Squeeze Chest, Breathless: New CPR Protocol.

[uncfnp]

So my best friend is a CRNA in the largest hearts OR in the state of Florida. She once told me that her experience in the operating room in more than 100 episodes where CPR was administered that only 1 time was the patient revived solely by the use of CPR. And of course it was administered by the best in the profession. If ems or another professional doesn't get on the scene pretty soon for some OTHER life saving tricks, CPR alone isn't going to do much.

I don't think we can say that the heart can be restarted 100% of the time, because of the various reasons that the heart stopped in the first place.

The purpose of CPR in a full cardiac victim really isn’t to revive but to prolong that golden period until help or an ACD arrives.

In fact in an unwittnessed arrest, a period of compressions prior to defibrillation may actually be beneficial and increase the odds of a successful defibrillation.

 

[Dr Simon Mitchell]

The purpose of CPR in a full cardiac victim really isn’t to revive but to prolong that golden period until help or an ACD arrives.

In fact in an unwittnessed arrest, a period of compressions prior to defibrillation may actually be beneficial and increase the odds of a successful defibrillation.

All true,

But the undeniable (slightly hidden) key message in superlyte's post is that even if someone suffers a true cardiac arrest in hospital the prognosis is poor, and by logical extension, in the field it is terrible. That is why administering rescue breaths early in a resuscitation sequence for an unresponsive diver is so important. It may be difficult to tell, but in a drowning / asphyxia / hypoxia scenario they may be in a window where breathing has stopped but the heart is still beating. If hypoxia persists then the heart will also stop, and they are almost certainly doomed. So, the best chance of saving them is to restore oxygenation and prevent a cardiac arrest. That is why compression only CPR is such a bad idea in this scenario.

Simon M

 

[guruboy]

My rule on a dive boat is no rescue breathing without the mask from my dive bag or another one.

This is why they teach breathless CPR for the "basic" level training.

According to my instructor, "they" found that people often do (or don't do) CPR based on what they are taught. So if they are taught breaths + compressions, and they don't want to do breaths due to a health risk or some other reason, they end up not doing the compressions either. If they are taught compressions only, they will do that without breaths.

The hope is that something (compressions) is better than nothing.

 

[tursiops]

This is why they teach breathless CPR for the "basic" level training.

According to my instructor, "they" found that people often do (or don't do) CPR based on what they are taught. So if they are taught breaths + compressions, and they don't want to do breaths due to a health risk or some other reason, they end up not doing the compressions either. If they are taught compressions only, they will do that without breaths.

The hope is that something (compressions) is better than nothing.

Perhaps you should read the rest of this thread.
See, for example, posts 7,10, 12, 13, 15, and 32.

 

[uncfnp]

All true,

But the undeniable (slightly hidden) key message in superlyte's post is that even if someone suffers a true cardiac arrest in hospital the prognosis is poor, and by logical extension, in the field it is terrible. That is why administering rescue breaths early in a resuscitation sequence for an unresponsive diver is so important. It may be difficult to tell, but in a drowning / asphyxia / hypoxia scenario they may be in a window where breathing has stopped but the heart is still beating. If hypoxia persists then the heart will also stop, and they are almost certainly doomed. So, the best chance of saving them is to restore oxygenation and prevent a cardiac arrest. That is why compression only CPR is such a bad idea in this scenario.

Simon M

True but in hospital it also kinda depends on the setting and the type of “arrest.” In acute cardiac care (MI, angioplasty/stent or thrombolytic), I don’t know the statistics and its been more than a few years, but it seemed we had a fairly good success rate with pulseless rhythms. Torsades and of course asystole, not so much. Or when the initial attempts at resuscitation failed you knew It wasn’t likely to end well.

 

[KevinNM]

So my best friend is a CRNA in the largest hearts OR in the state of Florida. She once told me that her experience in the operating room in more than 100 episodes where CPR was administered that only 1 time was the patient revived solely by the use of CPR. And of course it was administered by the best in the profession. If ems or another professional doesn't get on the scene pretty soon for some OTHER life saving tricks, CPR alone isn't going to do much.

I don't think we can say that the heart can be restarted 100% of the time, because of the various reasons that the heart stopped in the first place.

CPR isn't a magic wand. But it can work, even under less than ideal situations
Man Saved After 96-Minute CPR Marathon

 

[Kevrumbo]

True but in hospital it also kinda depends on the setting and the type of “arrest.” In acute cardiac care (MI, angioplasty/stent or thrombolytic), I don’t know the statistics and its been more than a few years, but it seemed we had a fairly good success rate with pulseless rhythms. Torsades and of course asystole, not so much. Or when the initial attempts at resuscitation failed you knew It wasn’t likely to end well.

The nightmare scenario at the Catalina Hyperbaric Facility, is a medevac USCG rotary wing delivered diving casualty in full cardio-respiratory arrest, Rule Out AGE & near Drowning, and having to perform CPR on this patient while the Chamber is being pressurized to 165ft /50m (6ATA) for a Table 6A Treatment --the heat of compression is well over 95°F/35°C (imagine being inside your Scuba tank during a fast air fill)-- you're equalizing your ears, narc'd out-of-your-mind and laboring with CPR chest compressions to near exhaustion inside the noise and heat of the Chamber trying to save this person's life. . .

The Paramedic inside the Chamber provides Advanced Cardiac Life Support, but along with a Chamber Tender Crewmember can only use manual CPR and Bag Valve Mask Ventilation -no aiding cardiac defibrillator unit is allowed inside because of the extreme fire hazard of electrostatic discharge in a hyperbaric oxygen rich environment.

The sobering reality is you have to continue working chest compressions and bag mask ventilations as a team alongside the LA County Paramedic-Lifeguard until the victim regains vital signs (unfortunately at this point, not very likely), or the until the Emergency/Hyperbaric Physician arriving by helicopter from the mainland at most some 20min later, pressurizes down in the auxiliary transfer Lock to 6 ATA, and examines & declares the patient dead.

 

[Duke Dive Medicine]

"and the fireman teaching us says it is changing to “not expect public to give breaths”,"
Changed about four years ago IIRC. I recertify every 2-ish years as required, and around 4 years ago, maybe 5, we were being taught CPR with breathing--but told the new standards had already been written and would be making the breathing unnecessary. Which can be problematic because you have to do as you've been taught, for liability reasons, so if you are classed as "professional" or have been trained with breathing...you have to keep doing it that way. If you haven't been trained that way, then you SHOULDN'T be doing it that way.

Apparently if someone is not conscious, simply circulating the blood will oxygenate the brain "enough". Statistically? There's a 10-minute window for CPR. If started immediately, there's about a 100% chance or restarting the patient. That goes down by 10% per minute, so if you don't reach them and start CPR within five minutes, they are down to a 50% chance of being revived, with or without breathing. After ten minutes, the odds are they will need a miracle. Either way.

On the one hand, yes, I would like to know and do what is best. On the other hand, if you don't follow your certification training, you become very open to liability suits. Nice, isn't it?

The new standards don't make breathing unnecessary. In out-of-hospital cardiac arrests in areas with fast EMS response times, high-quality compressions alone are sufficient until EMS arrives. As rsingler pointed out, the rationale is that there is enough oxygen in the individual's body to sustain viability until EMS arrives with a defibrillator. Also, the concept of "time off the chest" comes into play... alternating between compressions and breaths can be difficult for lay rescuers and can reduce the time spent performing high-quality chest compressions. Of course, as has been pointed out several times, water changes the equation and in the event of a drowning event, ventilations are necessary.

The statistic about the 10-minute window involves defibrillation. There is not a 100% chance of resuscitating a patient with CPR alone even in a witnessed arrest where compressions are started immediately, though I've seen it happen. In a witnessed cardiac arrest where high-quality chest compressions are started immediately, the statistical chances of survival drop by about 10% for every minute that defibrillation is delayed. That's not to say that resuscitation efforts should cease after ten minutes, but it does emphasize the need to rapidly defibrillate. The only two interventions that definitively influence survival to hospital discharge are high-quality compressions and early defibrillation.

The concept of high-quality chest compressions cannot be overemphasized, even though I've tried here Compress the lower half of the sternum in an adult at least two inches straight down, 100-120 times per minute. You may break ribs and/or separate the sternum from the ribs. It feels creepy. Keep going. Push hard, push fast, and allow for full chest recoil so that the heart can fill back up with blood. "Stayin' Alive" is the classic song to hum to keep time, but I've also used the old "Watch it wiggle" Jell-O jingle. Darth Vader's theme from Star Wars works too. Leverage counts; make sure your shoulders are directly over your hands, keep your elbows straight and use the weight of your upper body to compress the chest instead of trying to use abs and triceps.

Re liability, if you were in the US you would most likely fall under the Good Samaritan law of the state you were in. These laws protect bystanders who intervene in cardiac arrests and other emergencies.

Best regards,
DDM