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Thursday, July 22, 2010

When do you stop CPR?

There are a limited number of events that would prompt you to stop chest compressions:
  1. when something happens that makes it no longer safe for you to continue;
  2. when someone else takes over chest compressions from you;
  3. when an attached AED (Automated External Defibrillator - a device that, when appropriate, will shock the patient's heart so that it can start beating normally again) tells you to "stay clear of the patient" or "don't touch the patient"; or
  4. when the victim says "Stop doing that to me."
Absent one of these circumstances, you continue chest compressions with no interruption. You don't need to stop compressions to have someone else take over compressions - the relief person can put their hands on top of yours and take over without missing a beat as you pull your hands away, and you don't need to stop compressions while someone else is applying the defibrillator pads. It's that important.

Interrupting chest compressions for three seconds results in more than a three-second interruption in blood flow to the brain: when you resume compressions, the first few compressions simply prime the pump. Interruption in compressions is often the reason that there are so many people who don't die but who also don't survive with neurological functions intact.


p.s., a note for health care providers: you don't need to interrupt compressions during endotrachial intubation of adults anymore. Check out the S.A.L.T. airway by MDI. The insertion of the FDA-approved S.A.L.T. device is a simple, blind insertion, and once the device is in place, the ETT is inserted through the hole in the middle of the device. The results of a cadaver study will be published shortly. I have tried it on many different manikins and have been unable to make it fail. It's less expensive than a King Airway or Combitube. It's in the same range as an LMA, and it gives you the airway control of an ETT. Sweet.