New CPR Recommendation Takes Little Training – Just
Push Hard and Fast
Mouth-to-mouth no longer recommended for bystanders
trying to save lives
March 31, 2008 - Chest compressions alone, or
Hands-Only Cardiopulmonary Resuscitation (CPR), can save lives and can
be used to help an adult who suddenly collapses, according to a new
American Heart Association scientific statement posted on the Web site
today.
“Bystanders who witness the sudden collapse of an
adult should activate the emergency medical services (EMS) system and
provide high-quality chest compressions by pushing hard and fast in the
middle of the victim’s chest, with minimal interruptions,” according to
the new guidelines.
MICR emphasizes minimal interruption of chest
compressions
March 11, 2008 – Those experiencing a cardiac
arrest outside of a hospital have a scant chance of survival, despite
massive efforts in cardiopulmonary resuscitation (CPR) training and
efforts to place more automated external defibrillators in public
places. A new study, however, finds hope in minimally interrupted
cardiac resuscitation (MICR), which emphasizes minimal interruption of
chest compressions during a rescue attempt.
Read more...
“This recommendation is based on evaluation of
recent scientific studies and consensus of the American Heart
Association Emergency Cardiovascular Care (ECC) Committee. This science
advisory is published to amend and clarify the “2005 American Heart
Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and
Emergency Cardiovascular Care (ECC)” for bystanders who witness an adult
out-of-hospital sudden cardiac arrest.
An article in the Journal of the American Medical
Association earlier this month focused on the success of minimally
interrupted cardiac resuscitation (MICR), which emphasizes minimal interruption of
chest compressions during a rescue attempt. The new study found that those receiving MICR
were more likely to survive than those patients who received standard
treatments. (See link to story in side bar on left.)
“Cardiocerebral Resuscitation will have a
world-wide impact.”
April 14, 2006 - Survival rates following the most
common form of cardiac arrest – a common killer of senior citizens -
increased three-fold when emergency medical personnel used a new form of
CPR developed at The University of Arizona Sarver Heart Center. The new
approach, called Cardiocerebral Resuscitation, is dramatically different
from guideline-directed CPR procedures.
In January, the heart association kicked-off a
campaign to reduce deaths from sudden cardiac arrest by increasing the
use and "effectiveness of cardiopulmonary resuscitation (CPR)." The
announcement acknowledged too many lives were being lost due to lack of
action.
One spokesman for the campaign said CPR "rates are
woefully inadequate." (See news release below this news report.)
The latest statement, from the heart association’s Emergency
Cardiovascular Care (ECC) committee, is published in Circulation:
Journal of the American Heart Association.
Hands-Only CPR is a potentially lifesaving option
to be used by people not trained in conventional CPR or those who are
unsure of their ability to give the combination of chest compressions
and mouth-to-mouth breathing it requires.
“Bystanders who witness the sudden collapse of an
adult should immediately call 9-1-1 and start what we call Hands-Only
CPR. This involves providing high-quality chest compressions by pushing
hard and fast in the middle of the victim’s chest, without stopping
until emergency medical services (EMS) responders arrive,” said Michael
Sayre, M.D., chair of the statement writing committee and associate
professor in the Ohio State University Department of Emergency Medicine
in Columbus.
About 310,000 adults in the United States die each
year from sudden cardiac arrest occurring outside the hospital setting
or in the emergency department. Without immediate, effective CPR from a
bystander, a person’s chance of surviving sudden cardiac arrest
decreases 7 percent to 10 percent per minute. Unfortunately, on average,
less than one-third of out-of-hospital cardiac arrest victims receive
bystander CPR, which can double or triple a person’s chance of surviving
cardiac arrest.
By using Hands-Only CPR, bystanders can still act
to improve the odds of survival, whether they are trained in
conventional CPR or not, Sayre said.
“Many times people nearby don’t help because
they’re afraid that they will hurt the victim and aren’t confident in
what they’re doing,” he said.
“We want people to know that they can help many
victims, just by calling 9-1-1 and doing chest compressions. Don’t be
afraid to try it. We are sure many lives will be saved if the public
does Hands-Only CPR for adult victims of sudden cardiac arrest.”
The new recommendation for Hands-Only CPR for
adults who suddenly collapse is an update to the 2005 American Heart
Association Guidelines for CPR and ECC, which previously recommended
that lay rescuers use compression-only CPR only if they were unable or
unwilling to provide breaths.
The update puts Hands-Only CPR on par with
conventional CPR when used for an adult who has suddenly collapsed.
This change was supported by evidence published
from three separate large studies in 2007, each describing the outcomes
of hundreds of instances of bystanders performing CPR on cardiac arrest
victims.
None of those studies demonstrated a negative
impact on survival when ventilations were omitted from the bystanders’
actions. Hands-Only CPR is easier to remember and results in delivery of
a greater number of chest compressions, with fewer interruptions, until
more advanced care arrives on the scene.
Conventional CPR is still an important skill to
learn, and medical personnel should still perform conventional CPR in
the course of their professional duties. The new recommendations apply
only to bystanders who come to the aid of adult cardiac arrest victims
outside the hospital setting.
Hands-Only CPR should not be used for infants or
children, for adults whose cardiac arrest is from respiratory causes
(like drug overdose or near-drowning), or for an unwitnessed cardiac
arrest. In those cases, the victim would benefit most from the
combination of chest compressions and breaths in conventional CPR.
The public is still encouraged to obtain
conventional CPR training, where they will learn the skills needed to
perform Hands-Only CPR, as well as the additional skills needed to care
for a wide range of cardiovascular- and respiratory-related medical
emergencies, especially for infants and children.
The new statement is intended to increase how often
bystander CPR is performed. It emphasizes the importance of
“high-quality” chest compressions — deep compressions that allow for
full chest recoil, at a rate of about 100 per minute — with minimal
interruptions.
Heart group started snified national effort needed to save lives by
increasing use of CPR
American Heart Association scientific statement
Jan.
15, 2008 – A unified effort by the public, educators and policymakers is
needed to reduce deaths from sudden cardiac arrest by increasing the use
and effectiveness of cardiopulmonary resuscitation (CPR), according to a
new statement from the American Heart Association. The statement,
“Reducing barriers for implementation of bystander-initiated
cardiopulmonary resuscitation,” appears online in Circulation: Journal
of the American Heart Association.
“Bystander cardiopulmonary resuscitation rates are
woefully inadequate, resulting in an enormous missed opportunity to save
lives from cardiac arrest,” said Benjamin S. Abella, M.D., M.Phil.,
clinical research director for the Center for Resuscitation Science at
the University of Pennsylvania in Philadelphia, and lead author of the
statement.
Studies indicate that in many communities only 15
percent to 30 percent of out-of-hospital cardiac arrest victims receive
bystander CPR before emergency medical services (EMS) personnel arrive
at the scene. Considering that cardiac arrest survival falls an
estimated seven percent to 10 percent for every minute without CPR, the
low rate of bystander CPR has a big impact on outcomes, he explained.
Approximately 166,200 out-of-hospital sudden
cardiac arrest deaths occur annually in the United States. Sudden
cardiac arrest often results from an irregular heartbeat called
ventricular fibrillation (VF) which causes the heart to quiver so that
it cannot generate blood flow. Treatment of VF requires CPR to keep
blood moving through the body until the patient’s heart can be shocked
to terminate the VF and allow the heart’s pacemaker cells to establish a
normal rhythm.
In the last decade, automated external
defibrillators (AEDs), portable defibrillation machines, have become
increasingly common in public buildings such as casinos, airports and
schools. However, Abella said defibrillation is only one of the four
links in the Chain of Survival, a sequence of four actions that must
occur quickly to help ensure the best chances of survival.
The Chain of Survival requires: (1) early
recognition of the emergency and phoning 911 for EMS, (2) early
bystander CPR, (3) early delivery of a shock via a defibrillator if
indicated and (4) early advanced life support and post-resuscitation
care delivered by healthcare providers.
“Quick initiation of CPR, as well as providing high
quality CPR, is crucial to survival,” Abella said. “What’s needed is a
two-pronged approach: first, substantially increase the number of
bystanders trained in CPR who then provide CPR during an actual
emergency and second, improve the quality of training and actual CPR
performance through measures of its effectiveness.”
“In communities where widespread CPR training has
been provided, survival rates from witnessed sudden cardiac arrest
associated with VF have been reportedly as high as 49 percent to 74
percent,” Abella said. “Unfortunately, on average, approximately six
percent of out-of-hospital sudden cardiac arrest victims survive to
hospital discharge in the United States.”
The statement identifies specific potential
barriers to improving U.S. cardiac arrest survival rates including: fear
of infectious disease, fear of litigation and fear of poor performance,
all of which Abella said could be overcome with adequate education,
training and public awareness.
Specific recommendations in the statement include:
● Local, state and federal government agencies
should provide CPR education in such settings as school systems and
government-funded hospital and clinic systems.
● Communities should create and support
emergency dispatcher-assisted CPR training programs with an emphasis on
recognizing the symptoms of cardiac arrest.
● The public should understand that when
bystanders perform CPR immediately, the victim’s chance of surviving
cardiac arrest can double or triple at little risk to the rescuer.
● The public should be made aware of Good
Samaritan laws through CPR training materials and by including
information with community AEDs.
● Community lay rescuer and EMS programs should
include a process for continuous quality improvement that includes a
review of resuscitation efforts, quality of CPR and CPR instructions
provided to bystanders by dispatchers. CPR instructional programs
should always include an objective CPR quality assessment for
certification.
● Research funds should be targeted toward
improving methods of CPR education, skill retention and creative methods
to widen the scope of current CPR training and education.
Abella said creative approaches to CPR education
include initiatives such as the American Heart Association’s Family and
Friends CPR Anytime™, a 22-minute, individual training program that
provides an instructional video and an inflatable manikin, and other
approaches such as Internet-based instruction. Another idea is to
provide hospital-based training for family members of patients at risk
for cardiac arrest.
The statement also recommends directing research
dollars to learn more about ways to increase the use of bystander CPR.
“By broadening training and encouraging the public
to perform CPR, we believe we can save thousands of additional lives
each year in the United States,” Abella said.
Co-authors are: Tom P. Aufderheide, M.D.; Brian
Eigel, Ph.D.; Robert W. Hickey, M.D.; W.T. Longstreth, Jr., M.D.; Vinay
Nadkarni, M.D.; Graham Nichol, M.D.; Michael R. Sayre, M.D.; Claire E.
Sommargren, R.N., Ph.D.; and Mary Fran Hazinski, R.N., M.S.N.
Keep up with the latest news for senior citizens, baby
boomers
March 31, 2008 - Chest compressions alone, or
Hands-Only Cardiopulmonary Resuscitation (CPR), can save lives and can
be used to help an adult who suddenly collapses, according to a new
American Heart Association scientific statement posted on the Web site
today. 
Jan.
15, 2008 – A unified effort by the public, educators and policymakers is
needed to reduce deaths from sudden cardiac arrest by increasing the use
and effectiveness of cardiopulmonary resuscitation (CPR), according to a
new statement from the American Heart Association. The statement,
“Reducing barriers for implementation of bystander-initiated
cardiopulmonary resuscitation,” appears online in Circulation: Journal
of the American Heart Association. 