Exactly. It's no use getting oxygen unless it's actually getting circulated through the bloodstream.

As a bystander you do not have to be trained in Defib operation. You can be some smuck off the street, rip the pack off the mall wall and read the simple directions to deliver a life saving shock. While the EMS personell must go through hours of education to be qualified to use a defib- go figure

I find your comment "while the EMS personell must go through hours of education to be "QUALIFIED" to use a defib- go figure" quite insulting...our training is pretty important in saving your life. Yes in classes, defibrillation is talked about, and yes, it is practiced every 2 years at least when we renew our cpr license...however, the "GO FIGURE" comment is not needed...our training/classes/skills practice are used for lots of other things...things that "go figure" you wouldn't even have the slightest clue on what to do.....go figure

Abby said: As a bystander you do not have to be trained in Defib operation. You can be some smuck off the street, rip the pack off the mall wall and read the simple directions to deliver a life saving shock. While the EMS personell must go through hours of education to be qualified to use a defib- go figure

Thank goodness there are redundant safety features on defibrillators that keep the lay person from harming a person that is merely sleeping or having some other non-cardiac event. Thank goodness we EMS personnel go through thousands(yes thousands) of hours of training on equipment and new life saving techniques so that illiterate fools like Abby can go through life with other trained professionals watching their back. Go figure!

Defib can be dangerous and nuances must be addressed. I teach daily to healthcare and some nurses forget to plug the thing in or stand back. Some old boxes are three shock biphasic and new ones are one shock...confusing and I had some students press the green off/on button rather than the red/orange shock button...go figure. Remember, people are under duress while doing this...

Agree Monica & WHT3. In just the basic courses, I have to learn a step by step process... "Just in case..." Sometimes there just is no sticker to tell you what to do.

Remember...if witnessed; otherwise the oxygen level may be low and require breaths.

What they are doing is trying to overcome all the human traits that cause lack or quick response and reluctance to help.

Abby, the defibrillators used by EMS and hospital personnel are much more involved than the basic yet very useful defibrillators available for use by the public.

There are many variations of cardiac arrest. It is rarely simply a "stopped heart". In fact, total asystole (a completely "stopped" heart) is seldomly reversable.

The defibrillators used by professionals allow them to intrepret and treat the many different types of cardiac arrythmias. The training is very detailed and requires regular practice and recertification.

In the recent A/I/C CPR classs I attended, the instructor pointed out that when chest compressions are done with sufficient force, the lungs are compressed and depressed as well, causing air to enter and exit through the victim's mouth, and actually the only way they would get NO air is if there's a blockage.

Type of ArrestROSCSurvivalSource

Witnessed In-Hospital Cardiac Arrest
48%
22%
^[37]

Unwitnessed In-Hospital Cardiac Arrest
21%
1%
^[37]

Bystander Cardiocerebral Resuscitation
40%
6%
^[38]

Bystander Cardiopulmonary Resuscitation
40%
4%
^[38]

No Bystander CPR (Ambulance CPR)
15%
2%
^[38]

Defibrillation within 3–5 minutes
74%
30%
^[32][34]

Where ROSC means Return of spontaneous circulation.

The above chart is from Wikipedia......as an anesthesiologist, I believe it is close to my personal experience with cardio=pulmonary arrest. Curiously, the survival rate for unwitnissed in-hospital arrest is LESS than bystander resuscitation???

Also , ROSC is about the same in bystander as in-hospital.........which leads me to believe some bystander CPR was in error or not needed.......

Overall, survival in- hospital is only 22 % and the likelihood of receiving defibrillator therapy on the sidewalk within 3-5 minutes is a fantasy...........

Physiologically, the binding of oxygen to hemoglobin is a miracle of biochemistry. The downside is that only one or two oxygen molecules per hemoglobin are available for respiratory exchange at the tissue level, and that release of oxygen is highly dependent on tissue pH.......i.e., lots of oxygen, just a few available...........

The well-toted 5 minutes to death scenario really means that hemoglobin has exhausted its ability to deliver oxygen to the tissues, if respiration and circulation stops.......oxidative phosphorylation in the mitochondria ceases, and cell death begins......

If the American Heart Association believes that a change in CPR protocol will "double" survival from 4 % to 8 % ( which still means about 90 % of arrests die ), then I believe the protocol change is without merit.........

Critical to the notion of what AHA propagandizes, CP resuscitation is about as good as it gets, MOST victims are going to die, and resuscitating a corpse still results in a corpse with a heartbeat, and a dead brain...........

The training of para-professional personnel in this CPR technique is worthy, however, the requirement that board- certified anesthesiologists also be mandated, smacks of paternalism and undefined gains, such as the cost of time and course materials, to "train" accomplished physicians, who have been educated in the most detailed minutia of cardio-pulmonary physiology, to learn to count compressions and "hum - Stayin' Alive" ..........

In summary, the exclusion of respiratory assistance in CPR is ridiculous.......attempting to circulate blood that is fully desaturated is futile; and assuming that EMT assistance is just two minutes away is a fantasy.........

Levi777.........\

Your instructor is wrong.......if the airway is closed, then the assumption that chest compressions will ventilate is quite simply RIDICULOUS...........

Perhaps you should reread what Levi actually wrote.

By providing oxygen, you may be hurting the patient even more!

The secondary damage to the brain caused by the restoration of blood flow appears linked to a chain reaction that releases glutamateglutamate /glu·ta·mate/ (gloo´tah-mat) a salt of glutamic acid; in biochemistry, the term is often used interchangeably with glutamic acid. Keeping the blood cool curbs glutamate release from nerve cells in the brain. Too much glutamate, an amino acid, overexcites and kills these cells. Keeping the blood cool curbs glutamate release, Safar says.

http://www.thefreelibrary.com/Mild+hypothermia+aids+heart+attack+recovery.+(Chill+Out)-a083699429

Clearly I need to be re-trained on CPR procedure.

Cracks.........

That is why ABC instead of CAB makes more sense......airway MUST be open, if you don't check and correct, it is nearly ALWAYS BLOCKED.............

RN STUDENT.........

Peter Safar's work is really dated....(he was an anesthesiologist), ...his main concern was "brain resuscitation" and he used chimps as an experimental model, curtailing blood flow to the brain with a neck tourniquet.

He was able to establish two important principles of brain resuscitation- (1) a cool brain is better and (2) sodium pentothal somehow had brain preserving properties..........

Balancing glutamate production during brain re-perfusion with anoxia of the cellular mitochondria during cardio-pulmonary arrest begs the question......there will be no re-perfusion if the heart does not re-start...........

Dane Lover

Good posts.

DanrLover, how many in depth studies have you done to support your claims? So, too, you think a 4% difference makes the new protocol "without merit"; I hope some day you are in the 4 % that weren't saved BECAUSE the new technique and protocol wasn't used, MAYBE you might see the light and have your eyes open. I hope you aren't a Doctor, Nurse or other medical person; I Surely wouldn't want YOU anywhere near me with your attitude.

DanLover, why is it that studies show a better success rate in patients that have been chilled to ones that have not. Have you had the chance to read any studies on this as of late?

colonialgirl........

attitude is in the mind of the beholder and I believe yours needs some tweaking........

Dan Lover, Here is a recent article covering this. Is this dated as well?

http://online.wsj.com/article/SB10001424052748703298004574455011023363866.html

colonialgirl wrote to danelover

I hope some day you are in the 4 % that weren't saved

Wow wishing someone death because you don't agree with them!

Its odd that hospitals in the US are beginning to use this method being that it is dated as stated by Dan Lover. I also see that you are firm in your old ways.

RN..

You failed to list the source.

I said Peter Safar's original work was "dated" - about 1975.

Your original assertion was that ".....oxygen may be hurting the patient more.......". In the CONTEXT of brain reperfusion, it was Safar's discovery that glutamate MAY be harmful......

In the CONTEXT of heart resuscitation, oxygen is mandatory.

Here is an apple, and here is an orange......no physiology required....and is likely optional in educating a nurse.

"But an initial rush of blood to the brain, when resuscitation gets the heart beating again, also kills tissue and is "a more important insult," Dr. Mooney says."

Interesting..... I understand that oxygen is mandatory in resuscitating the heart, but you also run the risk of damaging the brain.

I sense a tinge of arrogance.

RN......student

Gosh,....welcome to the world of House, MD...........

It is NOT a new method......I was part of the cardio-thoracic team at Hershey Medical Center in 1975, when we discovered that modifying the whole body cooling during cardiac surgery bypass could be supplanted by cooling the myocardium locally, and that fiibrillating the heart instead of inducing potassium arrest, was detrimental to myocardial function.

I think a bit more respect for your "elders" would probably result in a better education than your "know-it-all" behavior as a tyro student...............

Thank you for a little background on yourself. Now since you have history in this, what is a better way to revive a patient? Let us hear in your words what the best way to revive someone is with the least cellular damage.

I still think you should drop the arrogance. Makes for a better learning environment.

Oooh I wish I could have been there.

RN......

Now that I have you in front of my white board.....I'll try to make this sound reasonable.

Tissue damage.......

With the initial cardiac arrest insult, tissue damage begins immediately......in ALL tissues, especially, those with high glucose and oxygen consumption-heart, brain, kidneys,liver....

In order for a cell to maintain homeostasis, glucose and oxygen must be delivered to the cell continuously, or the engine of the cell, mitochondria, begins to fail to produce ATPase in the Krebs Cycle. This is the chemical energy store of all cells, and without ATPase, the cell begins to die.

Safar and Mooney both understood this, and their research does not exclude this fact....it is a matter of timing. If, it was possible to ameliorate the effects of the initial cell damage, then the resuscitation MIGHT be more successful......for example, Safar was able to brain resuscitate his chimps more successfully, if the chimps were cooled and/or received Pentothal BEFORE the initial brain insult.......initiating treatment after the insult was widely more variable.

However, Safar also recognized that determining WHEN the insult was going to occur AND cooling and receiving Pentothal BEFORE that event was academic.....i.e., the model was NOT reproducible in reality.

Dr. Mooney may be correct, but no model can accurately separate initial damage from re-perfusion damage.....or, the extent of the damage initially, and its continuance into the post-resuscitation period...... dilemma.

And, basically, this is where resuscitation stands....there MAY be some value in cooling and barbiturate administration, but the results are difficult to interpret because the initial time and duration of the arrest cannot be controlled.

I'll try to answer your challenge with a personal experience with a 30 year old Amish farmer.......He came to the ER complaining of chest pain, EKG appplied, NSR for three minutes and then asystole---UNBELIEVABLE---a witnessed arrest three minutes after entering the ER.

Chest Thump- really hard- asystole to ventricular fibrillation, 200 joules on the defibrillator--NSR......farmer never lost consciousness--total time from arrest to NSR---16 seconds.

I later anesthetized this young man for quadruple CABG one month later.....he lived to see his children graduate from high school..........

I've trained in CPR at least five times since 1980. It has changed each time I trained. I trust the experts to teach me how to do it right to possibly save a life.

They remind me that if he lives thats great but don't take it personally because he has no chance without me. He is dead without me.

Keep up the good work folks. I'm not a doctor or EMT or medical professional of any kind. I am a mom with three grown daughters. While they were young I taught them all to swim and kept up with CPR. I could have never forgiven myself if anything happened to them and I did not give them or myself the tools to save their lives.

To all mom and dads take your children to swim classes or teach them yourself and take CPR classes. It is important! Don't take their lives for granted.

RN Student

"But an initial rush of blood to the brain, when resuscitation gets the heart beating again, also kills tissue and is "a more important insult," Dr. Mooney says."

Interesting..... I understand that oxygen is mandatory in resuscitating the heart, but you also run the risk of damaging the brain.

I sense a tinge of arrogance.

All I read out of your posts are "Cocky-know-it-all and think you can practice medicine" even though you are just a nursing student. Your type are the most dangerous ones. Thinking now that you read medical journals and studied nursing care..... now you can practice medicine.

Your job is to take orders from a doctor and follow through. If a patient is in cardiac arrest, and the doctor tells you give the patient 100% O2 and start CPR, are you going to lecture them on cold therapy and their methods are outdated?

Understand that all medical is only practice. Every event has variances that can change at any moment. It is not my place to lecture a health professional nor is it my place to practice medicine. But understand that we continue to make leaps and bounds in the medical field only because we do not close our eyes and only rely on what we know. Those who do not push the boundaries "researchers" do not progress. But to say that a doctor knows everything is by far a mistake. He/she may know a great deal but does not know everything. This is why it is called a practice. One must practice to become good at something. We also must be open to new ideas.

I by no means "know it all" but if no one ever questioned something, then we would still be in the stone age.

RNstudent........

Back to the White Board...........

"understand......" I like being lectured when someone is my intellectual equal, but not by a runny-nosed student who thinks a nursing education makes that person God's gift to medicine......

"...Every event has variances that can change at any moment..."- profoundly pathetic non-scientific PC language- laughable at any usage.......

"...because we do not close our eyes and only rely on what we know......"-- The basis of medical progress is founded on the Principles of the Scientific Method (not usually taught in nursing schools), that "what we know" is based on hypothesis, tested and re-produciible under controlled conditions........the common introduction of "field tests", such as Dr. Mooney's are poorly controlled, bias-tested, and NOT reproducible, and have a low element of controls.....and anecdotally list "miraculous" survival rates as science......the definition of "quackery"

The use of the word "practice" is not what you have misconstrued several times.....such as suggesting a physician "screws up" until he gets it right.......the word more correctly defines the act of applying scientific knowledge to the treatment and care of human beings.....and physicians are a special group that have been tested for knowledge, honesty and performance, certified by their specialty boards as possessing these traits and permitted by State Laws to apply their skills in the care of patients.....

"....One must practice to become good at something......."- the process of applying scientific skills to the care of patients is NOT a golf game.........someday you might understand this.....

"....We also must be open to new ideas......"-- Hope and change concepts of "pushing the boundaries" must remain confined to the Presepts of the Scientific Method, otherwise, one would run the risk of announcing that carbon dioxide is a toxic chemical, officially politicized by the EPA (Ministry of Truth) as hazardous to your health........when, in fact, carbon dioxide is present in atmospheric air and is used by plants (photosynthesis) to convert air and water into elemental oxygen (we breathe this stuff) and sugars and starches (we eat this stuff)......

"...questioning something...." is one thing; going ga-ga over a free library of questionable medical acts is not science, but cult rationalization..........

colonialgirl, chill out and learn how to play nice with others! Good posts DaneLover..thanks. And kudos to any who don't stand around wondering what to do, or walk on by and pretend they don't see the person laying on the ground.

And let me share a story with you: I had driven my daugther home, and was driving back to mine along a several mile long road that runs straight as an arrow, but had serious ups and owns along a hilltop. The car in front of me, an old Impala, took off normal at a stoplight, then all of a sudden, going uphill, drifted over into the oncoming lane (two way street, just two lanes, no shoulder). The horn on my old Mazda pickup didn't work, so I flashed my lights. Cars coming over the hill would have no time to stop, and no place to go but the ditch.
The impala swung back over and sprayed gravel from the side of the road, then seemed to straighten out. A short distance later, he did the same thing, and repeated the movement over and over again; swinging over into oncoming traffic, then back into the lane.
At the end of this straight stretch, the main road curved down to the right, but if you stayed going straight, there was a block long private road, with houses, and at the end of it, the road did a 90 degree turn. Where it turned, there was a pile of logs, and beyond that, a stand of trees and bushes. The impala went straight, hit the pile of logs, flew up in the air and inverted, and came to rest upside down suspended about 3 feet off the ground.

I slid to a stop, and ran to the first house, banging on the door and screaming. A man came out of the garage and I hollered "Call 911! A car went off the road down there!" And without waiting for a response, I got back in my truck and sped off to the site. Sliding to a stop, I got out, and worked my way to the car. It was still running, and the door was locked. I found a rock and broke the side window. Inside, I turned the car off, and found the driver was hanging upside down, with his seatbelt secured. He was a big man, I'm sure over 250 pounds, and with all that weight hanging on the seat belt, I couldn't get it undone. I began talking to him, and finding his wrist, checked his pulse. I had CPR and emergency combat first aid training while I was in the military, and was trying to get the man flat so I could work on him. His pulse was real weak, and continuing to talk to him, I looked around for something to cut the seat belt. There was nothing. I checked his pulse again, and while I had my middle and ring finger on his wrist, his pulse stopped, and the man died.
The County Sherrif had me sit in the back of his car, door open, while he took my statement. The aid personell worked on Mr. Ronald Davis for 45 minutes, but could not revive him. He was gone. The Sheriff said that he had died from a heart attack. If that is true, that makes the man a hero in my book, that suffering a heart attack, he avoided a head-on collision.

Because of that incident, I ALWAYS carry a Leatherman multi-tool with me. With the needle nose, I can break the window by gripping it tightly with my left and striking the end of the tool with my right. With the knife, I can cut the stupid seat belt. In addition, I always carry a cell phone to call 911, instead of wasting precious time finding someone to make the call.

I don't know if he would have survived, or if I could have saved him. I do know that unless we can get the person in a position where we can work on them, it is a moot point and we are ineffective. There are little tools available at most hardware stores that cut seatblets, and fit easily in a wallet or purse.

I understand survivor guilt, how it is very real and not really based in truth. "Why didn't I..." and "If only I..." We can rationalize, and philosophize, but there is no subsitute for preparation and readiness. Emergencies don't schedule themselves, and can happen to anyone at any time. I got home 6 hours after I left, with my wife wondering where the blank I had been. I was wearing slippers, and they and my pants up to my knees were covered in mud, and as I told her, we both began to cry because somewhere, someone would be grieving over this man that night, and all his chances and new beginnings were now over for good. And what we all wouldn't give, at times, for just one more chance. One more new beginning.

One grand post......good Levi777........

I, too, carry a Leatherman...not too many folks know what this is......My family uses a ferry to cross Lake Champlain frequently to get to Burlington, Vt......a ferry flip is nearly always lethal because the travelers cannot get out of their cars nor cut their seatbelts..........

You did your best........God was watching.........

It is so unfortunate that whenever some new guideline changes occur there has to be some negative feedback. Statistics can be reliable in most cases and overall the goal is to increase survival rates both in-hospital and out-of-hospital.

While danelover has obvious advanced skills and knowledge it appears the "basics" are still being overlooked.

If it is of any concilation to RN Student, some of most challenging students I deal with in my CPR classes are typically the Physicians and Anesthetists/Anesthesologists. They are too often getting into advanced thinking and procedures and they often miss the most basic steps and fundamental skills required to complete a CPR skills test. I train nearly 2000 students per year and the most receptive are the nursing students.

Of course in a clinical setting the patient is often going through a procedure in-hospital and the responders will have equipment, support and knowledge of the patient's condition. Out-of-hospital responders may have no equipment, no support and no knowledge of the victims condition. These new guideline changes, without a doubt, will have a positive impact on the survival rates of the latter.

Virtually none of the tweaking by the AHA has increased survival rates over the past twenty years..........

The AHA relies more now on evidence based changes than ever before. It makes sense to make changes based on current science as opposed to the more anecdotal methods used in the past.

Your "leftovers" contain on average 16% oxygen. The atmosphere contains 21% oxygen, and the body consumes about 5% of it during normal respirations. If you can figure out a way to exhale 30% oxygen, patent it and get rich. And they may revise the next text for you!

Medic is right...not even close to 30%. Reminds me of those oxygen bars claiming to deliver 100% oxygen. Interesting because it takes a doctors order to deliver that...its a controlled "drug".

Since when Oxygen is a drug? Those pharma companies trying to patent everything yet again!

Hmmm 16% huh! Ever run a blood gas on venous blood??? For that matter ever run one on oxygenated blood?? Yah didn't think so! The delivery of any oxygen to someone who is not breathing is a plus as opposed to no oxygen. Conversley, circulating that oxygen is equally necessary as one without the other is useless. Your mouth to mouth delivers considerably less than 16% and you have to remember you are also delivering YOUR CO2 in the process. Does that constitute a reason to not give mouth to mouth? Absolutely not.

The AHA splits hairs on this all the time. They do "studies" while we do real life. They sell books which are required for us to function under our license.

When the truck gets there the O2 goes through the ambu bag and delivery is as good as the person bagging as are the compressions. Bottom line: 1.How long has the patient been down. 2.What caused the patient to go down? 3. How effective has resuscitation efforts been? Cause and damage determines whether the patient will be revived or not in spite of perfect resuscitation effort. Even if I intubate and ventilate and you put an external pacer on!

I learned a little over the 20+ years I put in so far as a respiratory therapist.

Tammy,

That would be for a very long time now. You cannot buy Oxygen delivery systems without a prescription nor can you be given Oxygen without a doctors order (standing orders apply in emergency situations).

Oxygen is considered a drug as it can have detrimental effects when delivered at high percentag over time especially COPD patients whose drive to breathe is controlled by CO2 levels NOT O2 levels.

Thanks Jim,

Tammy don't talk about something if you don't know. I have been working with oxygen for 20+ years. It is just as regulated as morphine. You can't get it unless your doctor writes you a RX for it and if you don't know what you are doing with it you can hurt yourself and others. I can't give it to patients unless directed by a physician that I am working under. Thank you for your words of intelligence though. And no, oxygen bars do no deliver 100% oxygen. It is against the law. I have stopped and had many conversations with owners and workers. Save your money.

I am not sure what context you are referring to when you speak of delivering oxygen. Emergency oxygen is available in non-prescription form. It can can be ordered, shipped, deployed and provided in almost any rescue condition in which CPR or rescue-breathing is being implemented.

Read the FDA policy:

FDA - FOOD AND DRUG ADMINISTRATION
COMPLIANCE POLICY GUIDES GUIDE 7124.10

"Oxygen equipment intended for emergency use can be marketed for OTC distribution. Such equipment must deliver a minimum flow rate of 6 liters of oxygen per minute for a minimum of 15 minutes...."

Some comments posted here are just so vague and may be taken literally without consideration of a valid resource.

From the FDA:

Medical oxygen is defined as a prescription drug which requires a prescription in order to be dispensed, except as described above, for emergency use.

Further, we would strongly discourage the use of industrial grade oxygen due to the lack of control exercised over industrial high pressure cylinders and the possibility of contamination occurring. As for the use of oxygen concentrators, these are prescription devices and as such would require a prescription.

On September 19, 1996, FDA informed the Compressed Gas Association that a final decision had been reached on its citizen petition. The label for medical oxygen should bear the statement, "For emergency use only when administered by properly trained personnel for oxygen deficiency and resuscitation. For all other medical applications, Caution: Federal law prohibits dispensing without prescription."

Your blood still is highly enriched in O2.

I want lots of O2 not just whatever is residual!

RE: Without O2, you have 3 minutes before brain damage begins and 10 minutes before brain death occurs.

uhmmmm... this is by the book, indeed; however, there are plenty of cases in which CPR was given for up to an hour and people are well and alive (i.e. no brain damage.) No doubt, the human body is a miracle. Truth is, nobody knows for sure why some "make it" and why some won't.

nothing is by the book...I agree, the human body is, indeed, a miracle!

Yeah I never did figure out how they justified it. I'm just the messenger that went through cpr recert for a career, about 10 times.

MsAubrey........

Could you explain your statement???

While hemoglobin in a fully saturated state contains 4 molecules of oxygen, only two are available for exchange at the tissue level......if you do not breathe for 5 minutes, your hemoglobin desaturates to a level that will not sustain homeostasis in tissue cells........

Now, wanna' re-state your post????????

No, because you have to prove damages and that it happened as a result of derelect duty. Most states have Good Samaritin laws relieving one of liability.

Yes, they sure do! Everyone should become aware of the Samaritan Laws...

AHA BSL and ACLS are GUIDELINES, NOT laws.......no court or jury has been able to adjudicate these guidelines as law.......for a very good reason.....

Walk on bye would become the norm.........

I have to agree with Jack CPR as been around since 60's and yes some of the changes have improved reviving people. To make changes every couple of years I don't see it. However now everyone has to be retrained and new books published. So what is the real reason who is writting these books?

AHA has become a bureacracy of fees and books, with little demonstrable improvemnt in survival.......

DaneLover, again with the negativity. Books and material could be provided for free and there would still be someone out there like yourself that would find a fault. ILCOR (International Liaison Committee On Resuscitation) is the body that reviews and provides the guideline recommendations for most countries.

The body consists of numerous entities including AHA to contribute and recommend changes. The fact that some income is a derivative of those changes will always be debated. Let's all accept it at face value and move forward so that the general public receives the neccesary information to help save lives.

Be positive and contribute; promote and encourage; assure and affirm the current recommendations so that the message is received with minimal uncertainty.

Calrageous must be the local AHA cheerleader........

I am NOT negative, but a scientific questioner of the proposed guidelines.......this is NOT a crime....but, the normal process of peer-review, which the AHA has forsaken and therefore, takes its nonsense to the media........FOUL.......

They should sell them at pharmacies as well as require a purchase at training.

WHT3 cudos to you, Everyone needs to rememebr that "BREATHLESS CPR" has its limitations. Where alot of this is coming from is AHA recognition that people are reluctant to deliver breaths because of the possibility of transmission of a disease. Compressions Vs nothing is alot better and more people are willing to atleast do this. Compressions circulate O2 that is already in the bloodstream and we basically buy time so we delay biological death at the cellular level for about 3-5 minutes. The other theory is during "Compressions" you make the chest smaller and during the recoil phase some breath is drawn in. If the airway is not kept open there is no way for this to happen as our anotomy will block this. I leave you with this question about not delivering breaths anymore. Why do we ALL breath 12-24 breaths a minute, but it is ot not nesseary to breath when we are pulseless. Trying to make this skill so easy that anyone can do it is understandable but lets not do this at the risk of the media storm about not breathing anymore as the end all be all. These people need air, after a period of time you are just circulating unoxygenated blood.. Why?

RN student needs to read this......

It really should be for witnessed events; thereby the oxygen level would be higher.

Good points....if Angeline Jolie arrests I might forget the compressions.....

Good points....if Angeline Jolie arrests I might forget the compressions.....

But, you're cheerleading doc, not too impressive......

Ever notice how blue-black the arrest patient's ears......brain can't be any deeper blue....

I am a pediatric intensivist and a PALS instructor, and I agree with the new guidelines...obviously a witnessed choking calls for different interventions, but chest compressions in kids actually helps air movement in the absence of a blocked airway..their chest wall is so compliant that you would be mimicking breaths as well as supporting their hearts...

If you're an Instructor, then you'd know that they tell you to check for breath and heartbeat.

kidzmd.......

Sorry, but my observation as an anesthesiologist, as to the expertise of pediatricians concerning airway maintenance is that they are poor performers....frequently botching intubations and demonstrating dismal bag and mask skills........

Sharlene,

I assume you teach AHA and that you are a BLS Instructor, therefore you should be aware of lay-rescuer vs HCP differences.

You should also be communicating the appropriate differences of Child CPR vs Adult CPR to your students regardless of HCP or lay-rescuer.

Your question regarding the patient having a "heartbeat" is also of concern, because pulse check is not taught to lay-rescuers any longer. Try asking this question in your next lay-rescuer class: Who here has checked someone elses pulse in the last week? month? year? You are lucky to see one hand raise in a group of 12. This should give you an idea of what you are dealing with when comes to interpreting a "heartbeat".

And of course we teach recognition of foreign-airway obstruction and when to perform abdominal thrusts.

The new books will be a footnote to a bad idea..........

Thank you!!! I was going to write exactly that...that effective chest compressions also allow ventilation as the inward and outward movement of the chest actually mimics normal breathing....

I am disappointed but not surprised that the non medical people writing the article did not mention this, but I am MORE disappointed that some of the EMS personnel that chimed in on this forum also apparently did not know this....

Maybe it is time for a full course renewal of CPR/ALS/PALS for some of those providers, instead of the quickie renewals most do to keep their cards current...

When I last did my renewal in January I was told this change might come about for the exact reason you stated. The compressions do cause some air to enter and exit the lungs alowing oxygen to get into the blood stream.

My only concern with the new change is that they put compressions before airway. As stated by many, oxygen is an important key in reviving someone. But if the airway is not opened up how will oxygen even enter the lungs. I personally think that Airway should still be first, then compressions. It is not that hard, and does not take alot of time to throw in an OPA or NPA. That is for us EMS professionals, however. If it is a bystandard doing the CPR, they obviously won't have access to those tools.

If you read the newer ACLS books they are not pushing the "science" the are pushing "learn by rote" as in "This is what you do for problem A, or B, or C. Not "Problem A is caused by ____— and this is what needs to be done." The old BLS books for Health Care Providers used to be more than an inch thick, now it is barely a quarter inch thick. They took out all the science.

When I teach CPR/FA I explain things beyond the video (even though they (AHA) does not encourage that) and I have always taught that compressions alone is better than doing nothing at all. Fortunately AED are available and are of great benefit, but are not the be all, end all. Advanced Medical Care is required.

I encourage all lay responders to learn the science behind these changes.

Khalon; Many heart attack patients aren't having a heart attack due to a blocked airway unless they have vomited. If its a breathing problem from something swallowed, then YES do the airway; BUT IF its just a heart attack, then the airway IS open (I bet it doesn't automatically close from a heart attack), then it's by FAR more important to get the blood flow restarted. With paramedics, the airway is to enable them to administer oxygen which will enrich the blood and allow the heart to work less. If I have a heart attack and you let me die because you screwed around putting in an airway, I'm going to come back and haunt you.

Colonialgirl, It's obvious you have no medical knowledge. You are right in the fact that not every heart attack victim has a closed airway. However, many times when a person is unconscious, or dead, the muscles relax and the tong slips back into the airway, "blocking it". The oral or nasal airway is a basic airway devise used by healthcare professionals to maintain that open airway so that they are able to ventilate the patient. And fortunately, paramedics know exactly when to use them so you probably won't have to worry about coming back to haunt anybody ;-)

Simply "banging" on the sternum does NOT produce a viable tidal volume in the lungs....PERIOD.

The misconception that you are only delivering 16% oxygen when re-breathing is also bunk......."puffing" air to the victim mostly produces oxygen at near 21 %----why???....

because "puffing" of air means your inhalation is shallow and does not go deeply into the lungs, so little or none of the inhaled air is diluted........think, folks,..........think.....

I have not bought a new CPR book in YEARS.....purchasing a new book is NOT a requirement for maintaining CPR certification, being able to provide the correct answers and demonstrate effective resuscitation IS......

Many of the changes reflect new knowledge acquired by the medical community over time, and many of the changes are WAY overdue in being implemented, as it takes some time for new knowledge to be vetted and make its way into the rest of the world.

Would you prefer to go back to life without AEDs???

Not much value here...........the ASSUMPTION that air is moved during a sternal compression is just nonsense.......Minute ventilation to maintain carbon dioxide at 30-40 torr requires about 600-800 ml of tidal volume at a rate of 10-12 breaths per minute.........otherwise, the blood becomes more and more acidic.........

Well, that has the right tempo for compressions, and it's catchy.

Amen!!!

Not going to happen........expense exceeds the cost of burial.........

Then read the required material.

MsAubrey's response has no value...............

desaturation of blood occurs rapidly as monitored by a pulse oximeter, such that a saturation of 60% is achieved in about two minutes, if respiration ceases............there is no NEW oxygen because there is no respiration.......

When hemoglobin is desaturated to this level, NO oxygen is released to the tissues (Sigmund-Anderson curve)...........

No breaths......no life.....that simple.

Wrong !!!!!!!!!!!

NO, you might as well circulate mud.........

"Look at the patient and make the decision"??? Are you serious???

While you are looking at the patient and deciding i will be initiating CPR, activating EMS, and saving the person's life..

Apparently you must think that I'm a person of slow thought and of single ability, try dealing with combat situations before you make comment, nothing like starting CPR with a broken rib just ready to puncture an aorta or a piece of metal in-bedded the upper abdomen just waiting for you to compress and tear the crap out of their insides. Let me know where you live so if I do need emergancy treatment I can avoid your area.

"PATRIOT"... are you serious???? I have been certified in CPR and am also an instructor for many years. You DON'T just look at the patient and "decide" what to do. You quickly try to get a response from the patient "ARE you OK??"; and if no response, you yell for help and or call 911 and start the steps of CPR! I strongly recommend that you take a refresher course!

Patriot, The AHA is continuously conducting studies, most recently (over the past 5 years) Kansas City and Pheonix have been the chosen cities. These are not limited studies, they are huge and involve literally thousands of patients.

In a combat setting you are right, there are other factors to consider... But, broken ribs and metal in the abdomen are of no concern at all to DEAD people.

kidzmd 1 said,""Look at the patient and make the decision"??? Are you serious??" I would call that assessing the situation which is very important before you act. Also,is the person laying on a live electrical source or perhaps have another injury not easily visible?

Check for consciousness,Look,listen,feel. Check air way and give two breaths. This does not take long for those trained. For those untrained, if they are bypassing this process because of the reasons stated in this article, they may likely be doing CPR on someone with a pulse and is breathing, but unconscious. Pre-assessment is important. I know some will argue that more may be saved. It can also be argued that more may die needlessly because an untrained passerby was encouraged to do compressions only and by the new standard of even deeper compressions.

When you get "Stayin' Alive cadences, even the instructors get flummoxed......

This is my personal experience as a physician---Most instructors have NEVER resuscitated anyone !!!!!!!!!!!!

Their adherence to protocol belies thinking and decisionn-making..........

"Instructors" wear a red badge of courage.........their protocols have not increased survival rates.......

One question? What if the victim was as a result of a Oxygen deprived environment ( such as a tank that was flushed with nitrogen to reduce possibility of explosion), there would be no O2 in the system to flow to the organs. This is why I preach learn, asses, think ( practice thinking on a regular basis because it seems that is a short resource these day) and do.

then compressions are the next best thing. You would still be pumping oxygen rich blood to the heart and brain..... better than doing nothing.

There is no O2 enriched blood in a deprived O2 situation because the muscles and organs have consumed it. Arizona resident it is obvious you stay around a trailer court of seniors. The article delt with compression which is past the are you o.k. If you want a real lesson go to a third world country and address their situations out in the boonies were the closest medical treatment is a Shaman.

Patriot, All the article is telling you to do is to skip the first 2 breaths, not to skip them all together like they really should have. Now I see why they have decided not to do that, too many people would go crazy with the new standards if they would have made the big changes.

So an oxygen deprived environment, like drowning.... They clearly stated in the article that special circumstances, like drowning (where there is O2 deprivation) will have different guidelines.

"He said the guidelines could note the cases where breaths should still be given, like near-drownings and drug overdoses, when breathing problems likely led to the cardiac arrest."

Anesthesilogists look at this whole controversy differently than cardiologists...........

The article seeks to recruit more "life-savers....." by suggesting you do not have to touch the victim's mouth with your own.......

And, the article assumes that this will encourage more folks to rescue........

About a 2 %er.............

Most people will NOT rescue because ambulance-chasing lawyers will sue them........AND,...............that's a FACT............