The simplification of CPR
While everything else in this world seems to be getting more complicated, cardiopulmonary resuscitation (CPR) keeps on getting simpler. Airway clearing and pulse check have been eliminated from past guidelines and in 2008 the American Heart Association endorsed “hands only” CPR in many cases. These guidelines eliminate mouth-to-mouth breaths and put the emphasis on chest compressions.
Even if you’ve never taken a CPR class in your life, the heart association guidelines say to call 911 and then start pushing hard and fast — 100 times a minute — on the person’s breastbone until the emergency medical technicians (EMTs) or paramedics arrive. It’s also important to have someone go get an automated external defibrillator (AED) if one is nearby so you can attempt to shock the heart back into a normal rhythm.
So we’re all set: keep-it-simple, hands-only CPR is the way to go. Not quite so fast—two studies published in July 2010 are a reminder not to oversimplify the situation. The studies showed that people who received only chest compressions before EMTs arrived were just as likely to survive as those who received traditional CPR of compressions and breaths. But a finer analysis of the results of one of the studies showed that a small, but not insignificant, number of people did benefit from traditional CPR. They included people with “noncardiac” arrest, which usually means they had breathing problems before their hearts went haywire, as can happen with drug overdoses, asthma attacks, or near-drownings.
This is not an unanticipated finding. When the heart association gave its blessing to hands-only CPR, it came with a proviso that conventional CPR techniques might still benefit some people. Children and victims of drowning, trauma, airway obstruction, and acute respiratory disease are specifically mentioned.
Hold the breaths
There are two main reasons CPR has been simplified. First, the simpler it is, the more likely people will do it. We need CPR to be as uncomplicated as possible because we’re going to be fighting some strong emotions if someone collapses in front of us. And the mouth-to-mouth breaths make people hesitant because they are squeamish about coming into contact with the stricken person’s mouth.
The other reason is evidence that the mouth-to-mouth breaths may not accomplish very much — and may even do more harm than good. The chest compressions of CPR circulate the blood. They must be fast — faster than the usual heartbeat — because they don’t push the blood along with the same force as a working heart.
When people administer the breaths, that interrupts the compressions, so blood flow slackens. Maybe that wouldn’t be a problem, but most people take longer than just a few seconds — up to 16 seconds in one study — to deliver the breaths. Moreover, added pressure in the chest from breathing into the airways may impede the flow of blood making a return trip to the heart.
If someone collapses in front of you, it’s best to err on the side of calling 911, because the consequences of not calling if it’s cardiac arrest are disastrous. Getting help quickly for someone who has suddenly collapsed is one of the reasons the 911 system was created.
November 2010 update
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