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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 FFN WebTeam on
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Permalink Reply by Station10Capt106 on
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thanks, was trying to get the video to show like that but for some reason couldn't.
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Permalink Reply by Matthew Powers on
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My understanding is that in Maine the standard of care requires ventilation. These standards are contingent on isolation masks being available. Personally I would not put my lips on anyones except for my wifes. If I did not have a mask, the state can not require I vent. I have only had to do CPR in the hospital environment and we used an ambu bag through an ET tube with continuous compressions. We stopped for 15-20 seconds for the intubation. I think the theory is valid but if there are 2 rescuers and an isolation device I see no reason to withhold ventilation. Compressions move air, but I believe most of this is lost in the upper airway. You can really open up the lungs with a breath or a bag.
When you will be doing CCR, are you allowed to vent if you have the resources?
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Permalink Reply by FETC on
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As far as I know, it hasn't been adopted for professional rescuers who have the equipment and training to perform CPR within their Scope of Practice.
This video mentions untrained, non-certified, The State of Arizona approved/ Good Samaritan Law will cover you (Not Us) and "When Rescuers arrive" then they would provide ventilation.
Interesting? I gotta ask, so your EMS is not going to ventilate a patient? For how long may I ask?
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Our healthcare system which oversees EMS and fire dept's are adopting it starting June 1. Our protocols will be doing 3 sets of 200 compressions w/ defib prior to intubating and then providing ventilations. The theory is that hard & fast compressions will perfuse the body and that there is adequate oxygenation of the blood to support 10-15 minutes of CCR.
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10-15 mins huh. Thats interesting, if I hold my breath for 4-6 minutes I will die...
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that is not saying that you have a closed or compromised airway. The air way would be opened, but compressions will take precidence over ventilation. I'm not saying that I totally agree with it but they have been following the studies done in Arizona and believe that this will provide better results for the patients.
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I understand the hard and fast, without interuption of ventilations so you can maintain a survivable blood pressure. totally agree with that. Previously we were not perfusing victims to survive or respond to intervention.
Where and who are you following for accrediation on the 3 sets of 200 compressions? That is not AHA or RC. This was first looked at for bystander or non-protected rescuer, hands only CPR instead of doing nothing.
But without ventilations for 10-15 minutes?
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The logorhythim we will be following is:
For Cardiopumonary arrest of cardiac or unknown casue begin CCR prior to standard BLS, CPR or ACLS.
Begin Continuous Chest Compressions (at rate of 100/min) while applying defib bads/analyze rhythm. Insert OPA and apply NRBM @ 15L Oxygen
Analyze Rhythm and if shockable shock. Administer 200 CCC, Inititiate IV or IO, Administer 1mg Epinephrene q 3 min.
Analyze Rhythm and if shockable - shock. Administer 200 CCC
Analyze Rhythm and if shockable - shock. Administer 200 CCC
Insert non-visualized airway or ETT/PPV 8-10/min
Resume standard ACLS
This should take 8-10 minutes and if first responders/bystanders have already initiated CCR then we also take that into count and resume at the appropriate spot.
We follow the AHA guideline for CPR, but our medical direction from our healthcare provider decided to initiate CCR.
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Permalink Reply by Oldman on
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I think this will follow along with the new AHA guidelines coming out in October. Less emphasis on ventilations and supplemental oxygen.
The theory is that we really haven't been doing much for the patient with high flow O2, we have been blowing off too much CO2, thereby throwing the acid/base balance off to the detriment of the patient. The body cannot tolerate being alkyalotic as well as being a little acidotic.
If one looks at the physics of compressions, each time we compress the chest, the patient exhales. When we relax the chest, normal expansion occurs, and air is brought into the lungs. This has been made more evident when utilizing devices like the Autopulse and Lukas. As a result, effective compressions keep the perfusion to the vital organs, the exchange of some air lessens the chance of upsetting the acid/base balance, and so far some studies suggest a better outcome.
Of course the wind will change direction again, and another study might say there will be a better outcome if we stand them on their head.
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Permalink Reply by MInnFIrefighter on
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I am by no means an expert so sombody please help me out if these seems wrong.... the goal of compresions is to distribute blood to the body, because the heart has become un able to do so. that being said the body needs that blood to be enriched with oxygen ( that is the bloods main purpose). so... what good comes from pumping oxygen defficent blood?? i have understood CCR to be for untrainned and unequiped people how may witness an full arrest.....
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Minn, the blood does not collect all available oxygen during respiration. In fact we usually exhale about 17% oxygen compared to the 21% we inhale. This is one reason we can hold our breath for as long as we can. This also accounts for how skip breathing helps us conserve air in SCBAs. We can utilize the oxygen level below the 17% level if the level in our blood drops low enough.
Chest compressions also move air in and out of our lungs. The amount is small but significant in preventing death. Our lungs are located with the heart in the thoracic cavity in the chest. Pushing down on this cavity to pump the heart created a high pressure and expels gases from the lungs. Releasing pressure from the compression expands the cavity and creates a negative pressure in the chest for air to move in.
I hope this helps clear things up.
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