THE SHORT FORM:
Please go to www.slicc.org/CPRdetails.php and fill in the requested information. We need to understand the limits of chest compression capacity in more detail before we set about fixing the problem.
THE DETAILS:
Every five years, ILCOR & AHA issue their updated CPR Guidelines. In 2005, the guidelines called for two rescue breaths, followed by cycles of thirty compressions & two rescue breaths. The compressions had to be between 1.5 and 2.0 inches deep (~38 mm to 50 mm) and delivered at a rate of 100 per minute.
When those guidelines were put in place, it was as if someone had dropped a boulder into a pond: Instructors had to demonstrate that they could perform five cycles of "30 & 2" about every two minutes. A large number of CPR instructors were unable to renew their Instructor certificates.
Then in 2010, the new guidelines called for a rate between 100 & 120 (AHA) or a rate greater than 100 (ILCOR). The initial two rescue breaths were gone, but the compression depth went to "at least two inches" for adults.
With the passage of time the guidelines - established to ensure that the defined therapy meets the needs of the victim - keep on demanding more and more from those performing CPR.
...and things get messier when you realize that not all human chests have the same stiffness. It takes anywhere between forty and several hundred pounds to perform two inch deep compressions on a human, depending upon the characteristics of the specific human involved.
I must stress at the outset that "any CPR is better than no CPR." Please do not use anything in this note as an excuse to not even try!
Performing Guideline-Compliant Chest Compressions ("GC3's") requires two things: First, one must be able to compress the chest a full two inches, and second, it requires that one do so for a specified period of time: two minutes, if you are an EMT, Paramedic, Nurse, or Physician; Until someone else takes over, if you are a bystander. In the case of the bystander, this can mean anything from a few minutes to nearly twenty minutes. This is a challenge we'll discuss in a future post.
There are two forces at work when one tries to compress a chest: There is a force that comes from a portion of the rescuer's weight, and there is a component that comes from the deceleration of the rescuer's hands as they reach the bottom of the compression. These two forces add to form the total compressive force.
SLICC is currently gathering data in an effort to better understand the magnitude of the problem.
You can help by going to www.slicc.org/CPRdata.php and answering a few questions. Your help will be much appreciated.
The results will be reported here when they are available.
Thank you.
Bob
When you see a cardiac arrest, your brain fights you - "No, this isn't really happening" - and the circumstances fight you - "Dang! in CPR class the manikin didn't weigh very much and wasn't sitting in a deep chair. This blog deals with practical details and presents reports of "saves." Let me have your questions and comments - they will steer the course of this blog. This blog is brought to you by the volunteers at www.slicc.org
Friday, August 2, 2013
Saturday, July 20, 2013
Helping Bystanders Perform CPR Until EMS Is "Hands-On"
SLICC has officially begun promoting an alternative CPR technique for those who are - for one of a variety of reasons cannot perform guideline-compliant manual chest compressions.
THIS TECHNIQUE IS FOR BYSTANDERS ONLY. PEOPLE WHO ARE FUNCTIONING IN A ROLE REQUIRING HEALTHCARE PROVIDER STATUS MUST - AT LEAST IN THE SHORT TERM - CONTINUE TO USE MANUAL COMPRESSIONS.
Here's the announcement letter that just went out:
This recommendation has been previewed with a number of organizations and individuals and has been given a favorable reception in the context of use by Bystanders who need to use it to perform guideline-compliant chest compressions. We have no guarantee that there will be acceptance within all organizations, but this statement needs to be made.
Thank you again for your support, and please do not hesitate to suggest, comment, criticize.
With best regards,
Bob Trenkamp
THIS TECHNIQUE IS FOR BYSTANDERS ONLY. PEOPLE WHO ARE FUNCTIONING IN A ROLE REQUIRING HEALTHCARE PROVIDER STATUS MUST - AT LEAST IN THE SHORT TERM - CONTINUE TO USE MANUAL COMPRESSIONS.
Here's the announcement letter that just went out:
Thank you all very much for your comments and suggestions - and encouragement. The announcement video has been modified and can be viewed at
https://www.youtube.com/watch?- They cannot get down on the floor;
- Their arthritis (or any other condition) prevents them from pressing on the chest forcefully enough to achieve full GC3's (two-inch compressions);
- They have become too tired to perform GC3's manually; or
- The chest on which they are pressing is too stiff for them to achieve GC3's manually.
This recommendation has been previewed with a number of organizations and individuals and has been given a favorable reception in the context of use by Bystanders who need to use it to perform guideline-compliant chest compressions. We have no guarantee that there will be acceptance within all organizations, but this statement needs to be made.
Thank you again for your support, and please do not hesitate to suggest, comment, criticize.
With best regards,
Bob Trenkamp
Tuesday, June 18, 2013
SLICC's Annual Report for the 12 months ending 3/31/13
You can view our annual report for the fiscal year ended 3/31/13 at...
http://www.slicc.org/AR2013/
Enjoy?
Bob
http://www.slicc.org/AR2013/
Enjoy?
Bob
Saturday, June 8, 2013
Don't count on luck. Get the people most likely to see you arrest trained in CPR!
Merrifield man survives cardiac arrest
Posted: June 7, 2013 - 9:05pm
Brainerd
Dispatch/
Steve Kohls Joyce and Greg Ranweiler talk Thursday at their
Merrifield home about Greg's brush with death after suffering cardiac arrest
in a Janesville, Wisconsin hotel. He was gone for ten minutes before
being revived with the efforts of his wife Joyce's CPR and EMT
resuscitation with a defibrillator.
If just one small aspect in this series of events had been different, Greg Ranweiler would most likely be dead.
But somehow everything fell into place April 27 — the day Greg’s heart stopped beating.
“I was dead for 11 minutes,” he said. “I don’t say that lightly.”
“The circumstances orchestrated so beautifully to allow him to survive,” said Greg’s wife, Joyce Ranweiler.
Had the couple chosen a different hotel or been placed on another floor, Greg may not have made it. Or if the Ranweilers stayed home that weekend.
Joyce, who is notorious for misplacing her cellphone, for some reason had the device in hand when she found her husband collapsed face down on the floor not breathing, his heart still.
She dropped to her knees in their Janesville, Wis., hotel room and dialed 911.
The petite woman mustered up the strength to flip Greg’s lifeless body over, one hand on his belt, the other on his shirt.
The 911 dispatcher walked her through the steps of CPR. Though Joyce had only seen the procedure done on TV, she followed the beat the dispatcher sounded out to her. Three minutes in, a nurse staying down the hall of the hotel walked by the Ranweiler’s fifth-floor room. The nurse had run out of coffee cups and decided to take the long way downstairs to the front desk. That’s when she heard Joyce counting. It was a familiar rhythm. She knew it was the beat of CPR.
“Can I help?” the nurse asked, peeking her head inside the door. For the next six minutes, the nurse performed CPR until paramedics arrived.
It took five shocks with an automated external defibrillator (AED) before Greg took his first breath. More than 11 minutes had gone by.
“The paramedics told me it takes one or two times for most people,” Greg said of the AED. “They didn’t think I would come back.”
At 64, Greg has never had any major health problems. His heart has very little plaque buildup and he didn’t feel any signs that day that something was coming.
Doctors still aren’t quite sure why Greg suffered a sudden cardiac arrest.
His chance of survival from the episode was no greater than 10 percent. At the hospital, staff dubbed him “the miracle man.”
Looking back, Greg and Joyce know the situation was more than just a series of coincidences. There are just far too many.
“It is clear God was so involved in the situation,” Greg said.
The couple was in Janesville to watch their grandson’s soccer tournament. They chose this tournament out of the four they could have gone to. The hotel in Rockford, Ill., where the game was, was full, so the pair ended up in Janesville.
Should they have chosen a different game and been home that Saturday in Merrifield, Greg and Joyce thought he would have had a different outcome.
“The emergency response time is a lot longer out here,” Joyce said. “There’s no way I could have done CPR that long.”
As Greg was being loaded into the ambulance April 27, a doctor, who was staying at the same hotel, jumped in to help stabilize him.
“Not many people are lucky enough to have an actual doctor in the ambulance with them,” he said.
Greg doesn’t remember the episode, or most of the day Saturday until Wednesday when the hospital drugs started to wear off.
Greg cried when he was told what happened.
“It was pretty emotional,” he said. “It was tough to realize.”
He’s still trying to work through what happened that day, how things could have been different.
“Just one thing,” Joyce said. “Just one thing could have changed the whole situation for the worse.”
A quick glance at Greg today, and one couldn’t tell he’s suffered such a life-altering event.
There are no physical limitations or memory loss. The only evidence is a chipped tooth from the fall and a sore chest from CPR.
He embraces the trauma as a wake-up call to take life a bit slower.
He’s been retired for two years, but never really slowed down much. Now, he’s spending more time at home with his wife.
He’s trying not to feel guilty for taking a few minutes to sit down and do nothing.
And every morning after he wakes up, Greg thanks God he’s alive for another day, though he still thinks about why he was spared.
One thing for sure, though, is that Greg must tell his story.
“Things can happen so quick in life,” he said. “Make sure you have everything figured out in regard to your salvation. If you’re 15, 20 or 64, you don’t know how much time you have left...If through this, one person accepts God or realizes something is off in their life, it’s all worth it.”
JESSICA LARSEN may be reached at jessica.larsen@brainerddispatch.com or 855-5859. Follow me on Twitter at www.twitter.com/brainerdnews.
But somehow everything fell into place April 27 — the day Greg’s heart stopped beating.
“I was dead for 11 minutes,” he said. “I don’t say that lightly.”
“The circumstances orchestrated so beautifully to allow him to survive,” said Greg’s wife, Joyce Ranweiler.
Had the couple chosen a different hotel or been placed on another floor, Greg may not have made it. Or if the Ranweilers stayed home that weekend.
Joyce, who is notorious for misplacing her cellphone, for some reason had the device in hand when she found her husband collapsed face down on the floor not breathing, his heart still.
She dropped to her knees in their Janesville, Wis., hotel room and dialed 911.
The petite woman mustered up the strength to flip Greg’s lifeless body over, one hand on his belt, the other on his shirt.
The 911 dispatcher walked her through the steps of CPR. Though Joyce had only seen the procedure done on TV, she followed the beat the dispatcher sounded out to her. Three minutes in, a nurse staying down the hall of the hotel walked by the Ranweiler’s fifth-floor room. The nurse had run out of coffee cups and decided to take the long way downstairs to the front desk. That’s when she heard Joyce counting. It was a familiar rhythm. She knew it was the beat of CPR.
“Can I help?” the nurse asked, peeking her head inside the door. For the next six minutes, the nurse performed CPR until paramedics arrived.
It took five shocks with an automated external defibrillator (AED) before Greg took his first breath. More than 11 minutes had gone by.
“The paramedics told me it takes one or two times for most people,” Greg said of the AED. “They didn’t think I would come back.”
At 64, Greg has never had any major health problems. His heart has very little plaque buildup and he didn’t feel any signs that day that something was coming.
Doctors still aren’t quite sure why Greg suffered a sudden cardiac arrest.
His chance of survival from the episode was no greater than 10 percent. At the hospital, staff dubbed him “the miracle man.”
Looking back, Greg and Joyce know the situation was more than just a series of coincidences. There are just far too many.
“It is clear God was so involved in the situation,” Greg said.
The couple was in Janesville to watch their grandson’s soccer tournament. They chose this tournament out of the four they could have gone to. The hotel in Rockford, Ill., where the game was, was full, so the pair ended up in Janesville.
Should they have chosen a different game and been home that Saturday in Merrifield, Greg and Joyce thought he would have had a different outcome.
“The emergency response time is a lot longer out here,” Joyce said. “There’s no way I could have done CPR that long.”
As Greg was being loaded into the ambulance April 27, a doctor, who was staying at the same hotel, jumped in to help stabilize him.
“Not many people are lucky enough to have an actual doctor in the ambulance with them,” he said.
Greg doesn’t remember the episode, or most of the day Saturday until Wednesday when the hospital drugs started to wear off.
Greg cried when he was told what happened.
“It was pretty emotional,” he said. “It was tough to realize.”
He’s still trying to work through what happened that day, how things could have been different.
“Just one thing,” Joyce said. “Just one thing could have changed the whole situation for the worse.”
A quick glance at Greg today, and one couldn’t tell he’s suffered such a life-altering event.
There are no physical limitations or memory loss. The only evidence is a chipped tooth from the fall and a sore chest from CPR.
He embraces the trauma as a wake-up call to take life a bit slower.
He’s been retired for two years, but never really slowed down much. Now, he’s spending more time at home with his wife.
He’s trying not to feel guilty for taking a few minutes to sit down and do nothing.
And every morning after he wakes up, Greg thanks God he’s alive for another day, though he still thinks about why he was spared.
One thing for sure, though, is that Greg must tell his story.
“Things can happen so quick in life,” he said. “Make sure you have everything figured out in regard to your salvation. If you’re 15, 20 or 64, you don’t know how much time you have left...If through this, one person accepts God or realizes something is off in their life, it’s all worth it.”
JESSICA LARSEN may be reached at jessica.larsen@brainerddispatch.com or 855-5859. Follow me on Twitter at www.twitter.com/brainerdnews.
Sunday, June 2, 2013
Tools made of the element 'Unobtainium'
It's easy to forget that CPR guidelines have been changing. And with each change, they have been placing an increasing burden on the rescuer.
Does anyone remember how many CPR instructors failed to re-qualify when the '2005' Guidelines kicked in? it was the burden of demonstrating that they could perform five full cycles of 30 & 2 that they couldn't handle. That's two minutes of 1.5 to 2 inch compressions! - less demanding than today's "two inches or more."
The Tomlinson et al. data clearly shows the non-linear nature of the relationship between force applied and depth attained: compressing a chest twice as deeply takes more than twice the force. The data from the Netherlands, from Norway, and from a major US city [data has not yet been published] all show that even if we're only talking about 95% of the human chests, you have to be able to apply a force of more than 80kg (176 lb) to compress all the chests by two inches. (The lower end of the data is 18kg (40 lb), but that's not where the problem lies.)
If you are the only one there when someone else arrests, you're going to have to perform compressions for an average of ten minutes. Most people who are likely to have to perform CPR on a human can't make it to four minutes, and some just aren't heavy enough to compress the relevant chest to guideline depth even once!
It's easy to assume that there will always be someone there to help you, but more than 2/3 of all cardiac arrests in the U.S.A. occur in the home, and 1/3 of all homes have exactly two adults in them.
...and don't even get me started on "Get the victim on his back on a hard, flat surface and compress the chest...." If we're talking about rescuers whose age is about the same as the victim, very few know how to get their spouse out of a recliner or out of bed.
It's wonderful that you took that CPR course last year, but when you reach your physical limit, here's something else to try.
Just click Movie or copy this URL and paste it into your browser:
http://youtu.be/-6yS9dwceHg
(The movie hasn't been optimized for YouTube, so there is some jerkyness in the playback, but you'll get the picture.)
Bob
Does anyone remember how many CPR instructors failed to re-qualify when the '2005' Guidelines kicked in? it was the burden of demonstrating that they could perform five full cycles of 30 & 2 that they couldn't handle. That's two minutes of 1.5 to 2 inch compressions! - less demanding than today's "two inches or more."
The Tomlinson et al. data clearly shows the non-linear nature of the relationship between force applied and depth attained: compressing a chest twice as deeply takes more than twice the force. The data from the Netherlands, from Norway, and from a major US city [data has not yet been published] all show that even if we're only talking about 95% of the human chests, you have to be able to apply a force of more than 80kg (176 lb) to compress all the chests by two inches. (The lower end of the data is 18kg (40 lb), but that's not where the problem lies.)
If you are the only one there when someone else arrests, you're going to have to perform compressions for an average of ten minutes. Most people who are likely to have to perform CPR on a human can't make it to four minutes, and some just aren't heavy enough to compress the relevant chest to guideline depth even once!
It's easy to assume that there will always be someone there to help you, but more than 2/3 of all cardiac arrests in the U.S.A. occur in the home, and 1/3 of all homes have exactly two adults in them.
...and don't even get me started on "Get the victim on his back on a hard, flat surface and compress the chest...." If we're talking about rescuers whose age is about the same as the victim, very few know how to get their spouse out of a recliner or out of bed.
It's wonderful that you took that CPR course last year, but when you reach your physical limit, here's something else to try.
Just click Movie or copy this URL and paste it into your browser:
http://youtu.be/-6yS9dwceHg
(The movie hasn't been optimized for YouTube, so there is some jerkyness in the playback, but you'll get the picture.)
Bob
Sunday, April 14, 2013
That's the way it's supposed to work.
Eight year-old boy is struck in chest, suffers a cardiac
arrest,while playing baseball. Bystanders help, EMS arrives, one shock
brings him back.
That's the way it's supposed to work.
That's the way it's supposed to work.
Friday, February 22, 2013
Compression-Only CPR is better!
CPR: Compression-Only Wins the Long Race
Bystanders, forget about the breaths — pump that chest!
While rescue breathing might be important in certain situations, emergency medical service (EMS) dispatchers have a difficult time quickly establishing whether it's appropriate for individual victims. Compression-only cardiopulmonary resuscitation (CPR) obviates the need for this determination, but there have been no definitive long-term data supporting a shift to compression-only CPR.
Researchers combined data from two randomized trials comparing standard CPR with compression-only CPR and measured outcomes up to 5 years after the event. The aggregate group included 2500 patients. Overall survival was 11% at one year, 10.6% at 3 years, and 9.4% at 5 years. Compression-only CPR was associated with a lower risk for death (adjusted hazard ratio, 0.91).
Comment: While the rates of survival after CPR remain dismal, those who are fortunate to remain alive can look forward to a durable benefit. This study supports the 2010 Advanced Cardiac Life Support Guidelines and should encourage EMS dispatchers to instruct lay bystanders to initiate compression-only CPR in adult victims of cardiac arrest.
Published in Journal Watch Emergency Medicine February 15, 2013
CITATION(S):
Dumas F et al. Chest compression alone cardiopulmonary resuscitation is associated with better long-term survival compared with standard cardiopulmonary resuscitation.Circulation 2013 Jan 29; 127:435. (http://dx.doi.org/10.1161/CIRCULATIONAHA.112.124115)
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