Kickstart a heart

April 8, 2007 10:50 PM

PSAFilter: I was trained to do CPR wikipedia with a 15:1 compression to rescue-breath ratio. This is no longer recommended. In fact, for just-collapsed people, a recent study shows performing CPR without any-rescue breathing is better: although some think the type of collapse is important. Learn how to do CPR near you: any valid attempt at resuscitation is better than none. You could save a life.
posted by lalochezia (28 comments total)

Paging Ikuyyu2 and other doctors. Your opinions on the Lancet study and general ways to make people more cardiopulminonarily first aid aware pls.
posted by lalochezia at 10:51 PM on April 8, 2007

Just don't randomly stop giving aid once you start.

Just had my CPR recert... things are certainly a lot simpler now, especially now the portable auto defibrillators are showing up in more and more places.
posted by edgeways at 11:09 PM on April 8, 2007

I just renewed my CPR training and this was the new thing. Interestingly, when I took it before, they were already prepping this new 30:2 thing but wouldn't train us on it. After we had learned 15:1 the guy said "if my grandma went down, though, I'd do 30:2."

I second the "everyone should learn CPR" and add that you should get first response training too, just so you know some basics on what to do and what not to do when confronted with an injured person.
posted by BlackLeotardFront at 11:09 PM on April 8, 2007

MetaFilter: mouth-to-mouth may not be necessary
posted by pruner at 11:13 PM on April 8, 2007

How is 30:2 different from 15:1? My math education tells me they're the same.
posted by Citizen Premier at 12:16 AM on April 9, 2007

Citizen--

30 pumps, 2 breaths, vs. 15 pumps, 1 breath. Looks like the loss of that one pump hurts more than the extra breath helps.
posted by effugas at 12:24 AM on April 9, 2007

Someone collapsed in our home last fall, and my husband and I rendered aid--which is to say he did CPR while I conveyed instructions from the 911 operator until the paramedics arrived. She directed us to use the 30:2 method, which was news to us (both trained in CPR decades ago).

Happily, the victim, who had had a heart attack and was not breathing, survived with no brain injuries. The success rate for CPR is not encouraging, but in this instance, 30:2 worked beautifully. That, and a quick response from the local paramedic unit--which is an important reason not to get rid of your land line, if you were leaning that way. We were able to immediately connect with local emergency support staff who dispatched help to our door, while every time I've called 911 from a cell phone, I've gotten a busy signal!
posted by Scram at 1:01 AM on April 9, 2007

Scram--

I've called 911 several times while travelling, and each time I've ended up at my local 911 dispatch. Who's your provider?
posted by effugas at 1:04 AM on April 9, 2007

The most interesting part I found about the new CPR guidlines is removing the pulse check. The reasoning is sound though, when tested not even anaesthetists were able to find a pulse in an emergency situation enough times for it to be worthwhile.

As an aside, we've currently got a guy on my ward who had a heart attack and whose son rescusitated him. Unfortunately he wound up with an hypoxic brain injury as a result (hence him being on a neuro ward). We all secretly wonder if the son isn't wishing he hadn't saved his dad...
posted by Silentgoldfish at 1:25 AM on April 9, 2007

I'm betting the decision on new CPR procedural refinements goes to some elite medical committee who's members are all protecting their theoretical ballywicks. Sooner or later, the formula's going to end up being 52/Pi:7B (where W is the victim's blood type)...

Instead of adding complexity in pursuit of some esoteric higher level of physiological perfection, I believe they should simplify the CPR procedure to an absolute minimum so that more people may actually learn and remember it, and then be able to actually have a chance of effectively applying it in a paniced emergency situation.
posted by fairmettle at 2:33 AM on April 9, 2007

Uh, what? Did you even read the article? What you're suggesting is exactly what they did: simplify it to make it easier to remember.

They've done away with steps that didn't really work (like the pulse check), they've simplified the ratio of compressions to breaths to 30:2 for everyone (used to be different ratios for kids and infants) and they no longer have any guidlines on when to stop.

It's also recommended to no longer just to rescue breathing alone -- either do the lot or don't do anything so that's a whole nother list of things that don't need to be remembered any more.
posted by Silentgoldfish at 2:48 AM on April 9, 2007

Good posting, but...

earn how to do CPR near you:

We seem to be getting a lot of MeFi postings that assume the reader is American. I'm fairly sure, from experience, that MeFi is read by lots of Brits, Aussies, Irish, Canadians, and others.

I'm not asking for cultural contextualization for every posting. I just ask that posters don't assume the readership of MeFi is exclusively US.
posted by humblepigeon at 3:12 AM on April 9, 2007 [3 favorites]

I've heard rumblings about this for a couple of years now, and this is the way my wife, a doctor, has explained it: Lay-people almost universally do CPR wrong, training or not. So giving them simpler instructions that have a not-much-worse chance of working when done right actually have a higher chance of working when done by a lay-person.

Code Blue procedures in hospitals as well as EMT procedures are very unlikely to change as a result of this study.
posted by Plutor at 4:44 AM on April 9, 2007

We seem to be getting a lot of MeFi postings that assume the reader is American.

Since 2000, CPR guidelines have been promulgated through ILCOR, the International Liason Committee on Resuscitation. Their goal is to standardize CPR instruction worldwide. ILCOR does not have a web site, but the European Resuscitation Council does.

Plutor is right that most of the changes are meant to make basic CPR easier for lay people; if anything the guidelines for CPR, ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life support) for health professionals tend to become more complex over time. For one example, there is now a stroke algorithm as part of ACLS; it was optional in the 2000 guidelines and was not taught at all before that. The entire current guidelines are published in Circulation (I am at work where I can view it with our institutional subscription; I think this issue is available to the public, though).

There are two facts behind the changes mentioned by the original poster. The first is that without a fair amount of training and experience maintaining an airway and providing artificial ventilation is difficult. Many physicians, nurses, and EMT's struggle with it; someone with minimal training is very likely to be wasting their time, even on a patient with a relatively easy to manage airway. Second, early defibrillation is the key to survival if the patient is in ventricular fibrillation or pulseless ventricular tachycardia; the likelihood of succesful defibrillation decreases about 10% per minute. Early access to defibrillation is much more likely now with the availability of AEDs. After that crucial ten minute window passes, however, a patient will need rescue breathing, but defibrillation will be unlikely to succeed anyway.

The shortcoming to this approach is that there are a number of situations where the simplified CPR will not work. For example, in the case of a respiratory arrest (which is the most common cause of cardiac arrest in children) rescue breathing is needed. There are other situations (certain drug overdoses, cardiac arrest with hypothermia) where prolonged resuscitation may be needed before defibrillation will work. The hope is that trained responders will arrive in time in those situations.

I posted a related AskMe last year.
posted by TedW at 6:01 AM on April 9, 2007 [1 favorite]

Plutor: EMT procedures haves changed. The same guidelines apply in health care centers and lay-person CPR (the difference being only in the use of additional equipment).

The rhythm (at least in Europe and AFAIK in the US) used to be 15:2, so now we have added compressions. In fact, guidance given to lay persons in Finland by phone ignores mouth-to-mouth unless the patient has drowned, suffocated or is a child.

The findings are that efficient compressions are much more beneficial than fumbling with mouth-to-mouth (which isn't easy). And this also helps keep the rhythm of the compressions at a decent pace (100 compressions per minute).

The current guidelines are a welcome change since they really do simplify things. In fact, the most significant change is that assessing whether the patient is breathing or not must not take longer than 10 seconds after which CPR should begin. That's why checking for a pulse isn't a part of the guidelines any more. Finding a pulse is sometimes hard enough as it is and may cost valuable seconds (or even minutes).
posted by raminm at 6:10 AM on April 9, 2007

I can't help but add that "the father of CPR" was an anesthesiologist.
posted by TedW at 6:14 AM on April 9, 2007

Humblepigeon : apologies. I'm a brit who's living in the US. I learned my cpr through my university in blighty.

This may be a place to start for the UK.
posted by lalochezia at 7:05 AM on April 9, 2007

I have never personally had to do CPR, but working in a 9-1-1 center, I have given instructions over the phone numerous times. Believe me--simpler is better when dealing with the public.
posted by leftcoastbob at 7:26 AM on April 9, 2007

Related: Lessons of Heart Disease, Learned and Ignored. Great NYT article on how one of the biggest factors in surviving a heart attack is just recognizing that you're having one: the average patient doesn't even call 911 for 111 minutes, and many patients make the fatal or debilitating mistake of getting to the hospital by themselves or having someone drive them. This means they don't start getting care until after they arrive, with inevitable delays. Medical science has progressed to the point that many patients can be saved, but especially so in the golden hour right after the attack begins, yet the number of patients who get care in time is not increasing.

Also, there is poor education regarding the symptoms of a heart attack, and many post-attack patients voluntarily discontinue their medication, or have doctors who fail to make sure they do. If you've had an attack, you're generally supposed to stay on the meds for the rest of your life.
posted by dhartung at 7:33 AM on April 9, 2007 [1 favorite]

I'm a lifeguard trainer with the RLSS and we've been using the new guidelines since September last year. The changes brought in were to make it simpler for the general public (who might only do a one weekend first aid course) and also to standardise worldwide as they have been adopted by the American heart foundation and European resuscitation council and the various other bodies worldwide.

Lifeguards are trained to differentiate between the causes of collapse (heart attack or drowning related) and to treat accordingly. If it is drowning related 5 Rescue breaths are given before commencing full CPR, same goes for CPR on children and infants.

Also AED training is becoming much more prominent. Most pools, leisure centres and Hotels now carry AED's so training on these is vital as they significantly increase the chances of survival.
posted by TwoWordReview at 8:21 AM on April 9, 2007

Good points, TwoWordReview, but did you perhaps mean this RLSS?
posted by TedW at 8:38 AM on April 9, 2007

Yup, certainly did TedW, my bad!
posted by TwoWordReview at 9:40 AM on April 9, 2007

working in the back of an ambulance, cpr is utterly different. Although american heart recommends 30:2 counting "one one thousand, two one thousand..", on a real body you go much harder and faster than you learn in cpr, and only breath when pulse is evident from the thrusts. There's no point in oxygenating blood if there's no perfusion to vital tissues, which is much more important. If you find a pulseless body, you start CPR without any hesitation-so long as you know where the pulse should be (carotid, brachial, femoral..) It can work and bring someone back to life, which is why cpr ought to be a high school required class - imho

Another emt tip: if youre not breaking ribs, youre not doing it deep enough. sad but true. still, better alive with broken ribs than leave a pristine corpse.
posted by sarcasman at 11:00 AM on April 9, 2007

EMT procedures are very unlikely to change as a result of this study.

wanted to second raminm, emt guidelines did change to the 30:2 everywhere i'm aware of.

maintaining an airway and providing artificial ventilation is difficult. Many physicians, nurses, and EMT's struggle with it

no joke, did cpr for my first time christmas day in a room full of firefighters and medics. sarcasman is right, lots faster in real life. patient was intubated and i also got to use the bag for my first time and even with coaching as i was doing it, it was hard to not screw up a little (too much air mostly). whole different set of rules they never even mention in emt training for that situation. cpr's also harder work then you think.

as some nurses have explained the possible no rescue breathing changes to me (aside from the simplicity mentioned above) is that evidence (i haven't seen with my own eyes) suggests that people don't do cpr in some instances because of a fear of locking lips with a stranger. so they don't do anything. you can get key chain cpr masks for cheap with a quick google search.
posted by andywolf at 11:21 AM on April 9, 2007

"you can get key chain cpr masks for cheap with a quick google search."

...or a quick trip to a local Red Cross office. Most of them will sell such supplies.

Sadly, I have encountered many people that said they wouldn't jump in and give CPR because they are deathly afraid of being sued, regardless of the Good Samaritan laws that are supposed to protect them.

I re-certified through the AHA (BLS for Healthcare Providers) a while back and even for us they've de-emphasized checking for a pulse.

"Push fast, and push hard."
posted by drstein at 12:16 PM on April 9, 2007

"Push fast, and push hard."
posted by drstein

Advice for both obstetrics and CPR.
posted by leftcoastbob at 2:37 PM on April 9, 2007

"cpr's also harder work then you think."


Without a doubt! I once had to give compressions for 20 minutes and I was completely spent by the time we got the patient to the hospital.
posted by blaneyphoto at 3:08 PM on April 9, 2007

"Advice for both obstetrics and CPR."

Dude, explosive deliveries are not pretty at all. heh.
posted by drstein at 4:21 PM on April 9, 2007