CPR

[tootall]

What are your thoughts?

[hp4l]

I try to count them out but its easier to just keep pounding. Just like to get into a rythym and do my best. Unfortunately I am 0-for-15 or so. Maybe I need to change how I do it.

[thelurker]

there's guidelines??

[ENG27SQ]

thelurker said:

there's guidelines??

There's been quite a few new and updated guidelines Dean. I believe they are listed on the AHA site.

[Kramer]

Well, i'd say its an improvement because in my short time as an emt ive been on 2 saves using the new techniques...

[tootall]

Some facts about CPR and MIs. From the AHA website.


About 75 percent to 80 percent of all sudden cardiac arrests happen at home, so being trained to perform cardiopulmonary resuscitation (CPR) can mean the difference between life and death for a loved one.

• Effective bystander CPR, provided immediately after sudden cardiac arrest, can double a victim’s chance of survival.

• CPR helps maintain vital blood flow to the heart and brain and increases the amount of time that an electric shock from a defibrillator can be effective.

• Approximately 95 percent of sudden cardiac arrest victims die before reaching the hospital.

• Death from sudden cardiac arrest is not inevitable. If more people knew CPR, more lives could be saved.

• Brain death starts to occur four to six minutes after someone experiences sudden cardiac arrest if no CPR or defibrillation occurs during that time.

• If bystander CPR is not provided, a sudden cardiac arrest victim’s chances of survival fall 7 percent to 10 percent for every minute of delay until defibrillation. Few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of collapse.

• Coronary heart disease accounts for about 550,000 of the 927,000 adults who die as a result of cardiovascular disease.

• Approximately 335,000 of all annual adult coronary heart disease deaths in the U.S. are due to sudden cardiac arrest, suffered outside the hospital setting and in hospital emergency departments. About 900 Americans die every day due to sudden cardiac arrest.

• Sudden cardiac arrest is most often caused by an abnormal heart rhythm called ventricular fibrillation (VF). Cardiac arrest can also occur after the onset of a heart attack or as a result of electrocution or near-drowning.

• When sudden cardiac arrest occurs, the victim collapses, becomes unresponsive to gentle shaking, stops normal breathing and after two rescue breaths, still isn’t breathing normally, coughing or moving.

[RngrVnc33]

I dont count saves (and there has been a few) but I can tell you that the deaths out weigh saves tenfold! Its all about early CPR, early Defib, and early ALS intervention!

[actanonverba]

Clearly, the "old ways" aren't working. Outcomes for cardiac arrest are still low despite recent changes. Many factors attribute to ineffective CPR, I mean hey, it's alot to think about all at once. Just to name a few common malaises; hyperventilation (which is not only dangerous, but still practiced), the depth and "rebound"of the compression , and the rates/timing of respiration and compression are often neglected. It seems the common provider's belief is "the more the merrier" more oxygen and more compressions as quick as we can, right? Wrong. Often this will do more harm than good, causing ineffective perfusion as well as cause a number cardiopulmonary insufficiencies.
Aside from ALS skills the compotent BLS provider can only perform a few, if any procedures. But even simple things go a long way.
One study included below, indicates the alarming outcome of induced hypothermia in cardiac arrest patients. There have been a few studies like this, and two of them were halted because "it was unethical to continue the study with the placebo group because the outcomes were so positive"
It is necessary that EMS becomes more proficient and knowledgable about recessutation,and must evaluate and update it's practices with current, evidenced-based care.

Acta Non Verba
ABSTRACT

Background Cardiac arrest with widespread cerebral ischemia frequently leads to severe neurologic impairment. We studied whether mild systemic hypothermia increases the rate of neurologic recovery after resuscitation from cardiac arrest due to ventricular fibrillation.

Methods In this multicenter trial with blinded assessment of the outcome, patients who had been resuscitated after cardiac arrest due to ventricular fibrillation were randomly assigned to undergo therapeutic hypothermia (target temperature, 32°C to 34°C, measured in the bladder) over a period of 24 hours or to receive standard treatment with normothermia. The primary end point was a favorable neurologic outcome within six months after cardiac arrest; secondary end points were mortality within six months and the rate of complications within seven days.

Results Seventy-five of the 136 patients in the hypothermia group for whom data were available (55 percent) had a favorable neurologic outcome (cerebral-performance category, 1 [good recovery] or 2 [moderate disability]), as compared with 54 of 137 (39 percent) in the normothermia group (risk ratio, 1.40; 95 percent confidence interval, 1.08 to 1.81). Mortality at six months was 41 percent in the hypothermia group (56 of 137 patients died), as compared with 55 percent in the normothermia group (76 of 138 patients; risk ratio, 0.74; 95 percent confidence interval, 0.58 to 0.95). The complication rate did not differ significantly between the two groups.

Conclusions In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.