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Permalink Reply by Andrew on October 15, 2009 at 2:31am

I read the same exact article.

I assumed when learning CPR that giving "life breathes" was an essential part of cardiopulmonary resuscitation as it deploys a decent amount of oxygen into the lungs.

Maybe someone with more knowledge on the matter can enlighten us.

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Permalink Reply by Ron Hood on October 15, 2009 at 3:12am

I saw the same article on CNN, here in my neighborhood of Az, we have been practicing this for about a year. Its called CCR, CardioCerebral Resuscitation. Its got a much higher survival rate. Alot of people think that when they need to perform CPR they need to breathe for the patient, and alot of folks think there is a liability, which there isnt and unsafe for their health which could be true. But especially if you witness the attack, there is plenty of oxygen in the blood and keeping it circulating is much better than doing nothing, especially in the first few minutes, we all know this. Now, there are some circumstances on when you do and dont do it, but assuming the situation is right for it, it makes a ton of sense. Here you place the patient on a non-rebreather and do 100 compressions a minute, for 2 minutes, analyze and repeat as necessary. The fact behind this is that your compressions are moving air in and out of the lungs and ultimatelly supplying the patient with air on every compression vs your 2 breaths every 30 secs, not to mention stopping blood circulation for your 2 breaths. Thats our protocol here, but it is not being used in most places and I believe it should.

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Permalink Reply by Dustin J. Millis on October 15, 2009 at 5:11am

I agree with you 100%. I just took a re-cert on my CPR a few months ago. The American Red Cross is still going with 30 and 2 for CPR. From what I heard they are moving twoards going to 50 and 2. They are also trying to write a protocol of when you should use CCR rather CPR. As you said, the survial rates seem to be much higher.

It was kind of hard for me to understand at first the way I read about it but my instructor made it sound really simple.... Your heart PUMPS your blood through your body. PUMPS require PRESSURE. It takes approx 15 to 20 compressions just to build enough pressure to start circulating blood. Once you stop and give two breaths, you lost all your pressure. Thats why the ratio 5 to 1 was thrown out a few years back, we learned it was doing absolutly nothing. Doing only five compressions never built enough pressure to actually circulate any blood flow. It seems that 30 does create enough pressure but if it takes 20 compressions to get the pressure, then you are really only circulating blood for 10 compressions.

It does seem that the more compressions that are done, the higher the success rate will be. I'm not sure when The ARC is going to pick up on this but the sooner they do, the better.

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Permalink Reply by Ben Waller on October 15, 2009 at 5:26am

There is a good discussion of the merits of CCR vs. CPR on JEMS Connect here.

The deciding factor is a sudden cardiac death patient (usually ventricular fibrillation, usually shockable) from a hypoxic arrest patient (usually from a prolonged period without oxygen, usually not a shockable rhythm).

Adults who have sudden cardiac death do indeed have oxygenated blood in the arterial side of their cardiovascular system. These patients have enough oxygen in their bloodstreams to keep their cells alive for a while without ventilations.

Pediatric patients usually suffer cardiac arrest secondary to respiratory failure, trauma, or infection. They tend to be hypoxic for a long time prior to the cardiac arrest. The same is true for adult patients who have cardiac arrests secondary to respiratory failure from drowning, carbon monoxide poisoning, smoke inhalation, choking, or other respiratory failure cause. Those patients will probably benefit from ventilation along with CPR, as long as CPR is not interrupted to establish the airway and the patient is not over-ventilated.

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Permalink Reply by blair4630 on October 15, 2009 at 6:41am

Dustin and Ron said alot of what I was going to say, so I'll just add that with all the research and evidence-based studies that have been done on this (and many other areas of resuscitation, like theraputic hypothermia), that I would expect to see big changes in the 2010 AHA guidelines.

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Permalink Reply by Paul Montpetit on October 15, 2009 at 7:20am

The issues with using breaths and not using them stems from a study of hemodynamics...doing chest compressions moves blood faily well, and it keeps the pressures up...AS LONG AS COMPRESSIONS CONTINUE...but as soon as compressions stop so does the pressure...then it takes approximately 10-12 compressions to get it back up...so they have determined that "Fast and hard" is better than doing it the older way...American Heart and American Red Cross still teaches the old way for now....There is another issue to mention as well...they have found that people (non-professionals) are more likely to perform non-breath CPR than the old way (Due to fear of disease)...According to the research that I have read it IS and effective method if done promtly.....Will be interesting to see where it goes......Stay safe...Remember to Keep the Faith....Paul

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Permalink Reply by Andrew Dalgarno on October 15, 2009 at 9:08am

I did my FA/CPR re-cert (Canadian Red Cross) a couple of years ago. Not sure if what is being taught North of the 49th is any different, but they were teaching us 30 compressions and 2 breaths for one person CPR, but if two guys are there, we shouldn't stop compressions...continuous compressions with 2 breaths every 30 seconds.

Keep in mind, we don't do BLS/ALS. We are a fire department only, unless the paramedics get 911 to dispatch us for an assist. So we don't have an AED available until the paramedics get there.

Andrew

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Permalink Reply by Station10Capt106 on October 15, 2009 at 9:10am

I am an AHA CPR Instructor and yes, there has been research and discussion about hands only cpr. The AHA doesn't have a certified course in hands only CPR at the moment but has been studying it. They have found that what kept the lay person from doing cpr the most was how "complicated" it seemed.

They then looked at the essential parts of CPR and determined that the primary goal is to do compressions and circulate the blood through the body. Just the simple act of compression does create a negative air void in the lungs and upon release the vacuum that is created will pull in air, albiet not as much as we can deliver w/ breathes or O2 enriched.

We have been telling our Heartsaver classes (for the lay person) that hands only is an option if you are unable or unwilling to provide breathes.

I saw the article yesterday and that is the first time I have seen mentioned that hands only CPR is used and taughted in any professional capacity.

John

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Permalink Reply by Marc on November 4, 2009 at 9:20pm

hahahahahahahahaha!
I just re did my CPR cert yesterday, and someone brought this up during the class. The American Heart Association says that breaths are no longer required, while the AMerican Red Cross still say that breaths are required. It all depends on who ur do your CPR with.
I did ARC so i still do the breaths.

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Permalink Reply by Jen Ferrari on November 4, 2009 at 10:09pm

when i was getting recertified this summer my instructor told me that if it was an adult and if i didnt have any form of a mouth barrier, then i did not have to perform breaths, all i had to do was compressions. but if you need to perform CPR on a child no matter what, you have to perform breaths. i understand where they are coming from with the adult if you have no mouth guard, but still, i think that it is between life and death and i would still choose to give that person breaths. and if they still didnt make it after i did that then it is out of my hands and i knew that there was nothing more that i could do. if i never performed breaths, and that person died i would feel at fault for not doing more. but that is my personal opinion.

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Permalink Reply by Jen Ferrari on November 4, 2009 at 10:10pm

isnt the ABCs airway, BREATHS and then compressions...seems kind of silly to me

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Permalink Reply by Rick K. on November 5, 2009 at 12:44am

I herd about the study they were doing over 3yrs ago in arizona and from what i'm gathering compressions are going to increase and do away with the 2 breaths!!

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