LA Times article -- no mouth to mouth for CPR?

[Guest guest]

CPR study: Nix the mouth-to-mouth

Heart attack victims fare twice as well with chest compressions only than with

mouth-to-mouth too.

By H. Maugh II

Los Angeles Times Staff Writer

March 16, 2007

Overturning a century of conventional medical wisdom, Japanese researchers

reported Thursday that simple chest compressions without mouth-to-mouth

ventilation save twice as many heart attack victims as traditional CPR.

The findings could have important implications in emergency medicine. As many as

three-quarters of bystanders who observe a heart attack in a stranger decline to

perform CPR, fearing infectious diseases.

The report " should lead to a prompt revision of the guidelines for

out-of-hospital cardiac arrest, " Dr. Gordon A. Ewy of the University of Arizona

College of Medicine wrote in an editorial accompanying the study, which was

published in the medical journal Lancet.

The National Academies of Emergency Dispatch revised its guidelines in 2005 to

suggest that 911 operators emphasize cardiac compression.

" Most people do better with compressions only, " said Dr. E. Pepe, head of

the emergency medicine department at the University of Texas Southwestern

Medical School, who wrote the guidelines for the dispatchers.

But experts cautioned that the new rules applied only to people who collapsed

suddenly from a heart attack. Those suffering from respiratory arrest, including

victims of drowning and drug overdoses, still require conventional CPR.

The compression-only approach is effective for a variety of physiological

reasons, Pepe said. " The main determinant of restoration of a spontaneous pulse

is maintaining a high enough blood pressure in the heart, " he said.

Halting compressions to provide ventilation reduces blood flow by an

unexpectedly large amount.

The blood of a heart attack victim is fully oxygenated at the time of the

attack, and the body uses less oxygen in the aftermath of the attack, he noted.

That supply is usually enough to last seven or eight minutes, he said.

Moreover, most heart attack victims gasp for air every 15 to 20 seconds — a

phenomenon known as agonal breathing or a " death rattle. " That gasping provides

substantially more oxygen than mouth-to-mouth, he said.

" For people who are gasping, the body will take care of breathing for you, and

it does a better job, " he said.

Dr. Ken Nagao of the Surugadai Nihon University Hospital in Tokyo and his

colleagues studied 4,068 adult patients who had a heart attack in front of

witnesses. Paramedics questioned bystanders about what happened in each case.

Seventy-two percent of the patients received no resuscitation from bystanders,

18% received conventional CPR and the rest received only cardiac compression.

The study measured how many people were alive at one month with no mental

impairment.

The death rate was high for all patients, but those who received only

compressions fared twice as well.

For patients with apnea — a cessation of breathing — 6.2% of those who

received only compressions survived to the one-month mark compared with 3.1% who

had conventional CPR.

For those with a heart rhythm that could be shocked back to normal, 19.4% in the

compression-only group survived compared with 11.2% of the CPR group. And for

patients for whom resuscitation began within four minutes, the percentages were

10.1% and 5.1%.

There was no sub-group that benefited from the addition of mouth-to-mouth

respiration, they said.

The American Heart Assn. said in a statement Thursday that it supported the

compression-only approach " for anyone who is unwilling or unable to provide

ventilations while providing chest compressions. "

" This study supports the concept of lay providers performing compression-only

CPR in the first few minutes after witnessing an adult suddenly collapse, " the

group said.

________________________________________________________________________

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[Guest guest]

Not only is this not news, it has all been addressed in the 2005

Guidelines.

The rationale for compressions only CPR applies primarily to witnessed

arrests, where the patient was fully oxygenated seconds ago.

Non-witnessed victims are likely hypoxic, and need O2.

And the problem isn't with doing breaths. The problem is with REALLY

BAD compressions everyone is doing, including EMS and hospital personnel.

And you also have to take into account who is saying what:

1. Dr. Pepe is speaking from the perspective of pre-arrival

instructions, where keeping it VERY simple for these untrained

laypersons is a key, overriding the benefits that might be gained by

breaths in favor of making it simple so they'll do SOMETHING (which is

WAY better than nothing).

2. The folks in Arizona at the Sarver heart center, and particularly Dr.

Ewy, have been on the fringes of this debate for YEARS advocating

compression-only CPR. If you've heard anything about this for the last

10 years, it's likely from them. The press loves them, because they're

saying something different. I'm not saying they're right or wrong, but

just realize they do have a horse in this race, and been riding it a while.

So, like any good answer, it depends! You have to read the research,

read the standards, and apply these things in the context intended. One

size doesn't fit all, not in shoes and certainly not in patients!

=Steve , LP, RIT=

Chair, Instructor Development

American Safety and Health Institute

ExLngHrn@... wrote:

> CPR study: Nix the mouth-to-mouth

> Heart attack victims fare twice as well with chest compressions only than with

mouth-to-mouth too.

> By H. Maugh II

> Los Angeles Times Staff Writer

>

> March 16, 2007

>

> Overturning a century of conventional medical wisdom, Japanese researchers

reported Thursday that simple chest compressions without mouth-to-mouth

ventilation save twice as many heart attack victims as traditional CPR.

>

> The findings could have important implications in emergency medicine. As many

as three-quarters of bystanders who observe a heart attack in a stranger decline

to perform CPR, fearing infectious diseases.

>

> The report " should lead to a prompt revision of the guidelines for

out-of-hospital cardiac arrest, " Dr. Gordon A. Ewy of the University of Arizona

College of Medicine wrote in an editorial accompanying the study, which was

published in the medical journal Lancet.

>

> The National Academies of Emergency Dispatch revised its guidelines in 2005 to

suggest that 911 operators emphasize cardiac compression.

>

> " Most people do better with compressions only, " said Dr. E. Pepe, head of

the emergency medicine department at the University of Texas Southwestern

Medical School, who wrote the guidelines for the dispatchers.

>

> But experts cautioned that the new rules applied only to people who collapsed

suddenly from a heart attack. Those suffering from respiratory arrest, including

victims of drowning and drug overdoses, still require conventional CPR.

>

> The compression-only approach is effective for a variety of physiological

reasons, Pepe said. " The main determinant of restoration of a spontaneous pulse

is maintaining a high enough blood pressure in the heart, " he said.

>

> Halting compressions to provide ventilation reduces blood flow by an

unexpectedly large amount.

>

> The blood of a heart attack victim is fully oxygenated at the time of the

attack, and the body uses less oxygen in the aftermath of the attack, he noted.

That supply is usually enough to last seven or eight minutes, he said.

>

> Moreover, most heart attack victims gasp for air every 15 to 20 seconds — a

phenomenon known as agonal breathing or a " death rattle. " That gasping provides

substantially more oxygen than mouth-to-mouth, he said.

>

> " For people who are gasping, the body will take care of breathing for you, and

it does a better job, " he said.

>

> Dr. Ken Nagao of the Surugadai Nihon University Hospital in Tokyo and his

colleagues studied 4,068 adult patients who had a heart attack in front of

witnesses. Paramedics questioned bystanders about what happened in each case.

>

> Seventy-two percent of the patients received no resuscitation from bystanders,

18% received conventional CPR and the rest received only cardiac compression.

The study measured how many people were alive at one month with no mental

impairment.

>

> The death rate was high for all patients, but those who received only

compressions fared twice as well.

>

> For patients with apnea — a cessation of breathing — 6.2% of those who

received only compressions survived to the one-month mark compared with 3.1% who

had conventional CPR.

>

> For those with a heart rhythm that could be shocked back to normal, 19.4% in

the compression-only group survived compared with 11.2% of the CPR group. And

for patients for whom resuscitation began within four minutes, the percentages

were 10.1% and 5.1%.

>

> There was no sub-group that benefited from the addition of mouth-to-mouth

respiration, they said.

>

> The American Heart Assn. said in a statement Thursday that it supported the

compression-only approach " for anyone who is unwilling or unable to provide

ventilations while providing chest compressions. "

>

> " This study supports the concept of lay providers performing compression-only

CPR in the first few minutes after witnessing an adult suddenly collapse, " the

group said.

> ________________________________________________________________________

> AOL now offers free email to everyone. Find out more about what's free from

AOL at AOL.com.

>

>

>