Martyn said:Successful CPR depends on a number of things, but probably most significant, is why the person arrested in the first place. If they had an EMD arrest (PEA for the old timers) with correctable causes and thier downtime is minimal, you stand a half decent chance of getting an output, but if they infarcted, your chances are much slimmer. I've forgotten how many (in-hospital) arrests I've been involved in, but it's more than a few, I've led probably half of those and outcomes are generally poor unless there is a clear and correctable cause. The problem with resus in the field, is you have very limited means of identifying cause. You can treat hypoxia effectively, but I doubt many arrests are caused by hypoxia alone. Hypothermia is another which actually has good outcomes, with a good long term prognosis. But most of the other causes are much harder (or impossible) to identify in the field, with limited or no equipment. If you have IV siting skills and have the eqipment, you could treat hypovolaemia, but that's pushing reality. As others have mentioned, the awkwardness of in the field resus, also compounds it's effectiveness. The longest I've done is 40 minutes, taking turns with 1 other bloke. We failed to get an output and the team called it. But after 40 minutes of "ideal situation" CPR, I was utterly b***ered! I felt like I'd don 5 hours in the gym and could feel the ache in my shoulders for days afterwards - and my technique is practiced and pretty good. If you're trying to do CPR on your own, in less than ideal circumstances, I'd bet you'd give up long before then - I know I would.
However, those people that come into hospital, that have had effective bystander CPR with minimal downtime, stand a massively improved chance of survival. Sometimes you question whether it's all worth it, when outcomes are generally so poor - it can get depressing, but you only have to see the face of one little girl, after you've given her dad back to her, to make it all worthwhile.
40 minutes of CPR shared between two is REAL hard work Martyn, you deserve a medal... How often did you swap places? At work we try and keep it down to turns of about a minute, I know my own technique gets a bit 'ragged at the edges' as I start to get tired.
Just to add a little to the general discussion... I do feel sometimes that the difficulty many people encounter with first aid is not always a lack of training (I'm a senior nurse in a trauma theatre and in 17 years have NEVER been offered formal first aid training. Go figure....) but a difficulty in applying that training in a real life situation.
As I'm sure Martyn will confirm, spending hours cheerfully pounding the living daylights out of resussi annie (Its a traditional name for the cpr practice kit) cannot -really- prepare you for the somewhat stark reality of actually having to do it for real where the outcome isnt a passing or failing grade but life and death to some poor soul. Even folk who carry out CPR on a fairly frequent basis are a little thrown by a change of environment. I well remember how much more stressful it was on the one occasion I had to perform CPR whilst not at work (I was in Asda's carpark :yikes: ). It felt scarier by far and was pretty disconcerting to cynical old 'seen-it-all-done-it-all' me. I really do have the greatest respect for any non-clinician who attempts any sort of heroic first aid at all. I just wish I had the time to spare to get some formal FA qualifications, It bugs me because I really feel like I should be better qualified.
cheers,
simon