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CPR

I think it's good for everybody to know CPR. It's good for me, because I get to live - Jeff Wilson

CPR

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CPR is universally accepted worldwide as the emergency procedure of choice that is performed on people who have stopped breathing (respiratory arrest) or whose heart has stopped beating (cardiac arrest).

Contrary to popular belief, CPR is not meant to and is unlikely to restore a heartbeat. The objective of CPR is to keep the blood circulating, similar to 'priming the pump', until more advanced personnel arrive. CPR is just a part of the continuum of the medical management of cardiac arrest. If heart function is restored, it is usually by trained medical personnel with a medical device such as a defibrillator.

But, despite the advent of CPR, sudden cardiac arrest outcomes remain dismal. Unfortunately, because of confusion and the lack of knowledge about CPR, very few people are capable or willing to perform CPR during emergencies. It remains underutilized and misunderstood.

However, there are some heartening developments that should increase the incidence of bystander CPR.

Continued focus by the major advocate organizations on the promotion of bystander CPR - Studies have shown that bystander CPR is effective in improving the chances of survival of a cardiac arrest victim. In 1994 Swedish researchers reported that “cardiopulmonary resuscitation initiated by a bystander maintains ventricular fibrillation and triples the chance of surviving a cardiac arrest outside the hospital. Furthermore, it seems to protect against death in association with brain damage as well as with myocardial damage. Japanese researchers reported in 2007 that bystander-initiated cardiac-only resuscitation and conventional CPR are similarly effective for most adult out-of-hospital cardiac arrests. For very prolonged cardiac arrests, the addition of rescue breathing may help.

Ongoing simplification of CPR instruction - 'Hands-only CPR' is a good start. Not only is it easily understandable by both lay persons and medical professionals but it helps eliminate one of the major barriers to bystander CPR, mouth to mouth breathing. To facilitate counting 100 – number of compressions per minute the American Heart Association (AHA) trains people to time compressions to the tune of "Stayin' Alive" which has the right tempo.

Anybody can perform CPR, including children - According to a study by Austrian researchers. Kids as young as 9 years old who had received six hours of life support training could perform CPR correctly four months after the training. The study was performed to determine whether CPR training in schools is useful. It has been pointed out that young students may not have the physical strength and cognitive skills needed to correctly perform such complex tasks correctly. The study concluded that “students as young as 9 years are able to successfully and effectively learn basic life support skills including AED deployment, correct recovery position and emergency calling. As in adults, physical strength may limit depth of chest compressions and ventilation volumes but skill retention is good".

Bystander CPR is now considered an essential component in the continuum of care for Sudden Cardiac Arrest in EMS. - This management, called minimally interrupted cardiac resuscitation (MICR) technique probably produces the best chances for survival. Other terms used in this context are cardiocerebral resuscitation (CCR) or cardiac only resuscitation, or compression-only CPR. CCR entails three things; continuous chest compressions for bystander resuscitation, a new emergency medical services (EMS) algorithm and aggressive post-resuscitation care.

Promotion of widespread availability of Automatic External Defibrillators (AEDs) and PADs, so-called public access defibrillation - CPR alone cannot restart the heart in almost all cases, other than in the group of people that develop cardiac arrest from respiratory arrest, as in near drowning. Defibrillation by applying an electric shock directly to the heart is necessary to reverse the most common cause of cardiac arrest, ventricular fibrillation.

This is where the AED comes in. AEDs are portable, battery-operated devices that can be used to administer an electric shock and are designed to be used by lay persons even without prior training. As soon as the AED is activated, visual and audio cues guide the rescuer through the whole procedure. Evidence suggests that PADs can make a difference.

Bottom Line - The simplified generic version of the procedure 'hands only CPR' may increase the incidence of CPR and make a difference in the dismal outcomes from cardiac arrest. But, it is only part of the picture. More emphasis needs to be placed on the availability of PADs. But, what's important is, not how well CPR was done, but whether it was done at all! And what is even more promising is that even children can do it with minimal instruction.

The message is clear – CPR Needs Resuscitation and Resuscitation needs CPR.


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