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August 15, 2017

BehindTheMedspeak: Some CPR is better than no CPR

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It wasn't all that long ago that the American Heart Association (AHA) — as a rule late to the evidence-based medical party — finally came around to what anesthesiologists have known for years: no one can perform effective rescue breathing.

The organization's current CPR guidelines are dramatically different from those that prevailed for many years.

Among the biggest changes is the recognition that mouth–to–mouth breathing during CPR is now optional.

When I posted here to that effect 12 years ago I got all kinds of flak from both professionals and laypeople saying I was flat-out wrong.

Guess not.

As Dr. Robert O'Connor of Christiana Care Health System in Newark, New Jersey, one of the authors of the guidelines, told USA Today, "Some CPR is better than no CPR."

O'Connor went on to note that "until emergency medical responders arrive, chest compressions alone can often be just as effective in saving a life."

Note: proper chest compressions — strong and powerful, at a rate of 100/minute — cannot be continued for more than a minute or two by a single individual without some loss of effectiveness.

Good CPR will make you sweat and tire you out after that amount of time — trust me, I've been there and done that many, many times.

In the meantime, while you're resting and taking a break, increase venous return — and the likelihood of CPR being successful — by simply picking up the unconscious person's feet and holding them about two or three feet above the ground.

This will provide an autotransfusion of about two units of blood to the central circulation and heart, increasing perfusion and the likelihood of recovery without permanent brain damage.

No, it may not help — but it will not hurt.

Primum non nocere, remember, is what we're all about here.

August 15, 2017 at 12:01 PM | Permalink


Comments

Interesting. MASSIVE increase in CO2 but much less of a drop in O2 than I would have expected. Thanks Joe.

Posted by: PupTentacle | Aug 17, 2017 11:58:46 AM

PupTentacle,

You hit the nail on the head: "Any oxygen [i.e., 16%] is better than no oxygen [apnea]."

Screen Shot 2017-08-16 at 10.54.24 PM

Your LifeSaver I Merit Badge is in the mail.

Posted by: bookofjoe | Aug 17, 2017 7:18:39 AM

OK, Joe. I'm going to call on your expertise here a bit. I've always wondered how the breathing part of CPR could be effective, as anything I take into my own lungs is going to be returned largely as carbon dioxide. Wouldn't that negate a large amount of the usefulness, or would the concept have been "Any oxygen is better than no oxygen"?

Posted by: PupTentacle | Aug 16, 2017 10:22:35 PM

I watched EMTs focus on this technique the other day with just chest compressions and no breathing apparatus until the other was finished putting in IV lines and all that. And would stop the breathing any time they needed to do anything else...like speak to police officers to tell them what they had found.

It was almost as if the breathing was secondary...they got the man up again, but I was surprised how little they focused on this aspect.

Posted by: clifyt | Aug 16, 2017 10:00:34 AM

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