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Bystander CPR With and Without Rescue Breathing

William T. Basco, Jr., MD

Authors and Disclosures

Posted: 09/24/2010

CPR With Chest Compression Alone or With Rescue Breathing

Rea TD, Fahrenbruch C, Culley L, et al
N Engl J Med. 2010;363:423-433

Study Summary

Studies have shown that bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest can improve outcomes, and CPR protocols are continuously being revised in efforts to improve outcomes and simplify delivery of emergency care. Rea and colleagues note that some animal studies have suggested that compression alone can produce outcomes equal to compression plus rescue breathing, and this study aimed to apply that approach to human victims in the field.

Three municipalities or counties participated in the trial, 2 in the United States, and 1 in Great Britain. The study was conducted from 2004-2009. When bystanders called emergency dispatchers, the dispatchers determined whether the patient was eligible for 1:1 random assignment to compression alone or to combined CPR (compression plus rescue breathing). Eligible arrest patients were all out-of-hospital; were not undergoing CPR at the time of the phone call to dispatchers; had not had trauma, drowning, or asphyxiation; and were at least 18 years of age. Postintervention review and exclusion were also conducted -- patients were excluded if emergency medical services (EMS) personnel found them not to require resuscitation or if they were considered to have irreversible death at the time resuscitation was begun.

Dispatchers randomly assigned eligible patients to one of the groups, and instructions to the bystanders were given according to group assignment. The chest compression cycle consisted of 50 compressions. The cycle for the compression plus rescue breathing included 2 rescue breaths, followed by 15 compressions. The outcome of interest was survival to discharge from the hospital.

Approximately one third of the potential participants met eligibility criteria, with 981 analyzed in the compression-alone group and 960 in the combined-CPR group. Mean patient age was 63 years, and approximately two thirds were men. About 72% of the patients had arrest from cardiac causes and 7% from respiratory causes; 43% of the episodes were witnessed. The average time to EMS response was 6.5 minutes. Approximately one third of patients had a shockable rhythm when evaluated by EMS personnel. The patients assigned to compression alone were more likely to receive chest compression (80.5% vs 72.7%, P < .001). In the primary comparison, no difference between survival to hospital discharge between the 2 groups was found (12.5% for compression alone vs 11% for compression plus rescue breathing; absolute difference, 1.5%; 95% confidence interval [CI], 1.4%-4.4%). Discharge without severe cerebral disability was 14.4% among patients who received compression alone and 11.5% among patients who received compression plus rescue breathing, but this difference did not reach statistical significance (P = .13). Subgroup analyses suggested that patients with cardiac arrest fared better with compression alone, whereas patients with respiratory causes of arrest did better with compression plus rescue breathing, but again, the differences were not statistically significant. The investigators concluded that bystander resuscitation with compression alone did not increase overall survival rate relative to bystander compression plus rescue breathing.

Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest

Svensson L, Bohm K, Castrèn M, et al
N Engl J Med. 2010;363:434-44
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What's with Commotio Cordis?

THE SHORT FORM:

When someone gets hit hard in the chest in the area of the heart, cardiac arrest can result. This is one source of cardiac arrest in young athletes. Only about a quarter of these victims survive. Those that do survive are associated with immediate CPR and prompt defibrillation. Congenital defects can also cause these events.

Key points:

• Ask your doctor about a though review of your child's heart before permitting that child to participate in sports where being struct in the chest hard is a possibility or where a congenital defect might cause a problem under conditions where high levels of exertion might be encountered.
• Make sure that the trainer or coach that is present for all practices and games is trained in CPR and AED use.
• Make sure that there is an AED on hand at all practices and games. Don't accept an answer of "We only take the AED to games, not practices."

THE DETAILS:

Newspaper reports of young athletes going into cardiac arrest are becoming more common. One of several possible reasons for these arrests is 'commotio cordis' a condition that results from an impact on the chest wall in the area of the heart during a specific part of the heartbeat. (30-40 ms before the peak of the T-wave.)

Such an impact can cause a premature ventricular depolarization, leading to ventricular fibrillation, and subsequently, cardiac arrest. (see Link MS, Maron BJ, Wang PJ, et al. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol. Jan 1 2003;41(1):99-104.}

Some other possible causes of these tragic events are congenital abnormalities such as enlarged heart, abnormal structure of the coronary arteries, and longer than normal time between the Q-wave and the T-wave,

About one quarter of these stricken athletes survive to discharge with major brain function intact. (see Maron, BJ: Clinical Features of Commotio Cordis. Presentation of Registry Data at Heart Rhythm Society Scientific Sessions [database online]. Boston, Massachusetts: May 15, 2009.)

Although commotio cordis usually involves impact from a baseball, it has also been reported during hockey, softball, lacrosse, karate, and other sports activities in which a relatively hard and compact projectile or bodily contact caused impact to the person's precordium. (teven M Yabek, MD, FAAP, FACC, Pediatrix Cardiology Associates of New Mexico (a Division of Mednax Medical Group), Presbyterian Hospital Medical Center)

We could really use your help - Please!

MONDAY, SEPTEMBER 20, 2010

Please visit http://www.slicc.org/Pepsi

SLICC has applied for a $250,000 grant to deploy 75 AED's and equip/support 25 additional neighborhood CPR training centers in Chatham County, GA.

We need your non-financial support to win this grant.

Please vote online and by texting every day. This will save lives.

Thank you,

Bob

The importance of IMMEDIATE CPR and prompt defibrillation

Orange County teacher collapses, dies in classroom

September 21, 2010 | 8:00 am

A teacher at Woodbridge High School in Irvine collapsed in his classroom on Monday and was pronounced dead, officials said Tuesday.

Students found Kent Bentley during lunchtime Monday and alerted staff members, said Ian Hanigan, spokesman for the Irvine Unified School District.

“A staff member administered CPR," he said, "but despite their best efforts, he couldn’t be revived.”

There was no immediate information on the cause of death.

Bentley, 46, taught English and coached wrestling at Woodbridge for 12 years. Additional counselors and psychologists were sent to the school to assist students and staff.

“Obviously, there are still a lot of questions right now,” Hanigan said. “Our focus is on helping students and staff through the initial days.”

Bentley is survived by his wife, Mary, and two daughters, Jill and Katie.

-- Alexandra Zavis

We could really use your help - Please!

Please visit http://www.slicc.org/Pepsi

SLICC has applied for a $250,000 grant to deploy 75 AED's and equip/support 25 additional neighborhood CPR training centers in Chatham County, GA.

We need your non-financial support to win this grant.

Please vote online and by texting every day. This will save lives.

Thank you,

Bob

Church Saves Great-Great-Grandmother during Service

Posted by cocreator on September 20, 2010

The last thing Sallie Sims remembers about going to a funeral last week at CrossPoint Church of Christ was wondering if she would know the fourth verse to the hymn “No Setting Sun.”

“I finished the song and then, the next thing, I was in an ambulance, and a man was trying to put oxygen on me,” Sims said. “I told him I didn’t like having anything on my face.”

Sims is living proof that having an automated external defibrillator, or AED, on site can make a difference in whether a person lives after the onset of sudden cardiac death.

CrossPoint bought its defibrillator in 2006 at the urging of a church elder. Staff members rushed to get the device when Sims collapsed.

Sallie Sims the Survivor

“We had just finished the music for the funeral, and the first speaker had gotten up when (Sims) fell over, out of her seat,” said CrossPoint preacher Frank Mills. “Someone yelled, ‘Is there a doctor in the house?’ and luckily we had several there at that time, and they rushed to her.”

Bob Man, a local physician, said Sims didn’t have a pulse and was turning blue.

“We were giving CPR, by compressions and mouth-to-mouth, and she was shocked (with the defibrillator),” he said. “She didn’t start back right after she was shocked, and the machine was getting ready to shock her a second time when she started breathing on her own again.”

“Based on what I’ve been told, I’m convinced if not for the church having that (AED) she would not be with us today,” said Sims’ niece, Stacy White. “She was gone; there was no heart beat, but thanks to the defibrillator, she’s alive.”

White said her aunt doesn’t have a history of heart problems and didn’t have any symptoms, nor did she feel bad the day of the funeral. But the 71-year-old great-great-grandmother had to have five stents placed in the arteries in her heart.

“When I saw her in the emergency room, I told her she didn’t look like she had just had a heart attack,” White said. “She looked good, just like always.”

Mann said Sims suffered a sudden cardiac death because of a rhythm problem.

Bruce Carson, director of Keller and Lauderdale EMS, said the situation with Sims is a perfect example of how AEDs are intended to be utilized.

“This is the outcome that all emergency professionals want to see,” Carson said. “There is no doubt in anyone’s mind that early defibrillation and CPR saved this woman’s life. The swift action by the people there, and the early shock, was the absolute key to her survival.”

He said all volunteer fire departments and first responders have AEDs.

Mann said two years ago a similar situation occurred at Walmart in Florence.

“A woman was there, and she had a heart attack,” Mann said. “The store had an AED, and the manager used it to bring her back. I would encourage any public place to have them.”

Mark Killen, recreation outreach minister at CrossPoint, said church staff have gone through basic CPR training and have been trained on how to use the defibrillator.

“We’re considering buying a portable oxygen tank just to have in case of emergencies, and we plan on having refresher courses for the staff and any members who want to attend,” Killen said.

He said the situation with Sims was the first time the church used the AED.

“Our hope is that it hangs on the wall and we never have to use it again,” Killen said.

“There is a need for these in all churches and all public places,” said Jerry Dowd, who was sitting next to Sims when she collapsed. “Until you see it work, you may be skeptical, but I saw the results. Even if you only have to use it once, it pays dividends like in this case.”

Sims said Mann came to see her in the intensive care unit after her surgery to place the stents in her arteries.

“He said he would not call me lucky, but that I had a blessed day,” she said. “Without that machine, I wouldn’t have made it. The machine was my salvation.

“I’ve been told I was a medical miracle,” she said. “I must be.”

Sims’ friend, Julia Dowd, said while the doctors and other emergency medical officials worked on Sims at the church, people in the church prayed.

“It was a like a Hallmark story with a happy ending,” she said.

Read more: http://www.firstaidcorps.org/#ixzz104V2iUzV

Please visit http://www.slicc.org/Pepsi

SLICC has applied for a $250,000 grant to deploy 75 AED's and equip/support 25 additional neighborhood CPR training centers in Chatham County, GA.

We need your non-financial support to win this grant.

Please vote online and by texting every day. This will save lives.

Thank you,

Bob