Hands Only CPR: New Option to Save Lives
< Apr. 02, 2008 > -- Chest compressions alone, or Hands-Only Cardiopulmonary Resuscitation (CPR), can save lives and can be used to help an adult who suddenly collapses, according to a new American Heart Association scientific statement.
Hands-Only CPR is a potentially lifesaving option to be used by people not trained in conventional CPR or those who are unsure of their ability to give the combination of chest compressions and mouth-to-mouth breathing it requires.
The newly released statement is published in Circulation: Journal of the American Heart Association. The new recommendation is an update to the 2005 American Heart Association Guidelines for CPR and ECC, which previously recommended that lay rescuers use compression-only CPR only if they were unable or unwilling to provide breaths.
About 310,000 adults in the United States die each year from sudden cardiac arrest occurring outside the hospital setting or in the emergency department. Without immediate, effective CPR from a bystander, a person’s chance of surviving sudden cardiac arrest decreases 7 percent to 10 percent per minute.
Unfortunately, on average, less than one-third of out-of-hospital cardiac arrest victims receive bystander CPR, which can double or triple a person’s chance of surviving cardiac arrest.
Improving the Odds
“Bystanders who witness the sudden collapse of an adult should immediately call 9-1-1 and start what we call Hands-Only CPR. This involves providing high-quality chest compressions by pushing hard and fast in the middle of the victim’s chest, without stopping until emergency medical services (EMS) responders arrive,” says Dr. Michael Sayre, chair of the statement writing committee and associate professor in the Ohio State University Department of Emergency Medicine in Columbus.
By using Hands-Only CPR, bystanders can still act to improve the odds of survival, whether they are trained in conventional CPR or not, Dr. Sayre says.
"Many times people nearby don't help because they're afraid that they will hurt the victim and are not confident in what they’re doing,” he says. "We want people to know that they can help many victims, just by calling 9-1-1 and doing chest compressions. Don’t be afraid to try it. We are sure many lives will be saved if the public does Hands-Only CPR for adult victims of sudden cardiac arrest.”
Data Driven Change
The update puts Hands-Only CPR on par with conventional CPR when used for an adult who has suddenly collapsed. This change was supported by evidence published from three separate large studies in 2007, each describing the outcomes of hundreds of instances of bystanders performing CPR on cardiac arrest victims.
None of those studies demonstrated a negative impact on survival when ventilations were omitted from the bystanders’ actions. Hands-Only CPR is easier to remember and results in delivery of a greater number of chest compressions, with fewer interruptions, until more advanced care arrives on the scene.
Not for Infants, Children, or Unwitnessed Cardiac Arrest Victims
Conventional CPR is still an important skill to learn, and medical personnel should still perform conventional CPR in the course of their professional duties. The new recommendations apply only to bystanders who come to the aid of adult cardiac arrest victims outside the hospital setting.
Hands-Only CPR should not be used for infants or children, for adults whose cardiac arrest is from respiratory causes (like drug overdose or near-drowning), or for an unwitnessed cardiac arrest. In those cases, the victim would benefit most from the combination of chest compressions and breaths in conventional CPR.
The public is still encouraged to obtain conventional CPR training, where they will learn the skills needed to perform Hands-Only CPR, as well as the additional skills needed to care for a wide range of cardiovascular- and respiratory-related medical emergencies, especially for infants and children.
The new statement is intended to increase how often bystander CPR is performed. It emphasizes the importance of “high-quality” chest compressions - deep compressions that allow for full chest recoil, at a rate of about 100 per minute - with minimal interruptions.
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Putting external defibrillators in the homes of people after they had a heart attack did not improve their survival rate, a new study found.
But, the leader of the study still sees plenty of encouraging news in the research and is not necessarily ruling out the use of those heart-shocking devices in the home.
In a 37-month trial, half of 7,001 heart attack survivors had defibrillators put in their homes, while the other half got standard instructions to call for emergency help if a second heart attack occurred.
But, the death rate for both groups was just about the same - 222 of the people given defibrillators and 228 of those not given the devices, says study leader Dr. Gust H. Bardy, director of the Seattle Institute for Cardiac Research.
The defibrillators, which deliver an electric shock to restart an arrested heartbeat, were used 18 times, and six of those people survived, Dr. Bardy says. "Long-term survival of one out of three is not bad," he says.
Partly because of the high cost of external defibrillators, their home use should not be encouraged, says an accompanying editorial in the journal by Dr. David J. Callans, professor of medicine at the University of Pennsylvania. "Future efforts should turn toward education, modification of risk factors, and other methods for primary prevention of heart disease," Dr. Callans says.
But Dr. Robert Femia, chairman of emergency medicine at Lenox Hill Hospital in New York City, disagrees with Dr. Callans. "Early defibrillation offers the best chance for survival," Dr. Femia says. "My point is that there may be a role for a defibrillator as part of a plan developed by your physician on an individual basis."
Such a plan usually is lacking after a heart attack, Dr. Bardy says. "One thing that is not standard practice is consciousness-raising," he says. "Most post-myocardial infarct [heart attack] patients don't have a discussion of mortality, don't have a discussion of cardiac arrest, don't have a discussion of what to do if there is a cardiac arrest."
Any discussion with a doctor after a heart attack should include advice about carefully taking any medications that are prescribed, Dr. Bardy says, and about other medical measures needed to keep arteries clear.
When such steps are taken, he says, "the patient may or may not choose an external defibrillator. I see no downside for an external defibrillator. Whether or not it will help in the long run, I don't know."
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