have in the past). On thing to remember, the most common cause of sudden cardiac arrest is still ventricular fibrillation, and the number one treatment is still immediate defibrillation with an AED for laypeople. Just my 2 cents.

 

[HammerNoMore]

On thing to remember, the most common cause of sudden cardiac arrest is still ventricular fibrillation, and the number one treatment is still immediate defibrillation with an AED for laypeople. Just my 2 cents.

One thing I've noticed, as I do make an effort to look for AED's in public locations. The adoption of AED's seems to be sporadic. In my local airport, for example, I have been able to find 1 per terminal. However on a recent trip to Atlanta, I noticied that they were, as someone pointed out, more common that fire extenguishers.

If this topic is of interest to you, no matter which side you fall, you should make every effort to encourage public facilitles in your area to install (or install more) AED's...

 

[archman]

The lay public is so anti-mouth-to-mouth now, even if chest compressions-only are less effective a technique, at least they'd have a much higher percentage of being performed vs. no CPR.

I say spread the no-compression technique throughout the U.S. to all basic-level classes. The professionals can keep the fancier techniques if there's medical benefit.

 

[ParamedicDiver1]

I say spread the no-compression technique throughout the U.S. to all basic-level classes. The professionals can keep the fancier techniques if there's medical benefit.

I agree as long as it is a proven and accepted technique. Lets make sure it is appropriate for the patient before we make grand statements. :bubble_fi

 

[archman]

I agree as long as it is a proven and accepted technique. Lets make sure it is appropriate for the patient before we make grand statements. :bubble_fi

What, Tucson ain't good enough? It's not that back-woodsy.

 

[ParamedicDiver1]

What, Tucson ain't good enough? It's not that back-woodsy.

hahahaha!!! I guess not.

 

[liberato]

At the Heimlick Institute, there are some interesting statistics (factual, I have no idea) about how ineffective MtM is if the lungs are still full of water. HI advocates enptying the lungs of water and claim that in about 80% of the cases, the victim/patient starts to breath spontaneously (if memory serves).

The link is here...

http://www.heimlichinstitute.org/drowningart.html

There are many other interesting articles at that site that we should read. Now that I think about it, there were some things in my rescue training I had a sense were bogus (in-water rescue breaths for one). Now I am convinced. We should have practiced an in-water Heimlich.