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Permalink Reply by Oldman on January 14, 2011 at 1:04am

Ladies and gentleman;

Hands only CPR is aimed primarily for the layperson, not the Healthcare Provider. Yes, the "yuck" factor is partially responsible for this change, but the main focus is getting the blood flowing as quick as possible. There is already oxygen remaining in the blood which is not being used, and it is this oxygen which needs to be moved to the brain. In addition, considering that there is residual air inside the lungs, each time one compresses the chest, the air is forced out of the lungs. (exhalation) When the compression is released, the normal muscle movement draws some air back into the lungs. (inhalation) In effect, Hands only CPR is providing some ventilation. Considering there is 21% oxygen in the air, and the average person exhales 17%, there is no reason the 21% cannot sustain someone until trained responders arrive with oxygen.

The biggest change for the BLS Healthcare Provider is the change from the old ABCs, to compressions, airway, and breathing, and the reliance on end tidal CO2 instead of the O2 saturation. Where we used to use oxygen for an O2 sat of <95%, the new algorithm states O2 for a sat < 90%. Of course there are other changes not only for BLS, but ACLS, and PALS as well.

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Permalink Reply by Jay Barnes on January 14, 2011 at 7:20am

It has been proven that there is a better success rate with just compressions. Lets do it. Make the change.

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Permalink Reply by joe on January 14, 2011 at 12:03pm

As I had said before Dane Co. Wi has been doing this for years.. If it falls into a certain criteria (unwitnessed arrest, pediatrics, O.D. drowning etc...) we use the old fashion CPR until a advanced airway can be obtained, once that happens it goes into what we call CCR. CCR is also started if it is a witnessed arrest or (anything cardiac related) (heart stops before breathing compr.) Body loses 10 % oxygen each min. 0-1 min 90 % o2 in body 1-2 min 81% o2 etc... So if it is a CCR we start copmpressions at 100 per min,place a oral airway in and place Pt. on 15ltrs NRB. 0-100 pumper one 100 -200 compressions pumper 2 we switch to a different pumper to make sure no one gets tired to early and makes good compressions all the way through. at 180 compressions we charge defib, and if it is shockable we shock. if not we dump the charge. and start again 0-100 one pumper 100 - 200 2nd pumper again at 180 we charge shock if advised if not dump charge.. again back on chest pumper one 0-100 pumper 2 100 -200 charging at 180... shock if advised or dump once we are done with our 3rd shock or non shock. We palce either a KING LTSD or COMBITUBE... and keep the same pattern going till either a pulse is obtained and then we move pt or until it is called by a paramedic or hospital.. We are doing this at even a basic level.... Granted at the I.V. Tech level we also start an I.O and do some other things but that is more details. Just wanna give you the Idea of what we do.. The whole thing about Compressions Compressions Compressions is they want to try and not raise the interthoracic pressure (keeping it negative) this way when pressed and released the chest rise and fall should pull in air....because as you are bagging you are placing pressure inside the chest cavity making it harder for the heart to move blood during compressions....If you want more in depth discussion send me a message or look up Dane co WI CCR... Like Isaid this is just a quick look but can go into it more

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Permalink Reply by John Crabbe on January 14, 2011 at 2:36pm

we use the old fashion CPR until a advanced airway can be obtained, once that happens it goes into what we call CCR.......So if it is a CCR we start copmpressions at 100 per min,place a oral airway in and place Pt. on 15ltrs NRB. 0-100 pumper one 100 -200 compressions pumper 2 we switch

Knowing that Janesville and Madison have been part of this study for the last several years, much of the info to change to CCR has come WI as well as some other depts. The criteria for discerning if doing regular CPR and CCR is now really on the verge of changing if not already changed. The reason CPR was still done is because the study was limited in areas and not yet accepted yet.
That said, I believe there is still a hold up at the state level for the approval, but like Dane Co, area medical directors can elect to go with the new CCR standards.

With the new standards, CCR, is not dependant upon the obtainability of an advanced airway, as mentioned, it is now about placing an oral airway and a NRB at 15 LPM O2. Defib is only a priority if this was a witnessed arrest, or if there has been quality compressions already done prior to arrival of a defib. Otherwise it is 2 rounds of 100 compressions/minute.....so really defib waits until 2 minutes of compressions are done. Like mentioned, pause briefly for the machine to analyze, then back on the chest.

Any airway attempts now fall at the 6 minute mark, whether ET, combi, or King airway. Although, the ET attempts are limited to one try, because too often compressions were stopped while trying to get the airway.


What you will start seeing with CCR is more on scene time doing basic skills. We did train with metronomes set at 100 bpm, and while doing compressions for 2 minutes, you do get worn out, so it is important to switch out. With an advanced airway and BVM now being a lower priority, and even defib to wait for 2 minutes of compressions before shocking, will create some standing around, which doesn't always fit well with too many rescuers. I personally like the changes and believe this will make things easier in the future.

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Permalink Reply by John R. Eeten, Jr. on January 14, 2011 at 2:38pm

I started in the Fire Service in 1979, became a Firefighter / Paramedic in 1982. I had been an Instructor in CPR for 10 years. I have watched the skill levels decrease in all aspects of the Emergency Medical Field. I have watched the Instruction of students decrease to "Down and Dirty" techniques, due to lack of knowledge or due to time constraints. I have watched the "Specialty Trainings" come in causing us to attend more classes, costing our budgets more money, when the original classes were still the best classes to take.

No matter how hard and how fast you push, the brain still ceases to function after 6 minutes without O2. Compare your success rates of timely and properly intubated patients versus the dark purple complexion of your non-opened airway patient. That should be enough to tell you who survives and who doesn't.

Properly taught and practiced CPR Saves Lives. Always has and always will! Any variant indicates a lack of care of the instructor, student, to willing teach and learn in the time frame it takes to learn the skill, not the truncated time frame we are operating in today. This statement may sound derogatory and critical, it is meant to be! We have all become lazy to be proficient at the skills we need to have. This society of ours has become too concerned with the individual, instead of the community. PC is not “Politically Correctness”, but “Practically Complacent!” We all need to get back to “Perfect Practice makes Perfect” or we are all destined to be mediocre, minimally skilled Emergency Responders. Practice your skills every day to the level of total proficiency not to “I already did it once, that is enough.” Once is not enough. If you practice your skills to the point of, “I can save my Mom / Dad, Daughter / Son level,” then you might be close to the perfection / proficiency level you need to be at. Anything less and you are just kidding and lying to yourself and others about what you can do. You will not save everyone, however, if you can say to everyone you meet you did your absolute best and have a tear rolling down your cheek, as your voice crackles, then you have done all that is Humanly Possible to resolve the situation. If not, you’re just lying to yourself and everyone else you work on.

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Permalink Reply by John Crabbe on January 14, 2011 at 6:12pm

No matter how hard and how fast you push, the brain still ceases to function after 6 minutes without O2. Compare your success rates of timely and properly intubated patients versus the dark purple complexion of your non-opened airway patient. That should be enough to tell you who survives and who doesn't.

I disagree with your sentiment here. I for one do not agree that complacency is taking control over skill proficiency, instead studies and new information are showing that the way of doing business in the past, doesn't apply.

Sure, a brain without O2 ceases to function after 6 minutes, but it doesn't matter if a tube is inserted or not afterwards, all too often you are working a code for effect. This is also why new information and protocol changes start to reflect that. With CCR (at least our protocols) when encountering an unknown downtime and still asystole, go through the H's and T's, the chance of the pt coming back are slim to zero. Point is intubating a pt done for over 6 minutes isn't going to be any more effective than compressions for an hour.

Now over the years, such studies have shown that the body does contain oxygen and pausing to deliver breaths after 15 or even 30 compressions, negated the efforts of compressions. Studies have also shown that the body will draw in O2 with chest recoil, as to the reasoning that intubation now falls further down in priority. Too often compressions were being delayed for "just a couple seconds" while someone tries to intubate.....which in reality was more than a few seconds, meanwhile the brain is not getting any O2 at all.

Now yes, proficiency in skills like intubating and so forth has diminished, but not because of lack of "practice" but because alternatives have come around which reduces the reasons to intubate. CPAP has done a great job in improving a patient's condition while being very minimally invasive, whereas in the past, many of the same patients would have received a tube. That just shows that studies and improvements have improved patient care. One can practice tubing on a mannequin all day if they want, but when in the field, if there isn't a reason to tube, then don't. Sure skills may diminish, but is not the patient care the number one goal?


I don't see such changes as being lazy nor complacent, but an improvement. Yes CPR has saved many lives, and over the last several years, those departments and hospitals conducting the CCR studies have see improvement in success rates. When I first was CPR certified the ratio was 15:2, and then increased to 30:2, ACLS was a myriad of changes from meds like Vasopressin vs epi, then taken off, amiodarone vs lidocaine, but lidocaine around, bicarb being a primary med to rarely used and so forth. One thing medicine has shown us is that it is constantly changing, there are improvements discovered everyday, there are studies done everyday and we have to adapt those changes to what it best for the patient. It really has nothing to do with being lazy nor complacent.

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