# 4766
Having performed CPR in excess of 500 times over the years, and since I was an American Heart Association and an American Red Cross CPR instructor in my distant past, I’ve watched the adoption of a `compression only’ method of CPR for laypeople over the past couple of years with considerable interest.
Admittedly, the removal of rescue breathing from the protocol seemed a bit counterintuitive to me. Airway management and proper ventilation were a huge part of my EMT and Paramedic training.
But I understand the reluctance of bystanders to do mouth-to-mouth – particularly on strangers (which is why I own two Ambu-bags - one for each of my first aid kits).
Despite my initial skepticism, the NEJM has published the results of a comparative study of CPR outcomes with, and without, rescue breathing that support the notion of doing compression-only CPR.
At least among those who have little or no CPR training.
This study was conducted in Sweden, and researchers found that the 30-day survival rate was 8.7% in the compression-only group and 7.0% in the group receiving standard CPR.
Excerpts from the abstract follow.
CPR with Chest Compression Alone or with Rescue Breathing
Thomas D. Rea, M.D., Carol Fahrenbruch, M.S.P.H., Linda Culley, B.A., Rachael T. Donohoe, Ph.D., Cindy Hambly, E.M.T., Jennifer Innes, B.A., Megan Bloomingdale, E.M.T., Cleo Subido, Steven Romines, M.S.P.H. and Mickey S. Eisenberg, M.D., Ph.D.
N Engl J Med 2010; 363:423-433July 29, 2010
Background
The role of rescue breathing in cardiopulmonary resuscitation (CPR) performed by a layperson is uncertain. We hypothesized that the dispatcher instructions to bystanders to provide chest compression alone would result in improved survival as compared with instructions to provide chest compression plus rescue breathing.
Methods
We conducted a multicenter, randomized trial of dispatcher instructions to bystanders for performing CPR. The patients were persons 18 years of age or older with out-of-hospital cardiac arrest for whom dispatchers initiated CPR instruction to bystanders. Patients were randomly assigned to receive chest compression alone or chest compression plus rescue breathing. The primary outcome was survival to hospital discharge. Secondary outcomes included a favorable neurologic outcome at discharge.
<BIG SNIP>
Conclusions
Dispatcher instruction consisting of chest compression alone did not increase the survival rate overall, although there was a trend toward better outcomes in key clinical subgroups. The results support a strategy for CPR performed by laypersons that emphasizes chest compression and minimizes the role of rescue breathing.
(Funded in part by the Laerdal Foundation for Acute Medicine and the Medic One Foundation; ClinicalTrials.gov number, NCT00219687.)
Doing 1-man CPR, even for a trained responder, can be difficult and quickly exhausting. For a layperson, changing from compressions to rescue breaths and back again to compressions can be awkward and ultimately inefficient.
The end result is often poor ventilation and poor circulation.
Rescue breathing and trying to maintain a proper airway complicates CPR considerably, but emergency dispatchers can coach untrained bystanders to do chest compressions relatively easily.
By concentrating on chest compressions alone, the layperson can keep a little oxygenated blood flowing to the brain while waiting for medics to arrive.
This can help stave off brain death, which is the primary goal of bystander CPR.
I would urge everyone to take a CPR course, and follow up with refresher courses every few years. Contact your local Red Cross Chapter or the American Heart Association for training options.
You should be warned, however, that the `miraculous saves’ shown on many dramatic TV shows - where the CPR success rate is usually over 50% – aren’t very realistic.
CPR can, and does, save lives.
But the rate of success is usually 10%-15%, even under the best of circumstances. For a sobering, but realistic appraisal of CPR’s effectiveness you might wish to read:
CPR: Less Effective Than You Might Think
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2 comments:
Michael, this is all too fresh in my mind. 2 weekends ago a friend of mine and I were having a conversation as he collapsed and fell into a seizure. Within a minute or so, myself and another man noticed he stopped breathing and had no pulse. We immediately went into "2-man CPR" (5 & 1) which I was taught as a lifeguard back in college (and unsuccessfully performed on a drowning victim in '93). We continued the 5 & 1 "2-man" protocols for 5-7 minutes rather fluidly until the medics arrived and took over. The victim, my friend, is alive today and home with his family. However, I have since been told about the updated protocols and, despite the successful outcome, I feel somewhat guilty for not being up to speed.
Is it your opinion that the new protocols are more effective than a rather fluid 2-man version or is it simply that the "compressions only" method is more appropriate for the apprehensive?
The medics were using an air bag AND compressions when they took over- which leads me to believe that is preferable to the former. Some clarity on this would be helpful.
Kevin,
First congratulations for your quick and appropriate reactions to your friend's cardiac arrest. You and your CPR buddy should be proud.
As far as I can tell from my reading about it (I'm no longer an instructor), these `compression only' protocols are designed for the single `lay' bystander who might not be willing or capable of performing efficient traditional CPR.
`Breathless' CPR is better than inefficient CPR, or no CPR at all.
Standard CPR, the kind you were taught, is still used by Health Care Workers (and still appropriate for many children in respiratory/cardiac arrest).
So I'd say you did the very best thing you could.
I can assure you, I'm not throwing my ambu-bag(s)away anytime soon.
Thanks for sharing your story.
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