Not your father's CPR

[01101001]

AP: Experts Now Recommend Hands-Only CPR

You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR — rapid, deep presses on the victim's chest until help arrives — works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

Sorry, kids. There'll be no more practicing mouth-to-mouth with your little friend in your bedroom.

A child who collapses is more likely to primarily have breathing problems — and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

Oops. Practice on!

[Moose]

So... If they stop breathing, you do mouth to mouth. If their heart stops, you do chest compressions.

How is this any different from how it's supposed to be done?

Is this article suggesting that CPR (as in m2m + cc) was being taught as some kind of one-size-fits-all thing in lieu of, oh, I dunno, actual judgment?

[01101001]

So... If they stop breathing, you do mouth to mouth. If their heart stops, you do chest compressions.

How is this any different from how it's supposed to be done?

I was taught, oh... decades ago, that if the heart is stopped (and breathing will be too), you did chest compressions and mouth to mouth, interleaved. Sounds like the new recommendation is just the chest compressions as that itself moves the air.

(And it remains that if the heart is beating you do not do chest compressions.)

Edit: In a different article it's made clearer that the advice is not for CPR-trained people. WebMD: Hands-Only CPR Gets Thumbs Up

If the bystander isn't trained in CPR or is not confident in being able to do rescue breaths, then they should only do hands-only CPR until emergency medical assistance arrives or an automated external defibrillator (AED) is available for use.

If the bystander was trained in CPR and is confident in being able to provide rescue breaths with minimal interruptions to chest compressions, then they should give CPR with a 30:2 ratio of chest compressions to breaths or hands-only CPR and continue until an AED is available or emergency medical providers arrive to help.

I guess maybe CPR is still your father's CPR after all.

This new, other thing seems to be for those who don't know how to, or don't want to, do CPR.

[Swift]

So... If they stop breathing, you do mouth to mouth. If their heart stops, you do chest compressions.

How is this any different from how it's supposed to be done?

Is this article suggesting that CPR (as in m2m + cc) was being taught as some kind of one-size-fits-all thing in lieu of, oh, I dunno, actual judgment?

01101001 had it basically correct.

In adults, the main problem is heart failure. And when the heart stops beating, the respirations stop too. The idea of "only compressions" is that keeping circulation going is the most important thing, if you can do that, there is still a little oxygen in the blood, and one of the biggest fears people have with doing CPR is mouth-to-mouth and getting a disease. Plus, I remember reading an article years ago that chest compressions on their own will move a little bit of air in and out of the lungs.

Sure, old fashioned CPR (breathes and compressions) is better, but compressions alone are better than nothing (which is what happens around 70% of the time).

For kids, it is a completely different story. They usually first suffer from respiratory failure, which, if untreated, leads to the cardiac arrest. If they are given mouth-to-mouth quickly enough, you can prevent them from going into cardiac arrest. I also suspect that the average person has less fear about giving mouth-to-mouth to a child or infant.

My personal problem is that I've been taking CPR for almost 30 years, and I thought it for about 10. Just this last year, there was another change in the technique, and it takes this old dog a couple of years to learn a new trick. But as I thought my students, non-perfect CPR is much better than none at all. The patient is already dead, they can't get worse.

[Moose]

What's the new change, Swift? I'm not current.

[grant hutchison]

The European training (which I think matches the US) has been to start with thirty compressions, and then give two breaths, and repeat until help arrives. (That's a de-emphasis of breathing already, since the previous protocol was to start with two breaths, and then give fifteen compressions, then repeat.)

But there's been a lot of evidence that inexperienced people:
1) Will delay or avoid mouth to mouth contact
2) Are pretty hopeless at delivering effective breaths anyway
3) Take a long time out from the compression cycle while fiddling with the airway

Meanwhile, there's scientific evidence that:
1) Gaps in the compression cycle are very bad for your chance of survival
2) Compressions move air in and out anyway
3) Compression-only CPR produces similar survival to the standard method

So this is a new guideline for bystander CPR, in the hope that it will produce better outcomes in the hands of amateurs outside hospital. If you have your cardiac arrest in hospital, someone expert in the technique is still going to secure your airway and ventilate your lungs with oxygen.

Grant Hutchison

[Swift]

What's the new change, Swift? I'm not current.

What grant said. The compressions are also given at a faster rate.

At least I think those are the changes. I've had the new training once and I have to admit that if I suddenly had to do CPR, I would probably, out of habit, do 15:2.

[grant hutchison]

The thinking behind this is outlined in some detail in the AHA Science Advisory (7-page pdf). In particular, it emphasizes that the casualty is going to need some airway/breathing intervention at some point, since the oxygen saturation steadily declines during compression-only CPR.

The rate advice seems to be just "hard and fast", rather than trying to get inexperienced people to reproduce the 100/min compression rate recommended for trained personnel.

Grant Hutchison

[Moose]

At least I think those are the changes. I've had the new training once and I have to admit that if I suddenly had to do CPR, I would probably, out of habit, do 15:2.

I likely would as well. It's hard for me to untrain something I've trained myself to do, right or wrong.

[HenrikOlsen]

I remember the early years when I was taught CPR, the rules was if the heart was stopped, to start with three strikes to the chest, then check again.
I believe the thought at the time was that if the heart hadn't actually stopped but was in fibrillation this might be enough to break the heart out of it, either to get beating again or stop completely so it wasn't actively counteracting the subsequent pumping.
This changed so this shouldn't be done, possibly to prevent perforated lungs after adrenalin-boosted blows by a near panicking helper

I haven't kept my training current, so I'm still at the 15:2 which I expect is still considered better that hand-wringing bystanderism

[Swift]

I haven't kept my training current, so I'm still at the 15:2 which I expect is still considered better that hand-wringing bystanderism

Absolutely correct ( I like "bystanderism" ).

By the way, the thump on the chest can get a heart out of fibrillation, but only if it is done within the first few moments (the heart has to still be very well oxygenated for one) and if done properly. So, in theory, it can be helpful for a witnessed arrest and a well trained rescuer.

But that so rarely happens, and it is much more likely that all that will happen is the rescuer will just break a bunch of ribs, that it was dropped long ago.

[Extravoice]

My office is due for its annual Red Cross CPR retraining sometime next month. It should be interesting to see if they change the program that quickly. If it has boiled down to "press hard and fast", the training is going to be short this year

In one of the previous trainings, they told us that if the person is not breathing, we should start CPR without checking for a pulse. The reasoning is that most (untrained and minimally trained) people have trouble determining if a person has a pulse and waste lots of time trying to find one. They also sometimes find their own pulse, which delays the application of CPR.

As for your "father's CPR", I recall learning rescue breathing techniques called "back-pressure arm lift" and "chest pressure arm lift" back in the 1970s. I can also recite the definition of First Aid from memory. That may come in handy if I ever find myself on a trivia game show.

[Theunknownbook]

This new, other thing seems to be for those who don't know how to, or don't want to, do CPR.

compressions alone are better than nothing (which is what happens around 70% of the time)

So this is a new guideline for bystander CPR, in the hope that it will produce better outcomes in the hands of amateurs outside hospital

I'm guessing these are most likely the reasons