CPR/AED in Progress...

[Stonewall]

This video was shot, I think in 2007, prior to the change in the breath to compression ratio, which is now 30/2.  Plus, they are also operating at the professional level.  It is a perfect example of a real life rescue.  It shows the agonal respirations and the natural guarding the body does as a last ditch effort as the electric shock is delivered by the AED.

Japanese language student Takahiro "Taka" Ono is found lifeless in the water on a surprisingly calm day. With no breath and no pulse a resuscitation effort begins as Bondi lifeguards come to his rescue. Finally a defibrillator shocks him back to life. Ten minutes after the incident Taka is fully conscious.

Click here for YouTube video of CPR/AED in progress and saving a life.

[vento]

Beats BayWatch on all accounts. Quite educational. Thanks for the video link.

[FW]

It was a great video.  BTW; current compression/breath ratio for 2 person CPR is 15:2.  For 1 person CPR it is 30:2.  this is for infants, children and, adults.  (I just went through re cert last week)
For a layperson, there is no recommendation for breaths; just compressions

[Stonewall]

I'm an AHA CPR (BLS) instructor and according to current AHA standards, even for the lay person, the ratio is 30:2.  Yes, breaths are still taught, but an emphasis is on compressions.  If not, then I, as an EMT and my fellow instructor, also an EMT & USLA Ocean Rescue Instructor are wrong.  And I'm pretty sure I'm not wrong since I teach under the county EMS system.

[FW]

Hey, I'm only a doctor, the EMTs instructing me for my BLS Healthcare provider re cert gave us the guidelines I mentioned above.  As we noticed in the video, the LGs were using 15:2.  Did someone change things in the last 5 days?  I have no idea...... maybe I need a AED TX for my memory....

[isuhawkeye]

2 person CPR is currently the same as 1 person CPR. 

The current guidelines are from 2005

The american Heart Association Guidelines for Adult Basic Life Support can be found here

http://circ.ahajournals.org/cgi/content/full/112/22_suppl/III-5

There have been several important advances in the science of resuscitation since the last ILCOR review in 2000. The following is a summary of the evidence-based recommendations for the performance of basic life support:

Rescuers begin CPR if the victim is unconscious, not moving, and not breathing (ignoring occasional gasps).

For mouth-to-mouth ventilation or for bag-valve–mask ventilation with room air or oxygen, the rescuer should deliver each breath in 1 second and should see visible chest rise.

Increased emphasis on the process of CPR: push hard at a rate of 100 compressions per minute, allow full chest recoil, and minimize interruptions in chest compressions.

For the single rescuer of an infant (except newborns), child, or adult victim, use a single compression-ventilation ratio of 30:2 to simplify teaching, promote skills retention, increase the number of compressions given, and decrease interruptions in compressions. During 2-rescuer CPR of the infant or child, healthcare providers should use a 15:2 compression-ventilation ratio.

During CPR for a patient with an advanced airway (ie, tracheal tube, esophageal-tracheal combitube [Combitube], laryngeal mask airway [LMA]) in place, deliver ventilations at a rate of 8 to 10 per minute for infants (excepting neonates), children and adults, without pausing during chest compressions to deliver the ventilations.

[N Harmon]

The American Red Cross seems to teach 30:2.

http://www.redcross.org/flash/brr/English-html/cardiac-arrest.asp

There is also

Comparison of different cycles of CPR (30 versus 15 chest compressions)
M. Grzeskowiaka, R. Podlewskia, Z. Zabaa, C.Z. Zabaa and A. Turowska-Koskaa
Department of Teaching Anesthesiology and Intensive Therapy, University of Medical Sciences in Poznan, Poland

Conclusions

Increasing the chest compression ratio from 15:2 to 30:2 resulted in changes in arterial, but not mixed-venous, blood gases; therefore, the advantages of more chest compressions may outweigh a decrease in gas exchange.

[isuhawkeye]

There is a lot of controversy and study over CPR its affectivness and its science.  the next round of studys and research will be coming out in the next year, so hold on to your hats. 

It is often difficult for instructors and agencies to keep up on current standards and practices. 

Here is a cap talk discussion on CPR standards from a while back
http://captalk.net/index.php?topic=4679.msg90867#msg90867

[Major Lord]

Professionall medical providers don't provide "breathes" , we provide ventilations. You guys can put your lips on dead guys if you want, but I am going to carry an AMBU bag! ( and my trusty Lifepak AED) 30/2 was the last IO heard, with no "breathes" for citizen CPR. ( I think going through their pockets and looking for spare change is also a part of the new "no breath" paradigm......)

Major Lord

[isuhawkeye]

hence the term ventilations.  get the air in the victim however you like....  or dont 

[CadetProgramGuy]

In my paramedic class, they are teaching 30:2.  Then again we are 2 person crews.  Also the new recommendations they are looking at are in the range of 50:2.

Reason being is that more studies are showing that compressions are more important then ventilations in the pre-hospital setting.

Further along this is why the layperson is allowed CCC or constant chest compressions.

[Ned]

I'm "0 for 3" on CPR.

If I can save just one person, I'll be batting .250, which would be pretty good in the National League!

[Stonewall]

I'm "0 for 3" on CPR.

If I can save just one person, I'll be batting .250, which would be pretty good in the National League!

I am "0 for 4" on CPR.  Maybe 5, I forgot.  I was only a volunteer firefighter but maintained my EMT cert throughout the last 17 years.  All but one of my patients was 60+ years old and.  That was before the days where AEDs were just around each corner. 

[Major Lord]

I have had 2 out of I don't know how many ( in excess of 100) BLS "saves" . ( I don't really count them as saves unless they leave the hospital through the front door, so maybe the real number is closer to ......0) for pulseless, apneic patients. For ALS, maybe 50% jump-starts successful, but dropping to about 20% if you count the "walking out the front door" criteria. You can get a rhythm and a pulse from a baseball with enough electricity and epi, but its not really a "save".  I can't recall ever having a save from a traumatic arrest. CPR may not work well, but it beats the heck out of trying nothing......

Major Lord

[lordmonar]

I guess I'm the all star....I'm 3-5....that's a .600 averaverage....wooohooo!  I going to the show!

[EMT-83]

Only one save that meets the "walks out of the hospital" rule.

At the firehouse, in the middle of a community CPR class, this lady comes running in the door. Her husband is out in the car, in full arrest. We work the code and bring him back - talk about a motivated group of CPR students afterwards.

[wingnut55]

I was a Field Engineer for Physio Control in another life, I did spend some time in research on Difibs. An interesting development but little discussed is the increase in obesity and the power available for defibrillators. At one time we had defibs that went to 500 joules, now it is 250 to 350 joules delivered. It is not enough to get through the fat of obese patients.

Any thoughts on that? 

[JayT]

I was a Field Engineer for Physio Control in another life, I did spend some time in research on Difibs. An interesting development but little discussed is the increase in obesity and the power available for defibrillators. At one time we had defibs that went to 500 joules, now it is 250 to 350 joules delivered. It is not enough to get through the fat of obese patients.

Any thoughts on that?

I trained with an old monophasic Lifepak (dialed up to 360 joules), but our company carries newer Zollo Biphasic machines. From the literature I've read, the biphasic waveform really makes a difference interms of the impedence of extra....insulation.

[Major Lord]

I was a Field Engineer for Physio Control in another life, I did spend some time in research on Difibs. An interesting development but little discussed is the increase in obesity and the power available for defibrillators. At one time we had defibs that went to 500 joules, now it is 250 to 350 joules delivered. It is not enough to get through the fat of obese patients.

Any thoughts on that?

I guess we just have to have compromises. There are a lot of shockable rhythms that an AED won't shock for, many of which could easily prove lifesaving in the field, but the AED protocols just don't support them. There are a lot of good reasons. I wonder if larger pads, better skin prep, or posterior/anterior electrodes might make a shock more effective in a large body? ( Or you could whip out your trusty sternal saw, spreaders, retractors and internal paddles, but I think the shopping mall might be a little miffed) Compressions in really fat people can be less effective, and airway control can be a nightmare. To say nothing of carrying them down the stairs......(Note to self, put away the twinkies!)

I have always had a wild idea that for BLS CPR ( no cardiac meds, just ventilations and compressions) that sticking a patient with an EPI pen might be beneficial. I don't see adding epi pens to the wall dispenser for the AED coming anytime soon though.....

Major Lord

[SJFedor]

I have always had a wild idea that for BLS CPR ( no cardiac meds, just ventilations and compressions) that sticking a patient with an EPI pen might be beneficial. I don't see adding epi pens to the wall dispenser for the AED coming anytime soon though.....

Major Lord

Doubtful. Epi pens are only 0.3mg of 1:1000, for ACLS,  you're giving 1mg of 1:10,000 every 3-5 minutes. Wouldn't be beneficial enough to get anything started.

Granted, my medic partner has told me about the "old days" when they did high dose epi pushes with resuscitations. I'm told "you can give a rock a pulse with enough epi"

I was a Field Engineer for Physio Control in another life, I did spend some time in research on Difibs. An interesting development but little discussed is the increase in obesity and the power available for defibrillators. At one time we had defibs that went to 500 joules, now it is 250 to 350 joules delivered. It is not enough to get through the fat of obese patients.

Any thoughts on that? 

Most agencies are carrying biphasic defibs now, which do a better job getting through the more fluffy members of society, who oddly enough, seem to be most of the ones arresting pre-hospital. I can only think of a handful of pre-hospital arrests I've made lately that were less than 250lbs.