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Has Your Department Started Using CCR?
Our EMS service and county departments are switching protocols to start using CCR - Cardiocerebral resuscitation which is hands only CPR. Statisitcs have shown that the save rate can be as much as 10 times better than using traditional CPR.
If your department has been using CCR what can you tell us about its success or failure? What are the pro's & con's of using it.
https://www.youtube.com/watch?v=yjue2F4HoWI
Replies to This Discussion
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Permalink Reply by Capt./Chaplain Mike Petrosky on
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push the blood around but no need to oxygenate the pt.-interesting concept, I thought the brain needed O2 to support life. I suppose it will be easier for "untrained by-standers" to remember.
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Permalink Reply by Matthew Powers on
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Mike, remember that we are in a lawsuit happy world now. Some see this as once you are trained you will be obligated to give breaths. This is not a good way to get people to be willing to do CPR. If you give them the option of compressions only, they will perfuse the cells longer. I do not think it will move enough air to support the brain forever, but if it gives you 5-10 minutes and saves a life, you can bet someone will be happy.
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Permalink Reply by ff/emt 2155 on
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for the lay person any type of cpr is good but i firmly belive the pt needs o2 also if i;m by myself whell i have no choice but to ccr i also can understand theory of throwing off gases with high flow o2 but again i think you need o2 also our protocols are 35 comprss 2 hits frm ambu bag 35 pumps then hit with paddles no ambu bag after shock right back to compressions, even befor this came out people were just doing compressions only and if raised the bar from 5% to 10% survival i guess it works only time will tell with stats
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Permalink Reply by Tom Bouthillet on
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A couple of observations.
First, there's no question that continuous chest compressions are saving lives. Second, ventilations are unnecessary in the first several minutes after the onset of sudden cardiac arrest. Third, the vast majority of patients in cardiac arrest are hyperventilated which dramatically worsens their outcome, so let's place the blame where it belongs.
This was well known at the ILCOR conference in 2005. Unfortunately, there was a disconnect between the science and the BLS for Healthcare Provider course as well as the ACLS course.
Consider the following:
From Controversial Topics from the 2005 International Consensus Conference on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations - Resuscitation 2005; 67: 175-179:
"Animal evidence and one large case series suggests that ventilation is unnecessary for the first few minutes after primary VF cardiac arrest. But ventilation is important in asphyxial arrest (e.g. most arrests in children and many noncardiac arrests, such as drowning and drug overdose). Some conference participants suggested that recommendations provide the option of omitting ventilation for the first few minutes unless the victim is a child or the possibility of asphyxial cardiac arrest exists (e.g. drowning). To simplify lay rescuer education, the consensus among conference participants was to strive for a universal sequence of resuscitation (emphasis added).
And then in the next section:
"The obvious challenge was how to translate the need to increase chest compressions into recommendations that would be simple and appropriate for both asphyxial and VF cardiac arrest. There was agreement that continuous chest compressions could be appropriate in the first minutes of VF arrest, but ventilations would be more important for asphyxial arrest and all forms of prolonged arrest. There was also agreement that it would be too complicated to teach lay rescuers different sequences of CPR for different circumstances (emphasis added). For simplicity, a universal compression-ventilation ratio of 30:2 for lone rescuers of victims from infancy (excluding neonates) through adulthood was agreed on by consensus based on integration of the best human, animal, maniken, and theoretical models available. For two-rescuer CPR in children, a compression-ventilation ratio of 15:2 was recommended."
So why were professional rescuers treated like laypersons? You tell me. Regardless, ventilations need not interrupt chest compressions if the code is run properly.
What's stopping professional rescuers from initiating continuous chest compressions, dropping a blind insertion airway device (like the King LT-D) and delivering asynchronous ventilations at a rate of 6-8/min. (every 8-10 seconds)? It's working great for Wake County EMS.
Bottom line: all this talk about the "standard of care" is nonsense if you're not even measuring your "call received-to-first shock" interval or the number of patients who walk out of the hospital neurologically intact.
The vast majority of EMS systems in the country are saving 5% of their cardiac arrest victims (or less).
Tom
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Permalink Reply by FETC on
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I understand the theory of non-moving oxygenated blood and CCR, plus the layperson lip on lip issue as compared to no CPR all together, but I had never heard about professional EMS services going to CCR in their protocols.
I am an AHA instructor.
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Permalink Reply by Capt.Alex Arnold on
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OK first off for all of the AHA instructors (of which I am one) OPEN YOUR MIND AND DON"T BE AN AHA ROBOT. I am not saying that AHA is a bad thing. The exact opposite is true. AHA is a great organization that has been teaching people how to save lives for decades. The one :( thing is when they left the non-profit status behind and went to for-profit. Now I see that they are falling behind in standards and then have to continually play catch up with others every 5 or so years when they release new curriculum.
CCR is a bit above and beyond AHA right now. There are agencies that are using CCR protocols and guess what, it is working. These agencies aren't just making an uneducated decision about CCR. They have a cooperative effort by the agencies, MPD (Medical Program Directors), and Health care facilities in their regions/areas.
I mean for those of us that have been around for a while and especially us that have been teaching CPR for a long time are use to the grumbles. Just about every time they changes the standards there is always those out there that are going to give "kick-back" about it.
Yes, this is a new and effective method. It appears to be working. Let us remember that things change in this service. We are constantly finding new and better ways to be more effective at saving lives. Change happens.
Be safe and learn something new today.
P.S. No, we are not currently using CCR only standards. We are working with our MPD and medical centers to see if we want to go this direction.
P.S.S. To kind of put a “bee in the bonnet”, they are also looking at the possibility of removing ET’s from the airway standard for advanced airways in cardiac calls. The numbers are showing that an ET does not have an effective on the outcome of the patient. I would not be surprised if we see in the future ETs only being used by Paramedics and only in the case of a respiratory emergencies and traumas, not cardiac. Think about that one.
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Permalink Reply by Shareef Abdu Nur on
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We have adopted the American Heart Association's new updated ACLS protocols in regards to more uninterrupted compressions and less breaths, but we have not been introduced to the hands only CPR.
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I just have a quick (kind of smart-ass) question for yea FETC. Has your organization adopted NFPA, completely. I am going to guess no (Only a couple of agencies in the country have stated that they well follow all NFPA standards as their own. They are now looking at that decision because of financial reasons. Every time the standard changes they have to upgrade to it.
Now, like here, we use the NFPA to build our standards that work best for organization. The same is true for EMS. We work by protocols that are developed by the Medical authority (MPD in our case.) the MPD sets the protocols for us to use in the field. Like many other directors, when it comes to cardiac care, they just rubber stamp it with the old "Use current AHA standards." Well, there are agencies and communities that have found a new and "better for them" standard. The director saw enough sufficient evidence to step outta the box and say, "I am not going to rubber stamp this protocol. Instead we are going to using 'X' protocol." Remember that it is the final decision of the local agencies to decide what is best for their communities, not people in an office in downtown Dallas.
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The AHA is not "for profit" they are "not for profit" which only means that profits are invested back into the mission statement as opposed to being paid out to shareholders, but I agree with your sentiment. They are behaving like a "for profit" company and it's hurting their mission. Why should medical professionals like paramedics have to pay outrageous fees to read peer reviewed articles about heart disease?
Tom
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Tom- Thank you for that clarification. I agree 100%
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Permalink Reply by Jason Whitaker on
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I thought it was called CCC thats ok too I think my department is thinking about using this method but not sure yet since Illinois has to approve it
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Permalink Reply by MInnFIrefighter on
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Ok, thanks this really shines a light on things for me..... as for skip breathing,,,, well we can save that for another discusion. thanks for the info.
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