No more Breathe with CPR?!

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Permalink Reply by Michael Rocke on November 7, 2009 at 6:09pm

I am a AHA CPR instructor. If the AHA stated that breaths were not necessary for Healthcare provider CPR, I would know about it. If your instructor told you that breaths are not necessary for Healthcare provider CPR, then he/she is wrong. Read your book, you should have gotten one for your class. It is manditory

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Permalink Reply by Jen Ferrari on November 4, 2009 at 10:09pm

when i was getting recertified this summer my instructor told me that if it was an adult and if i didnt have any form of a mouth barrier, then i did not have to perform breaths, all i had to do was compressions. but if you need to perform CPR on a child no matter what, you have to perform breaths. i understand where they are coming from with the adult if you have no mouth guard, but still, i think that it is between life and death and i would still choose to give that person breaths. and if they still didnt make it after i did that then it is out of my hands and i knew that there was nothing more that i could do. if i never performed breaths, and that person died i would feel at fault for not doing more. but that is my personal opinion.

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Permalink Reply by blair4630 on November 5, 2009 at 8:48pm

They aren't saying do breathes with kids just because they're kids, it's because normally kids go into cardiac arrest because of respiratory failure that led to the arrest. They are normally hypoxic leading to the arrest, and need oxygen. The adults usually go into arrest from other causes, and need the compressions much more, as they usually have good oxygen reserves when the arrest.

The "new" cpr, ccr, or cardiocerebral rescucitation, stresses the idea that compressions put blood into the heart and brain, and that it's more important to keep that pressure in the chest cavity (through compressions) high, rather than messing around with breaths that aren't usually intially needed, and lose valuable pressure in the chest cavity while doing it. The results have been impressive.

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Permalink Reply by FETC on November 5, 2009 at 9:14pm

The thought of compression only CPR is for many reasons. When a victim initially goes down and is pulseless and apenic, there is quite abit of oxygenated blood in the body in which is now not circulating. Secondly, the compressions only part will move that oxygenated blood thus reducing the "no cpr downtime" and thirdly compression only CPR handles the lack of having a barrier device or mask to protect us when not afforded the protection we deserve.

So if you arrive in an offical capacity with a "duty to act" and have all the proper equipment to provide BLS or ALS, then the compression only CPR is not the standard of care.

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Permalink Reply by blair4630 on November 6, 2009 at 6:03pm

I think in your first paragraph, you and me are on the exact same page.

As far as compression only CPR not being the standard, that is correct for most areas, altough there are areas that are piloting the CCR I mentioned. Also, I think with the new AHA guidelines, we are going to see yet further progression towards compressions over breaths, especially prior to advanced airways, along with ITD's, hypothermia, and blind insertion devices.

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Permalink Reply by John Crabbe on November 6, 2009 at 6:49pm

Hopefully things from compression only CPR will start coming into the general certification process for those who are not taking part in this study. I do believe Madison, WI is part of this study and has been getting good results. Although we have seen some changes already like 30:2 compressions to breaths, a change from 15:2 and in the ACLS world, CPR being a bigger focus than interventions like airway etc.

The compression only CPR was discussed at my last ACLS renewal and for the most part the pt is placed on hi flow O2 via a non rebreather and an oral airway placed. The CPR process pulls that O2 in and because the person is down and the body protecting only vital organs, you don't have a need for a lot of O2. What has been found out is many PNB's prior to these changes were overoxygenated.

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Permalink Reply by blair4630 on November 6, 2009 at 8:59pm

I forgot that some places were going with the NRB and OPA, but yeah that's possibly a good adjunt to the CCR (compression only). It will be interesting to see how that pans out in the next 5 years of studies for the 2015 AHA guidelines.

It is nice to see (and very overdue) that EMS in this country is finally, in the past several years, throwing away the "we've always done it this way", and replacing it with evidence based, research validated, procedures and treatment guidelines. The results will be lifesaving.

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Permalink Reply by John Crabbe on November 6, 2009 at 6:43pm

it's because normally kids go into cardiac arrest because of respiratory failure that led to the arrest. They are normally hypoxic leading to the arrest, and need oxygen

Yep. And then depending upon the age of the kid CPR may have to be started before there is an absence of a pulse.

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Permalink Reply by Mike Ward on November 7, 2009 at 5:40pm

It is coming.

Amazing results from the Resuscitation Outcomes Consortium.

This item is from the June 2008 Society of Academic Emergency Medicine's conference (HERE)

Mike

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Permalink Reply by Michael Rocke on November 7, 2009 at 6:16pm

I am an AHA instructor. For Healtcare Provider CPR(EMT's, Firefighters, Nurses, Doctors) you are required to do 2 breaths per 30 compressions for an adult, if you have the proper barrier or oxygen delivery device. BSI is always first and foremost. If you respond on a truck as a first responder or in an ambulance as an EMT, you should have the proper equipment to do respirations. If you are on the street and do not have a barrier, then yes, do compressions only. Heartsaver and Friends and Family are two other AHA courses that teach compressions only. Make sure if you take an AHA class as a professional rescuer, that it is Healthcare Provider.

TCSS

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