Hypoxic CPR

[1stResponder]

What's everyone think about the new chest compressions only? If you haven't heard, basically people who don't know CPR are being told to do chest compressions only. No breathing. There's no risk for disease transmission, which is good. And your own safety comes first. But, the patient is getting zero oxygen. The arrival of EMS will probably be 4-6 min. That's at least 4min. with no oxygen. The report said people who recieved compressions only had a better chance of survival. I don't know if I can believe that. And even if they did have a better chance, did they have an increase in brain damage? The report didn't say anything about that. BIt's on the homepage here at firehouse.com. Check it out. I'm curious to what people think.

[9m18]

As a CPR instructor, I have a hard time believing that compressions without ventilations is going to do the patient a whole lot of good.
But on the other side of the coin, if the only people on the scene are not trained in CPR, then maybe something is better than nothing.
Maybe in an urban setting with AEDs in police cruisers and short response times it would be reasonable. But here, with rural response times and very few AEDs, I think I'd rather see the rescuer at least try to ventilate the patient.
Then again, what if the patient regains a pulse after being defibrillated in the field by a first responder. How long will that pulse last with no ventilations?

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Stay Safe.
You asked for my opinion, now you have it. It's mine and mine only. Any similarity to another opinion...living or dead...is purely coincidental.

[This message has been edited by 9m18 (edited May 28, 2000).]

[This message has been edited by 9m18 (edited May 28, 2000).]

[Boothby]

I think the study reflects the fact that even if the heart stops beating, that the blood retains a certain amount of O2(PaO2 as measured by ABG). Even this small amount of O2 circulated to the brain must have some benefit, even if it is a small one. Chest compressions alone will circulate the blood even with a low PaO2. Without any compressions the blood does not get circulated.

Alot of people are afraid to do CPR due to possible disease transmition, therefore they do NOTHING at all. With this new study we can now encourage people, who would otherwise do nothing, to do compressions alone and quite possibly help save a life.

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Larry Boothby
Firefighter/Paramedic
Truck 3 A-shift
Local 1784
Memphis.

[Lieutenant Gonzo]

I agree with Larry on this one...someone who is just doing compressions is better off than someone standing by doing nothing.

There is a way to increase survival rates...instruction in CPR should be mandatory for all high school seniors. Upon completion of the course, give each student a CPR Microshield that they can keep on a key ring or in their pocket. Many companies now have mandatory CPR training for their employees, and this is another step in the right direction!

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We boldly go where no one else dares...
take care and stay safe
Lt. Gonzo

[emsbrando]

Hi:

I believe that just chest compressions is better than doing nothing at all, but in a rural area you probably won't see anyone survive.

Keep in mind that the study was done in Seattle, and the survival rate was very low. I believe the study showed that the Dispatchers gave pre arrival instructions to do CPR with mouth to mouth in about 250 cases, and gave instructions to the same number of cases for CPR without mouth to mouth. The survival rate with the mouth to mouth was only 10%, and without mouth to mouth was 14%. I did not read the article, but my boss was telling us about it.

Also in the urban setting, especially in cities like Seattle, response is much faster so your ALS equipment is literally around the corner, or there is a Police car nearby with an AED.

Our dispatchers have tried to give pre arrival instruction for CPR including mouth ot mouth, and you would probably be surprised at how many will refuse, even on a family member.

Just my 0.2

Ed Brando

[This message has been edited by emsbrando (edited May 28, 2000).]

[This message has been edited by emsbrando (edited May 28, 2000).]

[LuxRes907]

I have to agree with Boothby, also remember that the lungs dont completely expell all the air in our lungs up cardiopulmonary arrest and the residual air will also compose of some O2. So any compressions will ,atleast for a while, circulate some residual O2.

[sthncross]

Yes, something is better than nothing but this is not practiced in Oz.

[EMT832]

I read in the New York Times, science times today that the chest compressions alone are only until an emergency responder arrives. As Larry said earlier the body does have some O2 in it to last from 4-6 minutes, but ultimately if the person does not receive defibrillation within 6-8 minutes after cardiac arrest the survival rate is less than 10%.

[EMT-P]

Thats just plain down right wrong. The whole purpose of even giving a breath is to get at least a small precentage of O2 down to the lungs so that as the heart is being compressed it can pick up some O2 to help perfuse the tissues and most of all brain. The first thing we were taught in paramedic school is to intubate an apneic person as quickly as possible. Why? To help get the O2 to the tissues including the heart to aid in SURVIVAL.

Although if a bystander did not know how to perform CPR by giving breaths into a lifeless person, I guess some blood being pumped throughout the body is better than nothing.

Just my thoughts.

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Life, Death, We are the difference.

[Catch]

I guess this is one of those things that doing anything is better than nothing. However, when you compress the chest, you great a negative pressure upon chest rise, pulling in some air. It's not as much as you get doing mouth to mask. But truth be told, mouth to mask is not as good as BVM with supplemental O2 or MtoM with the same, which is not as good as intubation with OT and bag. I'm one that will refuse to do mouth to mouth, and if I don't have my mask they'll have to do with just the air moved through compressions. It may sound bad, but I'm not taking home what some stranger has.

[crossfire]

It was hard for me to believe that health care professionals would suggest compression only CPR, but after reading a report on this about a year ago, I found out it does have it's points. The report suggested that compression only CPR would increase layperson use of CPR. The part about it having a better survial rate is new to me. Anyways, the report, I cant remember who wrote it, showed that only 30% of the public who knew CPR would use it if encountering a stranger in cardiac arrest. The number one reason for not starting CPR was doing mouth to mouth. The public is afraid of catching something from the arrested person. I can't say that I could blame them. Well unless it was me not beating. Now, knowing that people weren't willing to do mouth to mouth, the research started on compression only CPR. The results were decent and now more research is in place. Some countries in Europe already have compression only CPR in use. This is getting long, so if you would like anymore info..email me

[medic320]

Larry, maybe you are right, and that something is better than nothing. I know there is residual O2 left, but I can't imagine the lungs holding that much O2, though.
One of the services I run with is a rural service, and i believe compressions only is just a drop in the bucket. Our dispatch center tries to get bystanders to ventilate the patient as well as compressions until we arrive.

[NC-EMT]

CPR, to me, is useless unless both the cardiac and the pulmonary systems are working in tandem. I would still surmise that within 4-5 minutes of compression alone, brain damage would occur. I am curious as to how effective continuously recirculated O2 could possibly be. I can barely hold my breath for 45 seconds without turning blue. http://www.firehouse.com/interactive/boards/wink.gif

[crossfire]

I have located the report which I referred to in my earlier reply. If you would like to look it up, the name of the report is "A Reappraisal of Mouth to Mouth Ventilations During Bystander Initiated Cardiopulmonary Resuscitation." It was released by the AHA in July of 1997. It can be found in the November 1997 issue of the Annals Of Emergency Medicine. The AHA can send you a reprint at 1-800-242-8721 (US only). The reprint number is 71-0118

Thanks

[bob1350]

Chest compressions are better than nothing, but in our system, we have been taught to get an AED on as quick as possible which is almost as fast as you can start CPR, unless bystanders are already doing it. AED now takes presidence over everything (except for a few protocols). Apply for that grant money now. Thats how our dept. could afford to get all the ones we got