A different way of thinking about CPR

The American Heart Association teaches two types of CPR. For healthcare professionals, the BLS (Basic Life Support) class is required. For Bystanders, continuous chest compressions are taught for adults.

Understandably, a natural split has evolved along the lines of professional credentials: if you hold professional medical credentials, you perform BLS skills. If you do not, you perform what is taught in the bystander courses. But this may not be best for the victim.

A different way of deciding what to do when you witness an adult arrest is to ask yourself, "Am I going to have to call 911?" because if you are, then (1) you are not in a hospital or on an ambulance, and (2) you probably aren't going to be able to perform Guideline-Compliant Chest Compressions ("GC3's") from the time of the arrest until the "hands-on" arrival of the ambulance crew.

What I am proposing that you consider in this circumstance is performing continuous chest compressions with the heel of your foot (pedal compressions) whether or not you have BLS training.

This way of deciding what to do will lead to some non-traditional approaches. For example, arrests in doctor's offices, dentist's offices, local "immediate care" outposts of hospitals, while all places where one would expect to find BLS-trained people, they would initially be performing continuous chest compressions, and if short-staffed, might have to switch to pedal compressions to maintain GC3's until the ambulance crew was "hands-on" at the victim.

For further information, see the case for pedal chest compressions.

(Of course, if the victim has arrested secondary to choking or if the victim is a child or if the victim has begun to exhibit signs of a depleted oxygen supply and you have BLS skills, they would be more appropriate.)

Bob Trenkamp, President
Saving Lives In Chatham County

I love not being needed!

I also serve as a Medical First Responder in the community where I live. 

Last week I was toned out to respond to a local church where a person had passed out.

By the time I got there, two people in attendance at the church had determined non-responsiveness, called 911, determined non-normal breathing, begun CPR, retrieved the AED, applied it, and had a living, breathing Cardiac Arrest Survivor on their hands. The victim was transported and now has a pacemaker.

That, my friends, is how we solve the problem of too many dying form SCA's: Available AEDs and people who know how to recognize a Sudden Cardiac Arrest when it happens and what to do!

It's nice not being needed!

Bob

SLICC has once again been invited to present its research at the AHA's Resuscitation Science Symposium in Dallas on November 16th and 17th. I'll post a link to the presentation as soon as the AHA lifts the embargo.

Hey, thanks for hitting www.slicc.org/CPRsurvey.htm - we're almost there. The research got invited to AHA's ReSS in November. I'll share the presentation as soon as I'm allowed to.

CPR Details

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

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:

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?v=-6yS9dwceHg

The video shows someone treating a sudden  cardiac death in a 40+ year old and highlights the dismal probability that a lone rescuer will be able to perform Guideline-Compliant Chest Compressions ("GC3's") from the time of the arrest until the "hands-on" arrival of the EMS crew.

SLICC's video recommends that Bystanders "perform manual compressions unless:

1. They cannot get down on the floor;
2. Their arthritis (or any other condition) prevents them from pressing on the chest forcefully enough to achieve full GC3's (two-inch compressions);
3. They have become too tired to perform GC3's manually; or
   
4. The chest on which they are pressing is too stiff for them to achieve GC3's manually.

In the presence of these inhibiting factors, they should consider an alternative method, such as pedal compressions."

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

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