New method of CPR??? Sounds odd...

[roseglass6370]

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So I just read an article in the June issue of Readers Digest (okay, I know it's not a reliable medical journal but it made me curious anyway) that said that it's now recommended that CPR is performed using ONLY compressions and no mouth-to-mouth.

Anyone else heard this? It sounds kind of weird to me...I mean if the patient isn't breathing...??? 😕

 

[Blade28]

Huh? 😕 You mean for people afraid of bloodborne diseases?

Standard BLS/ACLS teachings still teach both mouth-to-mouth AND chest compressions.

 

[hopefuldoc87]

didn't reader's digest have that article last month "41 things doctors dont want you to know", and then cited a chiropractor?

id take what they say with a grain of salt, and realize they're looking for a WOW factor just as much as any other common magazine.

 

[Depakote]

Huh? 😕 You mean for people afraid of bloodborne diseases?

Standard BLS/ACLS teachings still teach both mouth-to-mouth AND chest compressions.

I believe they've taken to telling the uninformed public that they may skip the rescue breathing b/c too many people were afraid of contracting a blood-borne disease and not performing CPR all together.

As Blade points out, Standard BLS/ACLS does require rescue breathing, but it is better to do chest compressions than nothing at all.

EDIT: please note, perform CPR as you were trained to do it, don't take techniques away from this thread.

 

[dienekes88]

Huh? 😕 You mean for people afraid of bloodborne diseases?

Standard BLS/ACLS teachings still teach both mouth-to-mouth AND chest compressions.

The magazine is talking about "hands only" CPR, which is apparently an effort to simplify the provision of CPR. That way you don't have people freaking out thinking, "is it 5 compressions between breaths??? or 8? or 10? or 15?!? Two breaths? Or 1?" It lowers the activation energy as it were.

http://www.nlm.nih.gov/medlineplus/cpr.html

I imagine that trained individuals are supposed to continue the practice of performing both chest compressions and rescue breathing...

Edit: Dang. Depakote got in before I did.

 

[AmoryBlaine]

I think there was some discussion of this for bystander CPR -- chest compressions alone are better than nothing.

 

[facetguy]

Yes, it's more of a bystander thing. But it does seem to work:

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

 

[facetguy]

didn't reader's digest have that article last month "41 things doctors dont want you to know", and then cited a chiropractor?

id take what they say with a grain of salt, and realize they're looking for a WOW factor just as much as any other common magazine.

So what do you uncommon readers look for in a magazine?

 

[hopefuldoc87]

So what do you uncommon readers look for in a magazine?

oh i love readers digest. i also love time magazine, and try to read the ny times daily. (which i dont think are uncommon)

but my point was to not take everything they say to heart, since most of those type of publications compete with others, and must come out with interesting/eye-catching articles.

i suppose the uncommon reader reads JAMA, or other scientific journals to keep updated on the latest scientific news. since NIH also had this topic, then its legit. don't get me wrong, im not bashing reader's digest. im jus saying that if you want to have the latest scientific news, don't look at reader's digest for it. sorry if i came off as condescending.

 

[SonofOden]

According to the American Heart Association, the typical lay bystander will be hesitant to perform BLS because of the fear of Mouth to Mouth ventilation. So it was decided that for lay bystander CPR, it would be best just to do the compressions. I can't seem to find the reference. But as others have mentioned, if you are BLS, ACLS, PALS, NRP, etc. certified perform life support procedures according to your certification. This means if you are BLS certified then you better be doing mouth to mouth ventilation, if you don't have a pocket mask!

 

[alwaysaangel]

I think you guys are right to a point but when my med school class was taught BLS from the American Heart Association even we were taught to skip breaths if necessary (eg. blood around mouth or something else that makes transmission likely when you don't have a mask). We were actually told that as medical professionals we should NEVER do mouth to mouth without a mask.

Also, its now 100 compressions:2 breaths. The guy told us that they've basically found that doing compressions is MUCH more important than breaths when you talk about outcome, and if you're alone its almost better to just compress and skip the breaths entirely because it takes to long for you to move over and do breaths. Whereas if you have 2 people its different.

Sort of makes sense I mean even with out breaths there is O2 in the lungs to be picked up from the blood, whereas without compressions blood isn't moving, period.

 

[SonofOden]

Good point. I failed to mention that if there is blood or other bodily fluids, breathing can be skipped. But remember IF NECESSARY are the key words. Protect yourself! And I do remember them mentioning that information about moving and the delay between switching roles and how that can compromise the outcome of the resuscitation. But I do believe your compressions to breaths ratio is off. It is 30 compressions to two breaths for two person resuscitation at a rate of 100 compressions per minute. And remember that the American Heart Association continues to revise and update its protocols for life support and resuscitation. 👍

 

[Amaranthinemoxi]

I was just certified a few months ago, and they said that in most cases, when you do compressions properly, it does move a decent amount of air in and out of the lungs. In Europe, they don't do the breaths anymore. The most important thing is to keep the blood moving around the body with the compressions. Obviously, as people have said, if someone can help you with breathing, then you should do that, but you should never stop "thumping" for more than a few seconds at most....

and you should always try to get someone to find you an AED.... because that's what's going to save someone's life.

 

[SonofOden]

Any other questions should be able to be answered by going to the AHA website and opening the CPR and ECC guidelines. Here is a link for those who want it.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-12

 

[Depakote]

Any other questions should be able to be answered by going to the AHA website and opening the CPR and ECC guidelines. Here is a link for those who want it.

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-12

👍

 

[alwaysaangel]

Good point. I failed to mention that if there is blood or other bodily fluids, breathing can be skipped. But remember IF NECESSARY are the key words. Protect yourself! And I do remember them mentioning that information about moving and the delay between switching roles and how that can compromise the outcome of the resuscitation. But I do believe your compressions to breaths ratio is off. It is 30 compressions to two breaths for two person resuscitation at a rate of 100 compressions per minute. And remember that the American Heart Association continues to revise and update its protocols for life support and resuscitation. 👍

True. My bad. Yeah even for two people they taught us not to stop compressions during breaths. There's no need they said.

 

[mrmilad]

Hey there, I am a redcross CPR/AED instructor and I was trained in the traditional way, however I have been reading up on the new direction that they are taking CPR. If the patient isn't breathing usually there is an obstruction in the air way be it trachea or higher in the laryngeal area so the protocol calls for doing compressions on an unconscious person to remove whatever is in the airway. Moreover once the airway is opened there should be sufficient pressure by the compressions to create exchange of air in the lungs. Furthermore research had shown that the majority of respiratory emergencies occur in children and in adults the most common culprit behind the emergency is cardiac based so hence compressions are most critical. Anyway I also thought it was kind of weird at first, but when you think about it the purpose of CPR is to provide necessary care for the patient, and by cutting down on steps that may be redundant or inefficient you can increase the probability of survival.

All that said I personally think that they are doing this to cut down on the public fear of having to put their lips on someone else and transmittable disease.

 

[MaybeADoc]

the reason they are considering removing the breaths is that numerous studies have show that CPR (100 Comp/Min) without breaths is just as effective. If it is just as effective...and simpler, why not change to it?

 

[nick_carraway]

EDIT: oops MaybeADoc beat me to it.

Apparently the revised protocol isn't just for laypersons.

The AHA offered this revision: http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.189380

In part, it argues that there is no difference between traditional CPR and hands-only CPR outside of a hospital, when examining 30-day survivability in adults. The revision was made after three major reports in one year verified those results.

mrmilad is right in that adults and their cardiac issues require more compressions to move the oxygen already in their body (adults typically gasp before collapsing) and administering rescue breaths can take up to 16 seconds to deliver.

 

[scrubsaresexy]

This means if you are BLS certified then you better be doing mouth to mouth ventilation, if you don't have a pocket mask!

Wrong, wrong, wrong. I will never, ever do mouth to mouth. Please cite for me some kind of protocols that call for mouth to mouth. That was the first thing that I was taught in my EMT-B class. If you don't have a pocket mask, then wait until you find one (or better yet, a BVM). Have fun getting someone else's puke in your mouth.

Without insulting you or anything, are you BLS certified?

 

[thatscorrect7]

i think this has something to do with a county in virginia or somewehre around there that tried this method of no mouth to mouth and only compressions and it has turned out to be statistically favorable
i mean CPR has not been perfect anyway - now its 30 compressions instead of 15 as recommended by the AHA.
but things are a little different now in cpr i think since january

 

[NTF]

I am CPR certified as a part of my job and during training they explained that the point of the "compressions only" CPR statement is that keeping the blood circulating is of primary importance over the breaths. While doing compressions there will be passive air exchange in and out the lungs that will get some oxygen into the body and it's essential to keep that circulation going to oxygenate tissues. They revised standards from 30 compressions then 2 breaths from 15:2 for one person CPR for this reason.
The study that tested this was comparing 15:2 CPR with compression only and found that they give the same benefits. But 30:2 CPR is ideal. It's just that in a crisis situation the quicker and less complicated you can make it for lay people to sustain a person in a code situation before a 2-person EMT team can arrive the better outcomes you'll probably have. But yes if you have two people doing CPR together, adding breaths makes it more effective.

 

[Compass]

Hey all. I'm an EMT and we went over the changes.

For first-responders and so on, breaths are no longer mandatory. For EMTs and above, we still do breaths, per our county policy, and many units are sent to response, so there is no lack of helping hands to do compressions and then switch to bagging during CPR. Usually have a medic there pushing drugs and everything too, so just having everyone going at it simplifies things. Every moment we do bagging doesn't slow down transport. The only thing that slows us down would be AED, when we have to stop the ambulance/medic to shock.

I haven't been dispatched for an actual code yet. Most are false alarms or DOAs. I did do CPR on a person when I was still training to be an EMT, and it was pretty grueling, to be honest. At that point, the pt. was already at the hospital and my class instructor said, "Go have at it." So I'm sitting their doing my compressions while a nurse is doing bagging at her own rate, regardless of whether I was doing 30 for 2 breaths. Muh.

The reason the breaths being removed is because of a few reasons.
A. People were uncomfortable with the fact. I know, I know, grow up, but that's one of the reasons.
B. Alone, it's more important to keep the blood flowing with what oxygen you have than slow down to give oxygen and then get back to pumping.

 

[nick_carraway]

i think this has something to do with a county in virginia or somewehre around there that tried this method of no mouth to mouth and only compressions and it has turned out to be statistically favorable
i mean CPR has not been perfect anyway - now its 30 compressions instead of 15 as recommended by the AHA.
but things are a little different now in cpr i think since january

Phoenix, AZ, I think.

 

[SonofOden]

My statements about mouth to mouth ventilation without a pocket mask or a bag valve mask was intended to be a joke. But I guess it didn't come off that way. In response to your question about being BLS certified I am. And I am ACLS certified and PALS certified. Don't worry no insult taken. Like I said before the AHA will continue to improve protocols and revise procedures in order to improve resuscitation.

 

[scrubsaresexy]

My statements about mouth to mouth ventilation without a pocket mask or a bag valve mask was intended to be a joke. But I guess it didn't come off that way. In response to your question about being BLS certified I am. And I am ACLS certified and PALS certified. Don't worry no insult taken. Like I said before the AHA will continue to improve protocols and revise procedures in order to improve resuscitation.

Oh goodness, I'm sorry. I thought you were serious (sorry, I've been dealing with a lot of stupid people lately 😛) I was just concerned that some state somewhere was telling EMTs to go have at it, doing mouth to mouth.

...quite honestly, I was really getting concerned there for a minute. But since it was a joke, I feel much better about mankind in general

 

[TarHeelEMT]

You've got enough oxygen in your bloodstream to adequately perfuse the heart and brain for about five minutes with compression-only CPR. Depending on where you are, that's generally enough time for the first responders to arrive and initiate proper CPR with ventilations.

It can make a world of difference in patient outcome, but it is not helpful after the first five minutes.

 

[TarHeelEMT]

Hey all. I'm an EMT and we went over the changes.

For first-responders and so on, breaths are no longer mandatory. For EMTs and above, we still do breaths, per our county policy, and many units are sent to response, so there is no lack of helping hands to do compressions and then switch to bagging during CPR. Usually have a medic there pushing drugs and everything too, so just having everyone going at it simplifies things. Every moment we do bagging doesn't slow down transport. The only thing that slows us down would be AED, when we have to stop the ambulance/medic to shock.

I haven't been dispatched for an actual code yet. Most are false alarms or DOAs. I did do CPR on a person when I was still training to be an EMT, and it was pretty grueling, to be honest. At that point, the pt. was already at the hospital and my class instructor said, "Go have at it." So I'm sitting their doing my compressions while a nurse is doing bagging at her own rate, regardless of whether I was doing 30 for 2 breaths. Muh.

The reason the breaths being removed is because of a few reasons.
A. People were uncomfortable with the fact. I know, I know, grow up, but that's one of the reasons.
B. Alone, it's more important to keep the blood flowing with what oxygen you have than slow down to give oxygen and then get back to pumping.

You actually transport working codes? Where is this? We only transport if we get a return of pulses, otherwise we call it in the field.

 

[TarHeelEMT]

True. My bad. Yeah even for two people they taught us not to stop compressions during breaths. There's no need they said.

That's not true, unless you've secured an advanced airway like an ET tube.

If you bag them during compressions without an advanced airway, the vast majority of the air will go down the esophagus, causing a great deal of distention. You're end up raising the intrathoracic pressure considerably, and then they're going to vomit an unbelievable amount, and they'll aspirate severely with all subsequent ventilations.

 

[alwaysaangel]

That's not true, unless you've secured an advanced airway like an ET tube.

If you bag them during compressions without an advanced airway, the vast majority of the air will go down the esophagus, causing a great deal of distention. You're end up raising the intrathoracic pressure considerably, and then they're going to vomit an unbelievable amount, and they'll aspirate severely with all subsequent ventilations.

Well thats not what the American Heart Association taught my med school class last September.

 

[Caesar]

You actually transport working codes? Where is this? We only transport if we get a return of pulses, otherwise we call it in the field.

They do this where I am 2/2 of the cardiac arrests to come in should have been DOA, but of course since they came in by ambulance they had to attempt resuscitation.

 

[nsx]

Does anyone use Combitubes?

That's not true, unless you've secured an advanced airway like an ET tube.

If you bag them during compressions without an advanced airway, the vast majority of the air will go down the esophagus, causing a great deal of distention. You're end up raising the intrathoracic pressure considerably, and then they're going to vomit an unbelievable amount, and they'll aspirate severely with all subsequent ventilations.

 

[jerktown]

I'm a paramedic and CPR instructor and the "no breath" CPR is possibly on the horizon. The American Heart Association is apparently on the cusp of releasing a study showing that the FULL recoil of an ADULT's chest brings in sufficient O2. Their newer meathod of 30/2 shows that they are leaning towards uninterputed circulation as being more important than pausing for breaths. This does not apply to infants or people with compromised chest recoil.

 

[TarHeelEMT]

Well thats not what the American Heart Association taught my med school class last September.

It's the AHA standard for the healthcare provider level that you only do continuous compressions after an advanced airway is secured.

 

[TarHeelEMT]

Does anyone use Combitubes?

Yeah. BLS ambulances use combitubes, and lots of ALS systems use them as a backup for difficult intubations, the latter being the only time I've used one.

 

[TarHeelEMT]

I'm a paramedic and CPR instructor and the "no breath" CPR is possibly on the horizon. The American Heart Association is apparently on the cusp of releasing a study showing that the FULL recoil of an ADULT's chest brings in sufficient O2. Their newer meathod of 30/2 shows that they are leaning towards uninterputed circulation as being more important than pausing for breaths. This does not apply to infants or people with compromised chest recoil.

That's pretty cool.

 

[SB100]

They've changed it each time to include more chest compressions per set because it's more important to try to get the blood circulating until you can get an AED. Rescue breaths interrupt the administered chest compressions.

 

[TarHeelEMT]

The other part about reducing the number of breaths is that research shows cardiac arrest patients commonly are over-ventilated into respiratory alkalosis, which is why such an emphasis is now placed on capgnography being used once you secure your airway.

 

[GreenShirt]

Yes, it's true that CPR maybe heading in this direction. There is a lot of research going on regarding this topic. Part of it is that it simplifies the technique for lay responders making CPR more accessible to more people.

However, there is also research suggesting that rapid re-introduction of oxygen to oxygen starved cells actually causes cell lysis as compared to a slow re-introduction. Researchers found that it wasn't necessarily the length of time that cells where oxygen starved as is commonly thought, because they found that cells could survive for a long time without O2, but the rate at which the oxygen was reintroduced to the cells that caused potential damage. The study implicated further studies that would explore slower oxygenation of cardiac arrest patients possibly including chilling of body temp. Part of the compression-only push is due to this theory. I wish I had the link to this study, but I read about it a year or to ago. Maybe someone who is quick on the google can find it.

 

[Compass]

You actually transport working codes? Where is this? We only transport if we get a return of pulses, otherwise we call it in the field.

Montgomery County, MD. If it's working, we work 'em at the place, put them on the cot while working, work them in the unit, work them to the hospital, and work 'em in the ER. I've only been present for a single working, though, and that was the end-game CPR.

 

[TarHeelEMT]

Montgomery County, MD. If it's working, we work 'em at the place, put them on the cot while working, work them in the unit, work them to the hospital, and work 'em in the ER. I've only been present for a single working, though, and that was the end-game CPR.

Are you a paramedic-level service? The reason I ask is that a cardiac arrest is run no differently in the ER than it is in the field by paramedics, but CPR is proven to have a greatly reduced effectiveness in a moving ambulance. We work with the exact same ACLS algorithms, drugs, and capabilities minus pericardiocentesis (which is very rarely useful in cardiac arrest) as the ER.

I'm just a little surprised, is all...

 

[mandertwin23]

This new CPR suggestion was a result of a study done at the UNIVERSITY OF ARIZONA in TUCSON, they did find that doing only chest compressions had a better outcome than mouth to mouth. Makes sense to me.

 

[rockydoc]

Pretty much anyone who is an EMT or higher and has participated in a code of some sort knows that in a medical situation, ventilation and compression continue simultaneously w/o interrupting each other....this is ideal...in the field by yourself however if you had to choose one, it should definitely be compressions....(unless of course it is respiratory arrest or a child)
also, I heard a study that said that it takes about 15 compressions just to get the blood to start circulating, so the old 15/2 rule was actually kinda pointless.....that it why now it is really a rule just to pound and ground and dont stop (which is very very exhausting by the way)

 

[8744]

Does anyone use Combitubes?

Combitubes suck. At the first opportunity we pull them and get a definitive airway which a Combitube is not. I have had several patients brought in with these being ventilated down the wrong hole.

On the other hand, when they work they do work. But they are not a secure airway.

 

[8744]

Yeah. BLS ambulances use combitubes, and lots of ALS systems use them as a backup for difficult intubations, the latter being the only time I've used one.

Our backup airway is the LMA.