Changes in resuscitation will be announced by the UK Resus Council.

[BOD]

Prioritising CPR thrusts over EAR breaths makes sense but an experienced person should give the breaths where possible. I would irrespective of the current protocols and always for children.

People give up too easily. My daughters friend drowned and 'died' - no pulse, cyanosis after several minutes under water. CPR was given by first aiders and friends. The doctor who arrived examined her and pronounced her dead and started his saying condolences to the mother who had just arrived. Wife and friends continued resusciation and a bare couple of minutes later she started up.

Is there any change to "Airway" by the way? If you are not going to give rescue breaths anyway will the airway be checked? IF the victim choked then his blood will be more de-oxygenated that some one whose heart stopped due to disease. Such a person may have a healthy heart and be one of the 10% who might have lived...

 

[Sniper]

Still check and open the airway just in case a heart rythm does restart. Unfortunately it is true in some cases people do give up too early, and please remember that full CPR breaths and compressions is very hard to physically do for real so in some extreme cases it's where the first aider cannot physically continue, so where there is more than one of you it cuts the effort required in half. As I say this is the wisdom of the top think tank on such matters so the info is valid but as I say it's a matter of time as to when they decide it is time to roll it out for public consumption as it were.

 

[cbkernow]

you should be checking the airway as part of the initial assessment so shouldn't need to specifically open it if you're performing CPR without breathes.

If there is no phone or no one to get the phone, and after ascertaining the casualty is not responsive and not breathing, when you have returned from raising help, you should proceed with CPR immediately on return.

 

[Ronnie]

I hate this update, I really do. I wish they'd stop constantly changing them. It will be interesting to see whether the research shows better outcomes given the new guidelines for arrests in the community. Time will tell.

You can perfuse the body all you like by giving heart massage, but if you're not oxygenating that blood through giving breathes, it's not going to help much. There are some quite misleading things being said in this thread - the body certainly doesn't have hours of reserves of oxygen, it has a few minutes. Once these have been used, you can pump that heart all you like - it's not going to do anything or save a life. There is a theory that performing compressions will also incidentally push air in and out of the lungs, and so some ventilation will be performed - it's going to be pretty minimal. I would always attempt to ventilate as well as give compressions.

With children, cardiac arrest is almost always caused by a respiratory arrest. Ventilate a kiddie soon enough and they should come back. Primary cardiac arrest in children is very rare, and is usually only seen on the Paediatric Intensive Care Unit. Again, you should always try to blow air into their lungs during CPR.

 

[Bothwell_Craig]

I hate this update, I really do. I wish they'd stop constantly changing them. It will be interesting to see whether the research shows better outcomes given the new guidelines for arrests in the community. Time will tell.

You can perfuse the body all you like by giving heart massage, but if you're not oxygenating that blood through giving breathes, it's not going to help much. There are some quite misleading things being said in this thread - the body certainly doesn't have hours of reserves of oxygen, it has a few minutes. Once these have been used, you can pump that heart all you like - it's not going to do anything or save a life. There is a theory that performing compressions will also incidentally push air in and out of the lungs, and so some ventilation will be performed - it's going to be pretty minimal. I would always attempt to ventilate as well as give compressions.

With children, cardiac arrest is almost always caused by a respiratory arrest. Ventilate a kiddie soon enough and they should come back. Primary cardiac arrest in children is very rare, and is usually only seen on the Paediatric Intensive Care Unit. Again, you should always try to blow air into their lungs during CPR.

Ronnie

Three studies in recent years now support compression only CPR.

A Japanese study which featured in the Lancet concentrated on cardiac collapse in children which, as you pointed out, do not present with pulseless collapse for the same reasons as adults. Where the cause of collapse was cardiac then the study showed that mouth to mouth respiration made no difference to survival rates. None. Nada. Zilch.
For other child causes such as asthma attack and choking, mouth to mouth did improve survival rates better than chest compressions alone.

However two large scale, independent studies in the New England Journal of Medicine showed that compressions alone were just as good as compression plus ventilation.

The reality is that without early access to a defib the chance of survival beyond admission to hospital is negligible anyway.

The other reality is that many people do not undertake CPR of collapses because they do not want to perform ventilations. Personally the “if you are willing and able to perform [rescue breaths]” line is a winner for me and means that rescue breaths still have their place in the protocols.

I have had to perform CPR many times. I normally have a pocket face shield in my wallet and a face mask on my belt when operational. In my personal vehicle I have a Defib, BVM, O2, OP Airways….I’m sure you get the picture.

If I drop and the choice is get CPR minus breaths or no CPR then I know which one I’d choose.

Compression only CPR is a viable option. If you don't feel that you can give breaths be that because of facial trauma or lack of self protection then do chest only compressions. It can still buy time for a defib to get to your locus.

Craig

 

[Ronnie]

Excellent and well considered post, Craig.

I have to admit that my background is in Paediatric critical care, which is probably why I was so dubious of compression only resuscitation. So, I'm very interested in the New England Journal studies. I can only assume that this efficacy is due to incidental ventilation secondary to the compressions?

That being said, I've always ventilated as well as given compressions and will continue to do so.

 

[Scots_Charles_River]

Don't give up ............
http://www.nydailynews.com/news/wor...two_days_after_doctors_pronounce_.html?r=news

 

[BOD]

Yes do not give up.

I once gave CPR to a sailor who collapsed after a yacht race. I was talking to him when he collapsed and was first on scene. A surgeon was a second behind. I gave CPR. The ambulance arrived after 20 minutes and after the second defib there was a loud bang and flash from the machine!

So much for technology. . One of the paramedics gave breaths and I resumed compressions ( I was a senior marine SAR crew then so I guess she was happy to let me do compressions). However he was still connected to the ECG which still worked and I could see the result of each of my compressions - big spikes in the line - and the surgeon felt for the femoral (groin) pulse which was also strong.

Although I had done actual CPR before until then I did not truly appreciate that when you are giving CPR you really are that persons heartbeat and lungs.

And you are circulating oxygenated blood to the body.

What this thread does not address is the effect on yourself of them dying. In SAR unlike most RTAs there is a big emotional investment or commitment by first responder -rescuers. There is elation when all goes well but if it doesn't it can be very hard on rescuers. Some of my fellow crew have never gone out again and some water police crew have had PTSD. There is a "could I have done more/been faster?" side to the story that can be tough.

So be kind to yourself, use all you know and do the best you can.

Perry was my crew mate and with friends we had just finished a race together.

 

[Minotaur]

They have major league tested these changes. They work. Many pigs did not do well

They are not that big a change either, but I found them harder to remember and put into practice.

Ref them dying, look up the stats. Not sure on the changes, but it something like 1 in 20 survive. The big reason to do it, is you do not know what wrong with them.

Never done it myself, but have comforted a few people. It can be a bit of a shock to suddenly realise you have done it.

 

[bigbeewee]

If you are determined and prepared to commence CPR including AV you really need one of these.

I've dealt with three cardiac emergencies in remote areas in the last couple of months. The common factor with all was BLS (CPR) caused regurgitation of the casualties dinner/breakfast.

I'm used to bodily excretions but mouth to mouth is virtually impossible to continue in these situations and you certainly won't get any ready volunteers to spell you.

The another factor is people will step up and do compressions, and the nelly the elephant advice is all you need to get a complete non first aider up and running with adequate compressions

If you start, you won't want to stop but its tiring stuff and sharing the workload helps






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