By Carla McClain
The Arizona Daily Star (Tucson)
Copyright 2006 The Arizona Daily Star
Distributed by McClatchy-Tribune Business News
The “New CPR” — developed at the University of Arizona — has tripled survival rates for cardiac-arrest patients rescued by Phoenix paramedics, a preliminary study shows.
This is the latest in a mounting body of evidence suggesting that the “new CPR” — doing chest compressions only — can save more lives than the old CPR, which includes mouth-to-mouth breathing.
However, the evidence has not persuaded the American Heart Association — the group that issues national guidelines for cardiopulmonary resuscitation — to fully adopt chest-compression-only CPR for victims of sudden cardiac arrest.
But the Heart Association did issue new guidelines last year that called for significantly more “hard, fast” chest compressions and fewer breaths when attempting to revive these victims.
“Rescuers will be taught to push hard, push fast, and minimize interruptions in chest compressions” reads a section of the new CPR guidelines issued by the group in 2005.
The brainchild of a cardiac research team at the University of Arizona Sarver Heart Center, the new chest-compression-only CPR — better known as cardio-cerebral resuscitation or CCR — was unveiled three years ago in Tucson. Ever since, the team has worked to get the new system adopted worldwide.
Concerned that survival rates for victims of sudden cardiac arrest occurring out of the hospital have remained dismally low for decades — at about 6 percent — the UA researchers studied what was really going on when people attempted CPR.
They found that bystanders — untrained people who saw the victim collapse — often were reluctant to perform the mouth-to-mouth breathing required by the old CPR, and so most often did nothing other than call 911.
Even trained paramedics were found to spend far too much time doing mouth-to-mouth breathing in between the vital, blood-pumping chest compressions.
“Getting the blood flowing again to the heart and brain is most critical in saving these lives, and that’s what chest compressions do,” said Dr. Gordon Ewy, director of the Sarver Heart Center and one of the leaders of the “new CPR/CCR” effort.
“If you stop doing these compressions for anything — even for breathing — it damages the brain.”
In brief, the new CPR/CCR requires chest compressions only, at the rate of at least 100 a minute, with no mouth-to-mouth breathing, if done by untrained bystanders.
If done by trained paramedics, it calls for constant chest compressions first, for at least two minutes, before attempting intubation or a shock defibrillator, which used to be the first priority.
It is that protocol, now used by six Phoenix-area fire departments, that jumped the survival rate from less than 3 percent to 9 percent in a study of 1,000 cardiac arrest victims treated by paramedics in the field.
The results are similar to a Wisconsin study released in April that showed a 300 percent increase in out-of-hospital cardiac arrest survival rates when paramedics in two counties used the new CPR.
The Tucson Fire Department also is seeing increased survival with the new CPR, Ewy said, but is not ready to release its data.
Anyone using the much simpler and more easily learned chest-compression-only CPR/CCR must be careful to use it only on victims of cardiac arrest, and not on those suffering respiratory arrest.
“If you see the unexpected collapse of an adult, and that person is not choking or drowning, you can be pretty sure it is a cardiac arrest, and then you do chest compressions only,” Ewy said.
“If the person is choking or drowning, or if the victim is a child, it is likely respiratory arrest, and then you do the old CPR, with two mouth-to-mouth breaths after 30 chest compressions.”
That is the universal CPR guideline still advocated by the Heart Association, partly because their experts doubt untrained people can accurately tell the difference between cardiac and respiratory arrest.
What to do in an emergency
How to perform the “new CPR,” also known as cardio-cerebral resuscitation, or CCR:
- Ask someone to call 911, or make the call yourself.
- Put the patient on the floor, place the heel of one hand on the center of the chest (between the nipples), with the other hand on top of the first.
- Lock your elbows and perform forceful chest compressions at the rate of 100 a minute. Lift your hands slightly after each push to allow the chest to re-expand. Take turns with another bystander until paramedics arrive.
- If an automated external defibrillator (AED) is available, attach it to the patient and follow the machine’s voice instructions. Otherwise, keep pumping.
- Gasping does not mean normal breathing or recovery. Start and continue chest compressions even if the patient gasps.
- For cases of suspected drowning, choking, drug overdose, or collapse in children, do standard CPR — two mouth-to-mouth breaths for every 30 chest compressions.