ProCPR training programs follow scientific treatment recommendations based on the American Heart Association (AHA) and ILCOR Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. After the publication of the 2005 guidelines, several scientific studies showed that hands-only CPR can be as effective as conventional CPR in the out-of-hospital setting. The AHA published an advisory statement in the March 31, 2008 edition of the journal Circulation, to clarify and amend the 2005 Guidelines for CPR. The previous recommendation was that laypersons (bystanders) should perform hands-only CPR if they are unable or unwilling to provide rescue breaths.
Hands-Only CPR recommended for adults
The most recent AHA advisory states that Hands-Only (compressions only) CPR without mouth-to-mouth breaths is recommended for use by all people who see an adult suddenly collapse in the out-of-hospital setting. It consists of two steps; Call 911 and begin chest compressions by pushing hard and fast in the center of the chest. Hands-only CPR and conventional CPR are considered to be equally adequate for treating adults who suddenly collapsed.
Conventional CPR with rescue breathing still recommended for infants and children
The AHA continues to recommend conventional CPR (CPR with rescue breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems. For adults who suddenly collapse, the choice is yours. AHA states that if you are confident in your ability to provide CPR including breaths with high-quality chest compressions with minimal interruptions, then provide either the conventional CPR that you learned or begin hands-only CPR.
ProCPR applauds the AHA for simplifying CPR. We have consistently taught that complicating CPR training and adding confusion to the learning process is counterproductive to the goal of simply getting people to do CPR without fear of hurting someone who is dead. According to the American Heart Association, only 15-30% of out-of-hospital cardiac arrest victims receive bystander CPR before EMS arrives.
ProCPR remains committed to its fundamental principle of providing high-quality and easily accessible training that will get more people to perform CPR. We will make necessary enhancements to stay consistent with new AHA guidelines and recommendations. Rest assured, ProCPR will continue to provide the most up-to-date materials and training presentations.
Certainly, doing something is better than doing nothing at all. But are there statistics available that say how much less effective Hands Only CPR is than traditional CPR?
*Two theories at work*
“There are really two theories in resuscitation science: the cardiac pump theory, and the thoracic pump theory,” explained Dr. Charles Lick, emergency medical specialist and co-founder of Take Heart Anoka County , a program designed to improve outcomes in those who suffer cardiac arrest.
“In the cardiac pump theory, it’s the compression of the heart that pumps blood out into the organs, but in the thoracic pump theory we understand that the negative pressure [vacuum] caused by inhalation is what sucks or draws blood back into the chest so that it can be recirculated,” Lick explained.
Think of the circulatory system as a train on a circular, one-way track. The train has to go out, but it also has to come back. Without blood flowing back into the chest, the heart has nothing to squeeze out.
In the vast majority of people who collapse because of a cardiac arrest, the train is dead on the tracks. The heart is not squeezing, it’s fibrillating — a shuttering, seizure-type motion that generates no blood-flow. With the train sitting idle, no blood or oxygen can be delivered to the body, including the heart itself.
As critical as oxygen is, it turns out that in the first several minutes of a cardiac arrest, breathing is not that important. (You heard it here at MinnPost first: Breathing is not that important). There’s a few minutes supply of oxygen stored away in the bloodstream, but still, that blood has to be moving, and for that to happen the heart needs to be squeezing, not fibrillating. That’s why early shocks and chest compressions are so critical.
If the train isn’t moving, you can dump all the oxygen you want on it, but it’s not going anywhere.
*Real world vs. ideal world*
Wouldn’t it be best to have your cake (oxygen) and inhale it too? Wouldn’t it be better to have oxygen coming in and out of the lung, and the heart squeezing?
In a perfect world, yes, but as the AHA Scientific Advisory points out, that’s often not what happens in the real world. Studies show that for the lone rescuer, the time spent fumbling to breathe for the patient often comes at the expense of critical chest compressions. The AHA Advisory notes that “trained rescuers performing traditional 1-person CPR take much longer to initiate CPR than those trained to perform hands-only CPR.” The AHA also found that it took lay rescuers 16 seconds to move from giving chest compressions to providing rescue breaths, and even for health care providers there was a 10-second delay.
The second problem with trying to ventilate an arrested patient involves the thoracic pump theory and the train on the circular track. Very commonly, panicked rescuers mistakenly over-ventilate the victim by breathing too hard and too fast.
“We’ve been doing this wrong for a long time, over-ventilating people,” said Dr. Lick, explaining that over-inflated lungs create high pressures within the chest. That high pressure pushes back the blood that is trying to return to the heart. For the heart, low input means low output, and low output means low blood pressure. Or no blood pressure at all.