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  1. --
    Hell yeah! Hell no!

    CPR is a little messed up, try it without the mouth-to-mouth: Save 50% more lives

    Everyone pay attention. Now you don't have to get cooties when saving someone's life after that deadly choke out or UBER heart punch.

    Largest ever study of its kind proves no mouth to mouth.
    Continuous chest compressions better for out of hospital cardiac arrest

    A study published March 17, 2007 in The Lancet, one of the world's foremost medical journals, finds that the chances of surviving a cardiac arrest outside a hospital setting are almost twice as high if bystanders perform chest-compression-only resuscitation instead of traditional cardiopulmonary resuscitation (CPR) with mouth-to-mouth breathing.

    The study analyzed the outcomes of resuscitation attempts performed by laypeople at the scene after they witnessed a person collapse due to cardiac arrest.

    "The report confirms that what we have learned in animal experiments applies to humans as well," says Gordon A. Ewy, MD, director of the Sarver Heart Center at The University of Arizona in Tucson where chest-compression-only resuscitation was developed. "Bystander-initiated continuous chest compressions without mouth-to-mouth breathing are the preferable approach for witnessed unexpected collapse, which is usually due to cardiac arrest."

    In an invited editorial titled "Cardiac Arrest - Guideline Changes Urgently Needed," published in the same issue of the journal, Ewy notes that eliminating the need for mouth-to-mouth ventilation not only is more effective, but also should dramatically increase the incidence of bystander-initiated resuscitation efforts.

    Ewy and the Resuscitation Research Group at the UA Sarver Heart Center have advocated continuous chest compressions without assisted breathing as the appropriate method for cardiac arrest for years.

    The study reported in The Lancet analyzed the outcomes of 4,068 cases of witnessed collapse of adults in the Kanto area in Japan. The prospective, multi-center observational study, named SOS-KANTO, is the first large-scale account comparing the survival rates of out-of-hospital cardiac arrest patients who were treated either with or without mouth-to-mouth ventilations by bystanders at the scene.

    "For cardiac arrest, the term 'rescue breathing' is actually a paradox," says Ewy. "We now know that not only is it not helpful, but it's often harmful."

    Studies showed that because current CPR guidelines call for mouth-to-mouth ventilations, the majority of people would not perform CPR on a stranger, partly out of fear of contracting diseases. Research by UA Sarver Heart Center member Karl B. Kern, MD, and others found that even if bystanders are willing to perform mouth-to-mouth ventilation, it takes too much time away from chest compressions, which have to be continuous to improve the chance of survival.

    "We have found that the survival rate is higher even when the blood has less oxygen content, but is moved through the body by continuous chest compressions, than when the blood contains a lot of oxygen but is not circulated well because chest compressions are interrupted for mouth-to-mouth ventilations," Ewy says.

    All studies on out-of-hospital cardiac arrest have shown that the chance of survival is greatest in patients whose heart is in a condition that allows paramedics to shock it back into a normal rhythm with a defibrillator. Among these patients, the SOS-KANTO researchers found the percentage surviving with a favorable neurological outcome to be 19.4 percent if bystanders administered chest compressions without mouth-to-mouth ventilations. In contrast, the favorable neurological survival rate in those who received chest compressions and mouth-to-mouth breathing was only 11.2 percent.

    While the study provides unequivocal evidence that chest-compression-only resuscitation boosts survival rates for out-of-hospital cardiac arrest, Ewy points out that, for respiratory arrest such as near-drowning, drug overdose or choking, guideline CPR consisting of 2 breaths after every 30 chest compressions is still the appropriate method.

    "This study confirms how critically dependent the outcome of out-of-hospital cardiac arrest is on the willingness of bystanders to activate emergency medical services and promptly initiate continuous chest compressions in a case of witnessed unexpected collapse in an adult," Ewy says.

    "It is also very interesting to find how a sizeable group of laypeople, by spontaneously performing a technique that has neither been taught nor formally endorsed, achieved better outcomes than with a technique that has been advocated and taught at a cost of millions of dollars and millions of man-hours."

    Web links:
    Bystander CCR - three easy steps: Download pdf flyer at http://www.heart.arizona.edu/publice...sh-april06.pdf

    Podcast interview with Dr. Gordon Ewy: www.thelancet.com/audio

    References: Cardiac Arrest - Guideline Changes Urgently Needed. The Lancet 2007: 369: 882-884, by Gordon A. Ewy, MD

    Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. The Lancet 2007: 369: 920-26, by Ken Nagao, MD, et al.


    ----------------------------------------------

    Link.

    This makes total sense to me even though I've had thorough CPR and Emergency Responder training. It's almost a "duh" moment. Take note people.
    Last edited by Steve; 3/27/2008 3:09am at .

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    Posted On:
    3/27/2008 2:22am

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    --
    Hell yeah! Hell no!
    NOTE: (as pointed out by bornsceptic on Sociocide)

    While the study provides unequivocal evidence that chest-compression-only resuscitation boosts survival rates for out-of-hospital cardiac arrest, Ewy points out that, for respiratory arrest such as near-drowning, drug overdose or choking, guideline CPR consisting of 2 breaths after every 30 chest compressions is still the appropriate method.
  3. AlphaFoxtrot51 is offline
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    Posted On:
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    Sorry, I'm an EMT...and in order for your patient to live, the ABC's must be satisfied. Airway, Breathing, Circulation. If the first two aren't happening, neither is the third one. 2 breaths, every 30 compressions, for 5 cycles...that's the standard. You can't just do compressions and POOF, he gets up and going again.
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    Posted On:
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    Hell yeah! Hell no!
    I have heard this before - that there is often enough well oxygenated blood to get the victim going without breathing aid, that said obviously the airway neds to be clear. Too many people ***** about doing the compressions though.
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    Posted On:
    3/27/2008 5:39am

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    Quote Originally Posted by AlphaFoxtrot51
    Sorry, I'm an EMT...and in order for your patient to live, the ABC's must be satisfied. Airway, Breathing, Circulation. If the first two aren't happening, neither is the third one. 2 breaths, every 30 compressions, for 5 cycles...that's the standard. You can't just do compressions and POOF, he gets up and going again.
    If they're having a cardiac arrest then thier heart is the problem, not thier breathing. You get thier heart going OK, thier breathing should sort itslef out.

    On that note though, i would still do it personally, simply because i cant look at everyone i see and say '**** thier having a heart attack.' I work at a pool and as such water taken into the lungs or mouth is almost always a factor. That and thereis no way i'd work as a lifeguard again if i lost a heart attack patient and hadn't done the breaths. I dont think anyway. Until it becomes very common practice and guideline.


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    Posted On:
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    Hm. No mouth-to-mouth is what we've been taught here for the last 10 years. At least that's what my wife said, and she's a nurse.
    Curiosity killed the cat. But damn it had a blast.
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    Posted On:
    3/27/2008 7:03am

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    --
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    Quote Originally Posted by hpr
    Hm. No mouth-to-mouth is what we've been taught here for the last 10 years. At least that's what my wife said, and she's a nurse.
    Division 1 or 2? Wait... do you have division over there or are they different? nvm...

    Anyway, My mother is the same ( a nurse) and does it all the way she knows best. At my last LG update we were told not to check for a pulse and deliver compressions as if there wasnt one.

    Well, i dont know about you, but i'd preffer to have some idea as to whether or not my patients heart is beating. Even if i was going to ignore that and do compressions. They made it this way because apparenlty many lifeguards cant find and take a pulse quick enough or continually make mistakes as to whether or not it's there...


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    Posted On:
    3/27/2008 10:23am

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    --
    Hell yeah! Hell no!
    Quote Originally Posted by AlphaFoxtrot51
    Sorry, I'm an EMT...and in order for your patient to live, the ABC's must be satisfied. Airway, Breathing, Circulation. If the first two aren't happening, neither is the third one. 2 breaths, every 30 compressions, for 5 cycles...that's the standard. You can't just do compressions and POOF, he gets up and going again.
    I have a lot of respect for EMT's for the work they do, but you are not qualified to make a statement that contradicts research with hard evidence.
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    Posted On:
    3/27/2008 10:31am


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    Quote Originally Posted by Wolf
    I have a lot of respect for EMT's for the work they do, but you are not qualified to make a statement that contradicts research with hard evidence.

    I have 4 saves out of 5 attempts...I assure you that I'm qualified enough through my field. It was determined that the compressions are the most important part, which is why they bumped it up to 30 compressions. But the 2 breaths remain because you still need to breathe for your patient. Again...if you don't have breathing, you're not going to maintain a pulse. I can't name the patient, but we had one a few weeks ago that when we stopped respirations his pulse and BP dropped significantly...that's all the proof I need that what this article says is wrong
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    Posted On:
    3/27/2008 10:59am


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    Hell yeah! Hell no!
    And the 5th may have lived if you had not breathed for him, who knows 5 isn't realy a big enough sample group to be more than ancedotal anyway, just go with your conscience and keep going, I have trusted EMTs with my life before, Unless your written procedures and practices change no one expects you to have this choice to make anyway. Plus the study was for Witnessed Collapse so CPR was started straight away by a bystander not a called out professional as far as I can see, diffent case IMO. Maybe the difference was due to bystnaders not getting started soon enough because they were worried about breathing for someone else.
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