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CPR Techniques Are Changing: More Lives May Be Saved

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Your spouse has just clutched their chest, began to have trouble breathing and has fallen to the ground. They begin to have convulsions, their eyes roll up and breathing stops. It is your wife or husband, your son or daughter, your friend or the old guy you’ve known for ten years in your office. You can help. You can learn how to bring life to a lifeless body. A new technique means mouth-to-mouth might not be necessary.

Number one. Call 911. Help will actually come as fast as they can. In the UK, it is 999 and in Mexico 066. Do it right. Make sure they know the problem, your address and any important directions (“It’s 14th Street not 14th Avenue.”), and specifically say someone is not breathing and that you need medical assistance.

If possible have someone else call the emergency number while you start chest compressions. In the advanced countries emergency workers are trained and equipped for quick response. If another person is available have them light the way and (safely) guide the rescuers to your location.

In a recent cardiac arrest situation here in southern-border Mexico, I was alone and realized the Red Cross (Cruz Roja) ambulance had a 20 – 30 minute trip to get to us and that the emergency call to 066 might not go as quickly as needed, due to my mediocre Spanish and the past quality of local dispatchers. There are always decisions to be made when life hangs balanced before your eyes. I worked at resuscitation in the best way I knew until breathing was restored (luckily, before my own physical resources were used up). It was not by the book but, more importantly, get trained, stay up to date, try to make good decisions and more people can survive cardiac arrest.

Begin CPR – for which you should have taken a course or, at least, studied on the Internet. The University of Washington has a fine site, “Learn CPR – You Can Do It”. They present a great introduction, then tell you to take a course. Take the course!

El mismo sitio en Español es ”Aprendà RCP. Si, Se Puede!” RCP para adultos, ninos, infantes, gatos y perros.
Tambien, informaciòn sobre casos de atragantamiento.

A new study shows that changing Cardiopulmonary to Cardiocerebral resuscitation in cardiac arrest cases can improve survival rates by 300%. Outside-hospital cardiac arrest emergencies now show a 1-3% survival rate. Improving that kind of score is a worthwhile goal.

The study shows that the chest compression component is more effective than the mouth-to-mouth part of the process. I did not know that, but saw that the compressions were more effective so I concentrated on them and hoped I was not killing my wife. This new study and technique reassured me. As did her survival, for which I fought hard and long.

The new technique shows a 300% better survival rate after cardiac arrest according to “Gordon A. Ewy, director of UA Sarver Heart Center, where the new approach was developed. Ewy is one of few people in the world named a “CPR Giant” by the American Heart Association.”

Their new technique tends to downplay mouth-to-mouth in favor of chest compressions. Dr. Ewy explained that “In out-of-hospital cardiac arrest, the brain and the heart need resuscitation, not the lungs.”

This change will make it easier and less frightening for many – passers-by, rescuers who are not as well equipped as the professional lifesavers who will answer your first-world telephone call with help.

However, you cannot wait for them. Every second counts if the person is no longer breathing. With every second, they drift further away from this world and the brain begins to be damaged or to die from lack of oxygen. Every second is a second gained for you to breathe – or push – life into a human soul.

The U. of Washington site says: Call 911. Blow. Give 2 mouth-to-mouth breaths. Pump. Compress the chest and continue to give 30 compressions to 2 mouth-to-mouth air transfers. Yes, 30. I was taught, 25 or more years ago, to use almost equal chest compressions and mouth-to-mouth air transfer.

Originally it was thought that rescuers, even trained non-professionals, would need 4 seconds to switch from compressions to air transfer. The reality is an average of 16 seconds. “Eager” medical students (and they are healthy, young people) have been found to need 14 seconds. Each of those seconds is time lost, brain cells lost, survival chances lessened.

“But when you stop chest compressions to give mouth-to-mouth ventilations, no blood is moved and the organs essentially are starved.” Dr. Ewy said, “In fact, during CPR, blood flow to the brain and the organs is so poor that stopping chest compression for any reason – including so called ‘rescue breathing’ – is not helpful.”

About 490,000 Americans die yearly from cardiac arrest out-of-hospital. Even with life-saving efforts the survival rate over the last 20 years has remained a pretty sad 1-3% in large cities (without external defibrillators, which this study does not include).

The 300% improvement means a 9% survival rate, which is not comforting for the other 91%. But it is a big improvement. Somehow, my wife is one of the 1-9% and that pleases me. An earlier study in the American Journal of Medicine showed EMS people in two Wisconsin counties were able to bring their survival rates from 15 to 58% in cardiac arrest cases where the heart had a “shockable heart rhythm” – was “quivering” rather than beating, but could still be shocked by a defibrillator into normal beating – and where they used the new CCR protocol.

During my recent problems, I was very unhappy to realize that the automatic defibrillator in my chest did not come with jumper cables. Hopefully, Guidant will soon fix that oversight. All I needed were little Radio Shack wires, alligator clips from nipple to nipple, and red and black markers, and all would have been well.

Check with the American Heart Association for more informayion about classes in your area.

Hay mas informaciòn en el sitio del AHA en Español.

Then check with the American Red Cross for the availability of first aid and CPR courses in your community. They take a little time and some energy but they do it so well that it will stay with you in case, or until, you need it so desperately that you will never forgive yourself if you didn’t put in that effort.

The Mayo Clinic website has an excellent First Aid Index and on-line guide. You can also sign up for weekly email newsletters.

Dr. Ewy’s team also found that the technique that eliminates mouth-to-mouth will entice far more people to learn it and perform the technique.

Members of the UA Sarver Heart Center CPR Research Group started the “Be a Lifesaver” program to teach the new approach to the public at no charge. Bystander Cardiocerebral Resuscitation is easy to learn and easy to remember. To learn more about the program and to watch an instructional video online, visit their teaching site.

In my case I wrote about it almost a year ago when my wife suffered sudden death syndrome. Sadly, here in the jungle, where I do have a fine cardiologist, she wanted the local barefoot doctor who was charming and came to the house. Unfortunately, he turned out to be a totally incompetent, dishonest, immoral quack who, in the US, would be sued and his licence taken. Here, it is not worth the effort to try.

However, as an aside, tourists and visitors to Mexico and other “developing” nations should investigate medical evacuation insurance. The air ambulance from Miami/Fort Lauderdale takes about a day or so to arrange, requires around $13000 US cash or credit card in hand before they will even lift off from Florida and then 3 hours round trip. It is not something to be taken lightly. We residents don’t have the option of the insurance and, as good as our major medical policy is, it will not reimburse air ambulance evacuation costs.

I here add a quoted text from the Medical News Today story. I want it to be exact, and am not a medical professional, but I sincerely hope that many people will visit these sites and consider one of the fine courses the AHA or the Red Cross offer.

Bystander Cardiocerebral Resuscitation involves three simple steps:

1. Direct someone to call 911 or make the call yourself.

2. Position the patient on the floor. Place the heel of one hand on the center of the chest with the other hand on top of the first. Lock your elbows and perform forceful chest compressions at a rate of 100 per minute. Lift your hands slightly after each push to allow chest to recoil. Take turns with a bystander until paramedics arrive.

3. If an automated external defibrillator (AED) is available, attach it to the patient and follow the machine’s voice instructions. Otherwise, keep pumping.

NOTE: Gasping is not an indication of normal breathing or recovery. Initiate and continue compressions even if patient gasps. For cases of suspected drowning, drug overdose or collapse in children, follow guideline CPR (2 mouth-to-mouth breaths for every 30 chest compressions).

However, and it is an important “however”, all physicians are not created equal in the US, UK or here. We have a very fine cardiologist in the nearest city, Chetumal, who has cared for my heart for the past 8 years and now has my wife’s under control with medications. This cardiologist is equal to, or better than, my upstate New York cardiologists. After my heart attack, he charmed my wife, and has enough equipment to make a viable diagnosis, enough competence and compassion to control the situation. In him we hit the jackpot. Conversely, the local barefoot doctor should be hung by his primitive toes.

My personal disclaimer is that I am not a medical professional. Stick with the AHA, the Red Cross, and other sites that you trust. Have your emergency numbers programmed, memorized or posted prominently. Just today Scotsman.com reported that over 40% of Scots wouldn’t call 999 first if they thought they were having a heart attack. They would call a relative or pal, doctor or NHS24 if they were alone.

The British Heart Foundation has launched a campaign called “Doubt Kills”. Prof. Peter Weissberg, the medical director said, ” “Maybe this is down to our natural reserve and stoicism, but it is costing lives. Every second counts when you are having a heart attack, and the quicker you call 999 the greater your chances of survival.” That goes for 911 just as well.

Take the course. Visit the sites. Consider that someday, somehow, for some reason you might need the knowledge of how to save a life.

Think how you will feel if you didn’t take the time to learn.

About hfdratch

  • http://www.ifasc.org David Gonzalez

    When I was a paramedic, we were taught that tilting the head back would cause the epiglotis to block the airway. Now I’m seeing in many First Aid websites that tilting the head is back. Can this be true? I am now running an international NGO, and am not current in CPR technique changes. I live in a quite poor country, where emergency services all almost inexistent (reason for which most people die due to lack of emergency treatment on the scene) and I have considered creating/establishing an effective EMS center in various provinces, to help save lives. If anyone knows about these changes in CPR techniques, and their proven effectiveness, please, visit our website for the email address to write to me.

  • hhhhh

    hey hows it goin?