Hands-Only CPR

It is time for me to repeat a column that I first published over two years ago, and one that is vitally important to me. The topic is Hands-only CPR.

I received a message from one of you over the weekend concerning a “new” method of performing cardio-pulmonary resuscitation (CPR), and while I already am familiar with the technique, it is apparently still unknown to some people.

Then I was watching some back episodes of the game show, Jeopardy! from my DVR player and one of the clues given by Alex Trebek concerned CPR. The clue as read was, “It calls for two breaths for every ten chest compressions.” It bothered me that Mr. Trebek was broadcasting the incorrect, outdated method for performing CPR to a huge television audience.

The combination of those two incidents in less than a week inspired me to revisit my column from April of 2008 and republish it this week. Since I am one of those people who carry the risk of sudden cardiac arrest, I cannot pass up the opportunity to enlighten as many potential lifesavers as possible. I hope you will spread the word too.

(Actually, I am not a candidate for CPR, because I now have an implanted cardiac device, called an ICD. It will kick in whenever my heart has several irregular beats, or when the natural pacemaker in my heart quits or fails to work properly. My condition is so critical that I cannot wait for lifesaving techniques to be applied.)

For those who are at less known risk, or those who have no medical history of cardiac problems, the chance of a cardiac event requiring CPR is currently about thirty percent. In other words, one out of every three of you will probably require CPR. That also means that another thirty percent will have occasion to administer it to someone else. And that someone else is quite likely to be someone you know and love, a family member. That being the case, it pays to know how and when to do it.

There has always been some aversion to performing CPR. The main reason is that it has always required both chest compressions and mouth-to-mouth breathing. Aside from the possibility of same sex administration, we all seem to have some reluctance to get up close and personal with strangers. That has lead to a lot of missed opportunity and delays in performing CPR.

When I learned CPR and became qualified in the 1970s, the procedure called for a 10/2 ratio of compressions to breaths if performing one-on-one. If two people were present, the ratio changed to 5/2, but either way, there was no way to keep an even rhythm. The one-on-one ratio was changed in the 1990s to 20/2, but it still wasted about 10-15 seconds to change positions and do the mouth-to-mouth. Those seconds were critical.

In actual experience, it was found that the stricken person tended to gasp during chest compressions, so some air was being inhaled even without mouth-to-mouth. Also, the lungs are never completely collapsed, so oxygenation of blood was not really an issue.

The hands-only CPR not only keeps a steady rhythm to the compressions, but it also removes the objectionable part of the procedures that has frequently prevented CPR from being performed. In my opinion, it will likely cause a much higher incidence of recovery from sudden cardiac events.

The new hands-only CPR requires the rescuer to perform continuous chest compressions at a rate of 100 per minute. That compares to a rate of 30-40 compressions per minute with an irregular rhythm in the former CPR technique. The survival rate is likely to go up with the new guidelines.

Hands-only CPR
If someone collapses, stops normal breathing and is unresponsive to shaking, here are the steps you should take:
· First, have someone call 911 and summon help, if a phone is handy.
· Put the person on the floor face up.
· Place one hand atop the other in the center of the person’s chest.
· Lock your elbows so that your arms are straight from shoulders to hands
· Push hard and fast, 100 compressions a minute.
· If there is another person with you, take turns. It is hard work.
· Continue compressions until paramedics arrive to take over.
(Source – American Heart Association)

If the person on whom you are performing CPR regains consciousness or shows signs of a return of heartbeat and breathing, you may quit your efforts, but do not move them and stay ready to begin again. Do not allow the victim to sit up, but make them as comfortable as possible.

There is a Website where you can learn more about hands-only CPR and even get some online training. Just click on the link here for the American Heart Association. Then be sure to read the links within that page. Other links can be found at the following sites, and the last among them actually provides some step-by-step training.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/04/01/BAJ8VTF35.DTL

http://www.cbsnews.com/stories/2008/04/01/health/main3984803.shtml?source=RSSattr=HOME_3984803

http://medicine.arizona.edu/spotlight/learn-sarver-heart-centers-continuous-chest-compression-cpr