(Thu, 29 Jul 2010 11:32:00 +0000)
# 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.
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:
