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Hands-Only CPR?
so im sure everyone has seen the news report, they are trying (and starting) to shift over to hands only cpr. hands only cpr is pretty much what it sounds like, only using your hands. ; meaning you do not take rest periods to provide breaths. they are changing the order from a,b,c to c,a,b. they belive that when the person goes down they still have enough oxygen within their blood system that their brain can function, as long as the blood keeps flowing through the body
now ive had several conversations with my EMT-B instructor and we have come up with the conclusion that there is not a high probablity with the fact that their IS enough oxygen within the blood system, one major problem is how long has the person been down before someone finds them? if its been ten minutes is that oxygen within the body still there or even usable? we believe that the only reason why they are introducing this is to get the public more invovled into CPR, that when someone goes down they are not afraid to jump in and help; because they dont have to put their mouth on someone they dont know only push.
what i also want to know is if they plan on bringing this into health care protocols for health care responders or if this is only a public responce thing.
im just curious as to what you guys know about this method and how you feel about it, feel free to give its ups and downs.
Thank you, ill provide some links regarding handonly CPR
http://www.americanheart.org/presenter.jhtml?identifier=3060861
Replies to This Discussion
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Permalink Reply by Mark Oomkes on
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You're partially correct. Yes it is to reduce the "ick" factor.
It is supposed to be only for general public, EMS is supposed to continue with compressions and ventilation.
The other factor you're not coming up with is, if the heart is weakened from the arrest in the first place and not pumping or pumping inefficiently, defibrillating that heart is potentially harming it. Whereas, performing a couple minutes of CPR (unless the arrest was witnessed) it helps oxygenate the heart and the defibrillation will be more effective.
If the patient has been down for 10 minutes, it's unlikely anything is going to bring them back unless it was a cold water drowning.
Someone did some research as well, can't remember where, but the survivability increased a bunch by doing this. I want to say Phoenix and\or Seattle. Might want to do some research on these studies, I don't remember all the details, but we started hearing it 2 years ago and were told it was in effect a year ago at our last recert.
IMHO, it can't hurt, how many true saves are there without an AED and CPR only?
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Permalink Reply by Dale on
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i was not too sure how it was supposed to effect the EMS side, thanks, and i knew they were talking about it 2 years ago, im just now starting to see action
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Permalink Reply by Nick S on
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What Mark said is correct about the weakened heart, the "ick" factor, and partially about the existing O2 in the blood stream.
Another reason this works is because the average person doesn't walk around with an O2 tank for supplemental oxygen that someone will need during an arrest.
Which all leads to the point; the way compressions work. As I'm sure you are well aware, they change the intrathoracic pressure. So when you push, the heart squeezes. Well, what else is also in the same cavity in your body? Your lungs are! So during compressions there is some air exchange, not a lot, but some. This air exchange, according to the AHA, is sufficient for bystander CPR. Of course once someone who knows how to manage an airway and can ventilate with supplemental O2 arrives, oxygenation should certainly accompany compressions.
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Permalink Reply by M.J. 6821 on
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From what I understand the reason that they have been moving to more compressions and less breathing is it takes quite awhile for the blood pressure to get up to a level where the blood will be moving so if your stopping after 5 compressions the air that you breathe in is probbly not going to get to the brain anyway but if you keep compressions going the oxygen thats left in the blood stream will still be getting to the brain just at a smaller rate. And one other thing that I have been told is it lowers the end tidal CO2 which is actually pretty important in survivability of cardiac arrest.
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Permalink Reply by John Crabbe on
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First off all, these studies are not far off base here and there is more to this than just an "ick" factor. Out of those depts where the study was implemented, they found better survivability rates from compression only with pts walking out of the hospital.....moreso than just getting a pressure and pulse back.
This is why we also have seen a change in the standards of 30:2, vs 15:2 and also why intubation and abdominal thrusts are not a part of the standards as they were before. However, there is further talk in even professional responder CPR being even less invasive, meaning breaths and bagging the pt is being looked at. It is possible in the future you will see compressions with placing a non-rebreather O2 mask on the pt.
one major problem is how long has the person been down before someone finds them? if its been ten minutes is that oxygen within the body still there or even usable? we believe that the only reason why they are introducing this is to get the public more invovled into CPR, that when someone goes down they are not afraid to jump in and help; because they dont have to put their mouth on someone they dont know only push.
Somewhat for the lay person, but for most paramedics, if this was an unwitnessed arrest, with an unknown downtime, is typically a basis for calling the code in the field. Barring some unusual circumstances like hypothermia or drowning victim, the chances of a victim unwitnessed arrest and downtime and they are asystole, they are going to stay that way....meaning resuscitative efforts most likely won't be done.
So basically, worrying if there is enough, or usable, O2 in the blood after 10 minutes is a non-issue. Most likely the person is dead. 10 minutes is a very long time. The issue with compression only CPR and having enough oxygen in the blood is when this is a witnessed arrest and CPR is started right away. The O2 in the blood is enough to keep the brain alive, but isn't needed for the rest of the body, which is why there was the change to compression only. Just make no mistake, the chances of bringing someone back after 10 minutes of an unwitnessed arrest are very, very, very, minimal.
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Permalink Reply by SMOKEnPipesJim on
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Hands Only CPR is from all I have heard From the AHA for John Q Public based on the fact That an Unknowing Civilian can and will do MORE good Doing Compressions then NO one doing anything, You as a trained EMS worker are expected to Know CPR compressions and airway management guidelines MUCH less have with you Tools to "protect you and the PT"
The idea of anyone being instructed to Notify 9 1 1 and then start circulation is better , then "trying to get a person" to a) try ventilations b) actually do them effectively under typpical situations c) not haveing protection devices available.. at least most would be willing to do compressions and circulate blood even if is not oxygenated until an AED arrives
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Permalink Reply by Pararescue on
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The fact of the matter is, studies show that stopping chest compressions CAUSES the heart to remain in a fatal rhythm. Start... stop... start. Now just because your "pushing on the heart", your all so causing positive pressure in the lungs and the pt. exhales. When you lift your hands your creating a negative pressure in the lungs the pt. inhales. The approx liter pull in of air, (21% Oxygen), is 2 liters/ now about 42% oxygen. When you breath into the person your giving approx. 12% oxygen. I hope this helps clarify the reasoning. And this applies for lay person and fire dept if no ambu bag or oxygen is available.
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Permalink Reply by Trainer on
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I guess you'll have to look at it like this; if the standard comes down from the powers to be then that is what we will do. Question it if you like, but decisions like this one come from people with a lot more knowledge than anyone here.
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Sometimes we need to be warped to do what we do. And thats a good one.
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Permalink Reply by courtney lenz on
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in my medical class we havent done cpr yet and im the only one that knows how to do it and i told the teacher about the changes and how they apply when we go to clinical this winter and then i explained that EMS personel would probably still have to do the conventional 30:2 or 15:2 ratio of compressions and ventillations
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The other part is getting first responders to do the proper number of compressions per minute. 100\minute
And if you think that's easy or way more than what you do, you might want to time it sometime. It's actually relatively slow compared to what we are used to.
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