July 30, 2010 | 11:14 am
Posted by Albert Fuchs, M.D.
My regular readers are a sharp bunch, so you probably already know that cardiac arrest – the cessation of a pulse and of blood circulation – is very very bad for you. Most doctors don’t recommend it. Nevertheless, hundreds of thousands in the U.S. every year suffer cardiac arrest outside of a hospital, frequently due to a heart attack. Cardiopulmonary resuscitation (CPR) was developed 50 years ago for just such situations. Decades of data strongly support that the following two factors are key in determining survival after out-of-hospital cardiac arrest.
Despite this information, only a third of cardiac arrest patients receive CPR from bystanders.
Two years ago the American Heart Association revised their recommendations for CPR done by bystanders. (I wrote about it back then. See the link below.) The new recommendations removed mouth-to-mouth rescue breathing and focused on chest compressions. The recommendations have only two steps.
If you see someone collapse:
These recommendations received substantial support from two studies in this week’s New England Journal of Medicine. The studies, one Swedish and one American, involved emergency dispatchers who were called regarding a witnessed cardiac arrest. The dispatchers instructed the callers on how to perform CPR. The calls were randomized so that half of the bystanders were instructed to perform traditional CPR with 15 chest compressions alternating with two rescue breaths. The other half of the callers were instructed to do chest compressions only, without rescue breaths.
Both studies showed equal survival rates between the two groups, suggesting that rescue breaths are not helpful. The previous emphasis on rescue breathing may also have discouraged bystanders from doing anything at all, as many people find mouth-to-mouth resuscitation objectionable because of infection risks or general ickiness.
The major exception to these guidelines is cases in which the patient collapsed because of a breathing problem, such as choking or drowning. In these cases rescue breathing should be done with chest compressions. Since kids don’t have heart attacks, a collapsed child should be assumed to have had a breathing problem.
The bottom line is that if you see someone collapse, get help, and do something. You can’t make the situation worse, and prompt chest compression can make things much better.
Wall Street Journal article: In Many CPRs, Skip the Mouth-to-Mouth
Los Angeles Times article: Compression CPR Found Effective
My post in 2008: American Heart Association Recommends Hands-Only CPR
New England Journal of Medicine article: CPR with Chest Compression Alone or with Rescue Breathing
New England Journal of Medicine article: Compression-Only CPR or Standard CPR in Out-of-Hospital Cardiac Arrest
New England Journal of Medicine editorial: In CPR, Less May Be Better
Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice. Anything that I write is no exception. I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts. Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).
We welcome your feedback.
Your information will not be shared or sold without your consent. Get all the details.
JewishJournal.com has rules for its commenting community.Get all the details.
JewishJournal.com reserves the right to use your comment in our weekly print publication.
12.6.13 at 10:38 am | Neisseria meningitidis strikes Princeton and UCSB.
11.22.13 at 8:45 am | Why vaccines still matter even in developed. . .
11.15.13 at 1:55 pm | A revolutionary shift in deciding whom to treat.
11.8.13 at 8:32 am | The first cases of polio in over 14 years. . .
10.25.13 at 1:04 pm | Hydrocodone combination medications will be more. . .
10.18.13 at 2:03 pm | Concierge doctors and the future of American. . .
2.4.11 at 10:59 am | The FDA recently issued a warning about. . . (1238)
12.6.13 at 10:38 am | Neisseria meningitidis strikes Princeton and UCSB. (167)
3.15.13 at 10:38 am | The FDA warns about a popular antibiotic. (45)