1616 CPR Study

Friday, December 28, 2007

In CPR classes they teach you to alternate chest compression with ventilation. A new study says that compression alone will suffice. The article (at http://www.physorg.com/news117889437.html) seems to imply at first that it's because bystanders are reluctant to do mouth-to-mouth, so compression alone is better than nothing. But the actual study compared ventilation plus compression to compression alone, and found no significant difference:

Earlier this year, the then-largest study comparing survival rates of cardiac arrest victims in the light of the kind of rescue efforts performed by bystanders concluded that chances of leaving the hospital alive were actually higher for patients who received Continuous-Chest-Compression CPR (Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study; Lancet 2007:369:920-926).

Dr. Ewy says, “It is interesting that Continuous-Chest-Compression CPR, a technique that has not been advocated or taught and is most often performed by individuals not trained in CPR, results in similar survival as the guidelines-advocated approach, on which millions of hours and millions of dollars have been spent teaching and advocating.”

He adds that mouth-to-mouth ventilation is disadvantageous in cases of sudden cardiac arrest for three primary reasons. “A person whose heart suddenly stops, for example because of a heart attack, was breathing normally only seconds earlier so there is plenty of oxygen in the blood. The important thing is to move the blood around, and this is only possible by uninterrupted chest compressions. During CPR, blood flow to the brain and the heart is so marginal that stopping for anything, including ventilation, is harmful to the brain. In addition, research has shown that forced ventilation, including mouth-to-mouth breathing, increases the pressure in the patient’s chest, which in turn inhibits blood flow back to the heart.”

(Actually, survival rates are dismal in any case. But you have to try, I guess.)

So, CPR might become easier to learn. You still have to learn, because most people (even those who have taken the class) don't press in the right place. And you have to compress pretty quickly - more than once per second. And if you break a rib or two, you aren't compressing too hard - in fact, that's probably about right.

I will be happy to do away with ventilation. Not because I object to mouth-to-mouth, that really doesn't bother me (I carry a mask), but because when you're doing it alone, it takes time to get the head and neck in the proper position. I've seen even trained EMTs blow up the stomach instead of the lungs. (Besides not helping, it can lead to vomiting, which is a danger in itself, besides screwing up the rhythm. Bleck.)

I wonder if a change in recommendation will happen? And how soon?
.