New Studies Reveal That More People Would Attempt CPR If Given Better Instructions, No Mouth-to-Mouth

(AP) More bystanders are willing to attempt CPR if an emergency dispatcher gives them firm and direct instructions – especially if they can just press on the chest and skip the mouth-to-mouth, according to new research.

The two new studies conclude that “hands-only” chest compression is enough to save a life. They are the largest and most rigorous yet to suggest that breathing into a victim’s mouth isn’t needed in most cases.

The American Heart Association has been promoting hands-only CPR for two years, though it’s not clear how much it’s caught on. The new studies should encourage dispatchers and bystanders to be more aggressive about using the simpler technique.

“That could translate into hundreds if not thousands of additional lives saved each year. What are we waiting for?” said Dr. Arthur Kellermann, a RAND Corporation expert on emergency medicine.

An estimated 310,000 Americans die each year of cardiac arrest outside hospitals or in emergency rooms. Only about 6 percent of those who are stricken outside a hospital survive.

When someone collapses and stops breathing, many people panic and believe that phoning 911 is the best they can do to help.

The larger of the two new studies reported survival rates of about 12 percent when bystanders did dispatcher-directed CPR, confirming earlier research that on-scene CPR can dramatically increase a victim’s odds of survival.

Previous research has suggested that adults who need CPR get it only about one-quarter to one-third of the time when bystanders are around.

One of the new studies found that when dispatchers told callers to start CPR, about 80 percent attempted it when given hands-only instructions, more than the 70 percent who tried the standard version.

Sayre and others credited the increase on dispatchers who immediately told callers what to do, instead of first asking them if they’d had CPR training or if they’d be willing to try it until medical help arrives.

CPR, or cardiopulmonary resuscitation, is a technique that’s been in use for about 50 years. The standard version now calls for alternating 30 hard pushes on a victim’s chest with two quick breaths into their mouth.

The aim of CPR is to do some of the mechanical work of the heart by forcing at least some blood and oxygen to the brain and other vital organs.

Experts have come to believe that pumping is what’s most important in most adult cases, and advise doing chest pushes continually at a rate of 100 per minute and skipping the mouth-to-mouth. Some suggest using the beat of the old disco song “Stayin’ Alive” as a guide.

The studies are being published in Thursday’s New England Journal of Medicine.

While there is no good national data on how often hands-only CPR is used, Dr. Ben Bobrow, who directs the Arizona Department of Health Services’ emergency medical system, believes it is catching on.

“We’ve seen a huge trend in hands-only CPR in Arizona and I believe that trend is spreading across the country. I think these findings will further promote that,” he said.

Worry about doing CPR correctly was the No. 2 reason many people don’t attempt it, according to a Michigan study published in 2006. The No. 1 reason? People are too panicked.

Traditional CPR is still the preferred form of resuscitation for children or adults who have stopped breathing because of choking, drowning or other respiratory problems.

SOURCE: cbsnews.com

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New ways to survive cardiac arrest

Mike Mertz knows this firsthand. On January 23, 2008, the 59-year-old Arizona man was driving home from work. The last thing he remembers is pulling into his complex’s driveway. Then his heart stopped. Corey Ash, a passing UPS driver, noticed a silver Saturn wedged between a palm tree and a wall, with the engine running and a person slumped at the wheel. Ash stopped to investigate. He switched off the car’s engine, pulled Mertz out, and laid him on the ground. Ash called 911 and started pumping the older man’s chest. The next few minutes would be absolutely critical for Mertz.

If you had been there, standing over Mertz’s lifeless body, would you have known what to do?

A person’s life can slip away in a few minutes. Without a heartbeat, circulation slows to a halt. Blood no longer flows to the organs, and the brain is the first one to suffer. In normal times, the brain, which constitutes 2 percent of our body mass, consumes about 20 percent of the oxygen the body takes in. After 10 seconds without oxygen, the brain’s functions slow. Without oxygen or signals from the brain, other organs begin to break down. Diaphragm muscles no longer contract and release to bring in air. The kidneys stop filtering blood. At the same time, an elaborate chain reaction triggers a breakdown in cells throughout the body. Parade.com: 4 diseases you can fight with exercise

Scientists and physicians are now learning that this process can be reversed. When it comes to cardiac arrest, however, the chances of surviving an episode outside a hospital are poor. Only 2 percent of victims pull through without long-term damage.

The No. 1 thing that has been shown to make a difference is the action of a bystander. If a passerby jumps in and gives CPR, as Corey Ash did, the likelihood of survival rises significantly. But if onlookers do nothing, those chances drop — fast. According to the American Heart Association, for every minute that goes by without someone attempting CPR, the survival rate decreases 7 to 10 percent.

Studies have found that bystanders perform CPR in only 20 to 30 percent of cases. Researchers say it’s not because people don’t want to help — it’s because they’re apprehensive about putting their mouths on someone else’s, especially if the person is dying. But what I’m about to tell you may change your mind about what you can do in a situation like Mertz’s.

More than 15 years ago, cardiologist Gordon Ewy and researchers at the University of Arizona’s Sarver Heart Center were puzzling over how to get more people to give CPR. To simplify the method, they wondered what would happen if they advocated performing compressions without mouth-to-mouth respiration. After running successful laboratory trials, Ewy spoke to emergency-services directors in Arizona, Wisconsin, and Missouri. They were intrigued by his findings and agreed to promote the use of compression-only CPR among people in their states. They also implemented a protocol for their paramedics and firefighters that emphasized giving chest compressions with minimal interruptions to keep the patient’s blood circulating.

The results were remarkable: Not only were survival rates for people who got only compressions just as good as those for people who got traditional CPR, they actually were better. Why was it so effective? Mouth-to-mouth resuscitation supplies oxygen, which we need continuously. As it turns out, our bloodstreams contain plenty of oxygen at any moment. Even if we stop breathing, our oxygen levels remain normal for quite a while. If we do stop breathing, however, the sole way to make the oxygen circulate is by having someone pump our chests.

In 2007, Japanese researchers revealed the results of a massive study on bystander intervention. They looked at cases where a person (not in a hospital) suffered cardiac arrest in view of a bystander — and with his or her heart in a rhythm that would respond to a defibrillator. The survival rate was 11 percent for those who got standard CPR — mouth-to-mouth plus chest compressions — before an ambulance arrived. The rate was 19 percent for those who got only compressions. The act of keeping oxygen circulating could increase a victim’s chances of surviving by as much as 70 percent.

This is not a fancy technology born in a gleaming lab, yet it is one of the most significant recent breakthroughs in medicine. Because heart disease is the biggest killer in the United States, this simple act could save thousands of people’s lives every year.

Like Mike Mertz’s. Shortly after Corey Ash began CPR, paramedics trained in the compression-only technique arrived. Thanks to them and to an alert bystander, Mertz survived. One day, the bystander could be you.

SOURCE:

Dr. Sanjay Gupta, a neurosurgeon, is author of the new book “Cheating Death,” which will be published next month. This article originally appeared in the September 20, 2009, issue of Parade and Parade.com.

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Wii CPR – A New Way to Practice CPR.

Students should be taught basic life-support skills, researchers say.

From ABC News By Robert Preidt

FRIDAY, July 31 (HealthDay News) — Children as young as 9 years old can and should learn cardiopulmonary resuscitation (CPR), Austrian researchers say.

In a study of 147 students who received six hours of life-support training, 86 percent of the children performed CPR correctly at a follow-up session four months after the training, according to the report published online in the journal Critical Care.

“The usefulness of CPR training in schools has been questioned, since young students may not have the physical and cognitive skills needed to perform such complex tasks correctly,” Dr. Fritz Sterz, of the Medical University of Vienna, said in a news release from the journal’s publisher.

“We found that, in fact, students as young as 9 years are able to successfully and effectively learn basic life-support skills. As in adults, physical strength may limit depth of chest compressions and ventilation volumes, but skill retention is good,” he added.

In the training program, the children were taught CPR, how to use of automatic defibrillators, the correct recovery position and how to call for emergency services. Body mass index, not age, was the major factor in depth of CPR compressions and amount of air exhalation. That means that a well-built 9-year-old child can be just as capable at CPR as an older child, the researchers said.

“Given the excellent performance by the students evaluated in this study, the data support the concept that CPR training can be taught and learned by schoolchildren and that CPR education can be implemented effectively in primary schools at all levels,” Sterz and colleagues concluded.

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