And More, Sorcery, Witchcraft, Vodoo, etc.!

[Bill]

Study: CPR Would Be Better Without Mouth-to-Mouth
Friday , March 16, 2007

Chest compression — not mouth-to-mouth resuscitation — seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.

A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.

More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.

Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.

Sudden cardiac arrest — when the heart suddenly stops beating — can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.

In the new study, researchers led by Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR — compressions and breaths.

Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.

"Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival," Dr. Gordon Ewy, a cardiologist at the University of Arizona College of Medicine in Tucson, writes in an accompanying editorial.

A big caveat: The combination CPR in the Japanese study was given according to the old guidelines of 15 presses for every two breaths, not the 30 presses recommended now.

The American Heart Association said the study supports a focus on chest presses, but the association does not expect its advice to change. It recommends that bystanders provide compression-only CPR if they are "unwilling or unable" to do mouth-to-mouth breathing at the same time and for emergency dispatchers to give instructions on that.

The association wants to see survival results from programs that use compression-only CPR for cardiac arrest.

"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," a heart association statement says.

More than 300,000 Americans die from cardiac arrest each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.

Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital — partly because they don't get CPR.

Oxygen starved patients need hyperventilation - IT'S JUST THAT SIMPLE!

Pretty soon, some "number crunching" academic will try to sell us on not ventilating.

It's getting to the point where it's time to, "say no" to this kind of incompetence and stupidity!

With thanks to the Fox News Network.

[ResTech]

MY OPINION

I agree with these findings and think it makes sense to eliminate mouth-mouth during the initial phase of cardiac arrest by by-standers. We have been providing CPR for many years based solely on empirical data and we are now starting to see what we have been doing may not have been the best for our patients. Scientific, research based EMS is where its at and what we need to embrace and recognize. This is not the first study done on this... several others were done and found very similar results.

Pauses in compressions results in a decrease in perfusion pressure and overall oxygenation which is the basis for recommending by-standers not to perform mouth-mouth. Every time you stop compressions, blood flow ceases and when you start again, you have to get that pressure to pump blood built back up which by the time u do your stopping compressions again to perform mouth-mouth. Again, this is the reason the CPR guidelines were changed to perform compressions longer before ventilating.

This study doesn't negate the need for ventilation and oxygenation. It simply says we need to keep blood moving. Ventilating isn't gonna do the cells any good if the oxygenated blood isn't circulating. Pausing frequently for mouth-mouth inhibits circulation.

Oxygen starved patients need hyperventilation - ITS THAT SIMPLE

This is another practice based on empirical data that has been found to be detrimental to patients in cardiac arrest. The condition is known as Hyperventilation Induced Hypotension. It causes an increased intrathoracic pressure which results in decreased coronary perfusion. Google it.. a lot of good info on the net about it. This is also why some companies have marketed electronic devices that signal when to ventilate to help keep providers from becoming overzealous with ventilation. Also a reason I am a big fan off automatic transport ventilators over BVM.

I think its important to embrace research and be willing to change our "old-school" modalities and approach to patient care. This is an excellent example of that.

[Bill]

WAY TO GO RESTECH!

Maybe we can have an intelligent discussion for a change.

I agree that, "Ventilating isn't gonna do the cells any good if the oxygenated blood isn't circulating. Pausing frequently for mouth-mouth inhibits circulation."

Poor ventilation or not ventilating at all isn't going to provide oxygenated blood to circulate.

Empirical data? So much for the many different ways that data is collected/acquired and the many different ways that it is interpreted. Some of the "old school modalities" seem to practically work for me especially lately. Differences of opinion are great. They keep us all thinking. Me? I've had quite a few discussions with quite a few cardiologists lately. All seem to favor aggressive oxygenation and aggressive chest compressions.

Three of us resuscitated a patient from asystole. The patient was hyperventilated, given aggressive chest compressions and developed a rhythm that could be successfully shocked into sinus. The patient was not intubated. The patient was not hypotensive nor did the patient suffer gastric distension as a result of aggressive hyperventilation. The patient survived to be discharged from a tertiary care facility without any loss of mental capacity.

Anyone else want to weigh in on this?

[ResTech]

Personally I think God likes to play with us when it comes to cardiac arrest resuscitation...lol. Every time we think were making progress and doing the right thing someone comes along and says the opposite, you know. But I do truly believe the current research makes sense and is founded on numerous international studies which adds a great deal of credibility.

I think I know the case your referring to Bill and I am so sorry you had to go through that with someone so close to you.... and am grateful to hear of such an awesome outcome. I know its so hard to change and accept change when for so many years we have done the same thing over and over and it "appears to work". I'm with everyone on that to, but also believe we have to be willing to try new approaches with our care delivery.

I love getting into discussions like this so ppl come on and add to the great discussion Bill started.

[Bill]

GOD??

I love it. We'd better keep our heads down. The scientists will get us if we don't watch out.....

H'mm, it's great that you interject this very significant variable.

Actually, I believe that there is no "appears to work." Either it does or it doesn't. If it does work, you have a live and viable patient. If it doesn't, you have a perfectly dead patient.

Truthfully, I must confess to you my amazement as each day passes! Cardiac rehab is a trip.

Restech is correct! Are there other perspectives?

[legendsneverdie]

I am on the fence on this one, I've been reading and pondering the studies for months since they came out in the fall. The way I see it, you need oxygen and circulation to live. Honestly I feel they go hand in hand, one without the other doesn't really help a situation. What good is a well venitlated patient with no circulation or vice versa a patient that has good circulation but no oxygen in the blood that is circulating?? There are very few cardiac arrests that are text book and you'll never have 2 that are the same. So I personally think that it's hard to trust a study going one way or the other. With the "traditional" CPR we are accustomed to the patient is getting oxygen and circulation both. Just a thought from my years of experiences with cardiac arrests.

Bill- Glad to hear that Sue is recovering well & life is working on getting back to normal for your family.

[Bill]

Thank you to Restech and Legends for you kind words and support. We are getting a little closer to "normal."

This topic is generating a lot of discussion. It was discussed at EMS Council last night for a bit. I look for more at the Regional Advisory Council Meeting on Wednesday Evening.

Interesting. There sure are no two of these alike. There are so many variables with resuscitation and they are as different as the past medical histories. That's why I question the conclusions and data in these studies.