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New CPR technique triples survival rate

Disclaimer: This article is intended for informational purposes only. It should not be construed as medical advice nor as CPR training.

Update: We published this web page in 2006. In 2008, the American Heart Association’s Emergency Cardiovascular Care committee recommended that bystanders who witness a sudden collapse in an adult should give CCR [ref:NIH]. In 2010, mainstream TV news finally picked up the story as “breaking news.”

A new CPR technique is said to dramatically increase survival rate for adult (over 15 yo) cardiac arrest victims. Survival rate for out-of-hospital witnessed cardiac arrest is nearly tripled by the technique called “cardiocerebral resuscitation” (CCR). Not only is CCR more effective, it is simpler and more people may be inclined to render aid. Many people are reluctant to perform mouth-to-mouth on a stranger, but would probably be willing to perform CCR, so additional lives might be saved.

There are two situations where CPR applies: cardiac arrest and respiratory arrest. “Sudden unexpected collapse in an adult is almost always due to cardiac arrest,” explains Gordon A. Ewy, MD, director of the Sarver Heart Center. “The new approach is not recommended for respiratory arrest, a much less common situation.” Respiratory arrest is usually the result of drowning, choking, asthma, lung problems, or drug overdose. In these cases, or if the victim is a child, traditional CPR is still recommended. Also, this technique is only recommended for witnessed arrests (as this increases the likelihood the arrest is cardiac, not respiratory).

The new approach emphasizes fast, forceful chest compressions over airway management. The most important factor for survival of cardiac arrest patients is to keep the blood moving through the body by continuous chest compressions. Ventilating the victim by mouth-to-mouth respiration is far less important. Dr. Ewy explains: “Stopping chest compressions for ventilations is far more harmful than helpful.”

The theory is that it takes about 15 compressions to build up enough pressure to circulate the blood. If you stop, the pressure drops almost immediately. Dr. Ewy puts it bluntly: “excessive interruptions are lethal.” When a victim falls, the blood is already well oxygenated. The primary concern is to move the blood. Furthermore, many victims will gasp, so some self-ventilation may be occurring.

Dr. Ewy writes:

Some of the major unanswered questions are as follows: When is ventilation mandatory during prolonged cardiocerebral resuscitation? Ventilation is probably mandatory after 15 minutes of chest compression only in patients who are not gasping. This needs to be studied.

If one is willing to do mouth-to-mouth rescue breathing for witnessed cardiac arrest, what is the best compression-to-ventilation ratio? One of our studies suggests that it might be continuous chest compressions for the first 4 minutes, follow by 1 or 2 ventilations before each set of 100 compressions.

The essential steps are these:

  1. Evaluate scene safety
  2. Check Responsiveness and Breathing
  3. Call for Help (911)
  4. Chest compressions (100/minute)
  5. If willing to do mouth-to-mouth, 1 or 2 ventilations after 4 minutes; repeat thereafter each set of 100 compressions

If an AED (Automated External Defibrillator) is available:

  1. Evaluate scene safety
  2. Check Responsiveness and Breathing
  3. Call for Help (911)
  4. Attach Pads
  5. Chest compressions (100/minute) for 2 minutes
  6. Rhythm analysis, single shock, immediately resume CCs
  7. If willing to do mouth-to-mouth, 1 or 2 ventilations after 4 minutes; repeat thereafter each set of 100 compressions

Don’t expect to learn this new technique in a CPR class anytime soon. While some EMT’s in Arizona and Wisconsin are saving lives by using this technique today, the American Heart Association just revised their Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care last year (2005) and is not expected to review them again for several more years (approximately 2010). Until they do, it is unlikely Red Cross or other CPR educators will teach the new technique.

For more complete information, visit these web sites:

Comments

Right on schedule, four years later (i.e. 2010), the mainstream news services picked up on this story. Remember, you read it here first in October of 2006!