Someone's having a heart attack? Skip the CPR but keep the chest compressions

  1. Heart attack? Forget the mouth-to-mouth: study


    Thu Mar 15, 8:03 PM


    PARIS (AFP) - The chances of surviving a heart attack outside a hospital double if a bystander performs chest-compressions but omits the mouth-to-mouth resuscitation widely regarded as part of standard rescue procedure, according to a study released Friday.
    Nearly everyone has witnessed the scene dozens of times on television, and perhaps a time or two in real life: someone, mostly likely a man getting on in years, collapses to the pavement clutching his chest.

    A take-charge passerby drops to his side, pinches the victim's nose and begins mouth-to-mouth resuscitation, alternating this treatment by pushing repeatedly and vigorously on his chest.

    But there is something wrong with this textbook picture of CPR -- shorthand for cardio-pulmonary resuscitation -- according to the study, published in the British journal The Lancet: it does more harm than good.

    Not only is there "no evidence for any benefit from the addition of mouth-to-mouth ventilation," writes Ken Nagao, a doctor at the Nihon University hospital in Tokyo who led the study of more than 4000 heart arrest cases in the Kanto area of Japan.

    The chances of surviving with a "favorable neurological outcome" are twice as high when would-be rescuers skip the mouth-to-mouth and focus exclusively on trying to revive the heart by rhythmic chest-compressions.

    "This finding ... should lead to a prompt interim revision of the guidelines for out-of-hospital cardiac arrest," wrote Gordon Ewy, director of the University of Arizona's Sarver Heart Center, in a commentary.

    The purpose of pushing air into a heart attack victim's lungs is to oxygenate the blood, while the massaging the chest aim to restart the heart or re-establish a regular heart-beat.

    But this first-ever, large-scale comparison of survival rates of cardiac arrest patients puts the lie to the standard CPR technique, which has been taught to millions of people around the world, wrote Ewy.

    "We have found that the survival rate is higher even when the blood has less oxygen content but is moved through the body by continuous chest compressions," he noted.

    If results of the Japanese study are used to revise the standard guidelines for helping cardiac arrest victims before medical professionals arrive at the scene, it could, in fact, have another positive effect: more people might be willing to try.

    Of the 4,068 adults examined who had heart attacks witnessed by strangers, 439 received cardiac-only resuscitation and 712 were given conventional CPR.

    But 2,917 -- more than 70 percent -- were left to fend for themselves.

    "Studies have shown that because current CPR guidelines call for mouth-to-mouth ventilations, the majority of people would not perform CPR on a stranger, partly out of fear of contracting diseases," said Ewy.

    While the study provides what Ewy called "unequivocal evidence" that chest-compression-only resuscitation improves survival rates, the authors of the study caution that the same does not apply to respiratory failure brought on by near-drowning, drug overdose or choking.

    In these cases, they say, an alternation of two breaths and 30 chest compressions is still the appropriate method.
     
  2. That's interesting. I have to renew my CPR next month. I'll definitely see if they've changed anything. I might even print this out and give it to the instructor....:yes:
     
  3. ^ I need to renew my CPR too and wonder if they have any new guidelines

    thanks for posting- great food for thought!
     
  4. Yes this is the new thinking on CPR, it was used in the hospital I worked in in the UK.

    Chest compressions are said to be better and all paramedics there were using this new regime.

    We were advised to deffinately do this if you dont have another person to do mouth to mouth or bag and air.
     
  5. It makes sense if you think about it. If someone has a heart attack, the idea is to keep the heart pumping, hence the chest compressions.

    But I never really understood the point of mouth-to-mouth (at least, not for a heart attack). Maybe that was to get the chest rising up and down, but the best bet would be direct pressure to the chest.
     
  6. ^^The rationale for the mouth to mouth is that the brain MUST have a steady supply of Oxygen or you get brain damage. So the person doing the rescue breathing is suppling the oxygen.
     
  7. Interesting, thanks for posting!
     
  8. IMPORTANT NOTE: I brought this up in my Medical Terminology class. (The teacher has had a strong medical background and we're working on the cardovascular system.)

    She suspects that what they're really saying in the article is that if you don't really feel comfortable doing mouth to mouth, then chest compressions are better than nothing.

    My teacher points out that chest compressions are useless without mouth to mouth, and that the breathing is very important, so if you're worried about possible infection, make a make-shift barrier. Use a mask, your t-shirt, their t-shirt, anything, but keep doing mouth to mouth.
     
  9. This is not the reasoning behind skipping the mouth to mouth.

    I cant actually remember what was said about it but its not for fear of infection thats for sure.

    Paramedics in the uk are using this technique and they have mouth guards to hand as do hospital staff.

    Goodness by the time youd made a makeshift mask the patient could be dead.

    There are different opinions on things from different people such as ice being put on to relieve swelling if theres a possible break.

    This compression only advice is the most up to date information following recent reserch.
     
  10. The chest compressions only circulate the oxygen through the body, though. It doesn't add new oxygen. The brain needs oxygen, and you have about 5 - 6 minutes before it starts losing oxygen.

    I'm not trying to change people's minds; I just want people to consider both lots of information. I e-mailed the same article to my teacher, and I'll post her reaction to it.

    Finding a makeshift shield wouldn't take that long: if you're in a restroom or the gym: paper towel or washcloth. If you're in a bedroom: piece of laundry or pillow case.

    If there's nothing else, take off your t-shirt and use it.
     
  11. basically in most cites in the us, the first response is PD to clear a secene of "danger" and at the same time fire is there then an ambulance. the ambulance has normally 2 people to be considered ALS (advanced life support), an EMT to drive and a paramedic. If the heart attack occurs, and chest compressions are needed, then usually a fire fighter will accompany the ambulance to do compressions while the paramedic either intubates or just puts an O2 mask on the patient. keep in mind survival rate at this point, is slim. during this time there is continual chest compressions, which was noted to have a higher survival rate BUT there is also a supply of O2.

    from my experience in EMS and with work in Trauma Rooms, your brain needs O2 so if there is another person around and has a heart attack and their heart stops and their breathing stops then please two people need to step in, on to breath and one to compress...but please check that they need compressions (have no pulse) and need resuce breathing (arent breathing).
     
  12. Okay, I see this is an old thread. Just thought I would update anybody about guidelines as I just renewed my CPR two days ago. For adults the compression rate is 30 compressions to 2 breaths. For children it is 30 compressions and 2 breaths but if you are doing 2 person CPR it is 15 compression to 2 breaths because you get more breaths in this way. For infants under 1 year of age it is also 30 compressions to 2 breaths, or 15 compressions and 2 breaths with partner cpr.

    Hope that helps for those who were interested. The new class I took was really fun for the healthcare provider course. It's very interactive in a DVD format.