Here we go again, new CPR protocols

[Cthippo]

CHICAGO - More people can survive a cardiac arrest when emergency medical workers use a new resuscitation method that starts with a round of 200 chest compressions before a defibrillator shock, U.S. researchers said on Tuesday.

Rescue teams in Arizona who used the new approach on people who had a cardiac arrest outside the hospital tripled the survival rate of the standard approach.

"Cardiac arrest is incredibly common and survival is poor," said Dr. Bentley Bobrow, medical director for emergency services for the state of Arizona and a researcher at the Mayo Clinic in Scottsdale.

The new resuscitation method, which is not intended for bystanders, increases blood flow to the heart and brain when the heart stops pumping blood.

"Even if you could improve survival by a few percentage points, you will save thousands of people across the country," said Bobrow, whose study appears in the Journal of the American Medical Association.

For bystanders, the most important thing is to give chest compressions while waiting for an ambulance, many experts say.

Cardiac arrest occurs when the heart stops circulating blood. Most often, people with cardiac arrest have a type of heart rhythm known as ventricular fibrillation, in which the heart quivers but does not pump blood.

If no shock is delivered in the first four minutes of this deadly rhythm, the heart stops altogether and it becomes much harder to get it restarted. During this phase, old-fashioned chest compressions can help push blood back into the heart, making it more likely to restart.

WAITING TO DEFIBRILLATE

As most emergency teams do not arrive on the scene in that critical first four minutes, the new resuscitation approach calls for a round of 200 chest compressions given in the first two minutes to improve the odds that the heart will restart.

"Traditionally, we've told them to defibrillate right away. When they do that, the patient dies frequently," Bobrow said in a telephone interview.

In 2004, only 3 percent of people in Arizona who had a cardiac arrest outside of a hospital survived.

Bobrow wanted to improve those odds. He and colleagues studied the use of minimally interrupted cardiac resuscitation, a highly choreographed method of CPR for emergency medical workers that is also called cardiocerebral resuscitation.

After the first 200 compressions, the victim gets a shock, then another worker jumps in and gives another set of 200 chest compressions. At that point, they may give a shot of epinephrine to stimulate the heart, and then insert a tube into the trachea to ventilate the lungs.

The approach is focused on continuously pumping blood to the heart and brain. Bobrow's team trained emergency workers in two city fire departments in the state, then compared the survival data before and after in 886 patients with cardiac arrest. The data were collected between 2005 and 2007.

The rate of people who lived long enough to be discharged from the hospital rose from 1.8 percent before the training to 5.4 percent using the new protocol.

The benefit was greatest for those who had ventricular fibrillation with a shockable rhythm. Survival in those patients rose from 4.7 percent to 17.6 percent.

Dr. Mary Ann Peberdy of Virginia Commonwealth University in Richmond said the findings suggest the need for a back-to-basics approach to cardiopulmonary resuscitation.

"We are learning more and more that we can't get sloppy on how we do CPR," Peberdy said in a commentary in JAMA.

Original story

I'll believe it works when we actually get one back, Hasn't happened on a call I've been on yet in 6 years.

[PSYCtest040]

As most emergency teams do not arrive on the scene in that critical first four minutes, the new resuscitation approach calls for a round of 200 chest compressions given in the first two minutes to improve the odds that the heart will restart.

After the first 200 compressions, the victim gets a shock, then another worker jumps in and gives another set of 200 chest compressions. At that point, they may give a shot of epinephrine to stimulate the heart, and then insert a tube into the trachea to ventilate the lungs.

HOLLY CRAP!!!!!!!!!!! 200 compressions in two minutes!!!!!!!!!!! Is it even possible to deliver that many compressions, in that short amount of time, and have effective blood flow?

[GaHazMedic]

HOLLY CRAP!!!!!!!!!!! 200 compressions in two minutes!!!!!!!!!!! Is it even possible to deliver that many compressions, in that short amount of time, and have effective blood flow?

Yes, it is. The current standard is 100 compressions a minute, which equals 200 compressions in 2 minutes.

[Cthippo]

Unless you're using a Res-Q-Pump, then it's 80 because it's not physically possible to do 100 a minute. Trying to do so may induce MI in anyone attempting to use the (&$)! thing.

Yes, I'm told it works, but I still hate it.

[Medic_QT]

Yes, it is. The current standard is 100 compressions a minute, which equals 200 compressions in 2 minutes.

Didn't they say 2 minutes of CPR in an arrest if it was unwitnessed anyways?

[Cthippo]

Didn't they say 2 minutes of CPR in an arrest if it was unwitnessed anyways?

I think that's the current standard, 2 minutes CPR, then shock, then two more minutes before you analyze again. The exception is if they arrest right in front of you then you can go straight to the AED, but I could be wrong.

[Medic_QT]

I think that's the current standard, 2 minutes CPR, then shock, then two more minutes before you analyze again. The exception is if they arrest right in front of you then you can go straight to the AED, but I could be wrong.

That's our protocol. It was also the AHA protocol when I took my BLS For Healthcare Workers and ACLS cert about 2 years ago. I was just wondering why people were amazed by it?

[paramortis]

Because it can be hard remembering which ratio/protocal to use when they change it every two years, especially when those years are halfway through your license life(NREMT)

[bubbamedic]

Unless you're using a Res-Q-Pump, then it's 80 because it's not physically possible to do 100 a minute.

Sorry, you are wrong. The 80 a minute is the actual compressions if you interrupt them to give ventilation. If you continue straight through, it is quite easy to do.


I have gotten two COR saves with this technique.

[Cthippo]

Sorry, you are wrong. The 80 a minute is the actual compressions if you interrupt them to give ventilation. If you continue straight through, it is quite easy to do.


I have gotten two COR saves with this technique.

I think you're thinking of a different device. According to our protocols the correct rate when using the pump is 80/minute applying 65-100 lbs of down force on the compressions and 20-30 pounds of up force on the decompressions. As you might imagine it gets pretty damn tiring in a hurry, so we trade out every cycle of 5, if not more often.