Transcript Chest Compression Only CPR Layperson Presentation

Developed by the University of
Arizona Sarver Heart Center
Resuscitation Research Group
• Are the most common cause of death in
the United States
• Unfortunately, the first sign of
cardiovascular disease is often the last, as
the first sign is often cardiac arrest
• Since most occur out of the hospital
• Out-of-hospital cardiac arrest is a major
public health problem
Heart Attack vs. Cardiac Arrest
Heart Attack:
• Blockage in coronary artery
Cardiac Arrest:
• Electrical issue, heart stops
pumping
• Person usually conscious
• Person is unconscious
• Upper body discomfort
or pain
• Often no previous symptoms
Primary vs. Secondary Cardiac Arrest
Primary
• Heart stops pumping
• Blood in arteries full
of oxygen
• Unexpected
witnessed collapse
Secondary
• Heart stops pumping
due to lack of oxygen
• Drowning, Drug
Overdose, Lung
Failure (severe
asthma or
emphysema)
Out-of-Hospital Cardiac Arrest
The majority of all out of hospital
cardiac arrests are Primary Cardiac
Arrest
Unexpected, witnesses (seen or
heard) collapse in an individual who is
not responsive
Chest Compression Only CPR
Ann Emerg Med. 1997 Jul;30(1):69-75.
What is
Chest Compression Only CPR?
• A new method of resuscitation developed
through extensive research at The University
of Arizona Sarver Heart Center for primary
cardiac arrest
• Continuous forceful chest compressions to
circulate the person’s blood to their brain and
heart
• Mouth-to-mouth breaths may actually
be harmful
Why isn’t
Rescue Breathing Necessary?
During Cardiac Arrest:
–Lungs are full of air
–Blood is full of oxygen
–Circulating the oxygenated blood is the key
Why Might “Rescue Breathing” be
Harmful in Primary Cardiac Arrest?
• People less likely to perform
• Causes interruption of chest
compressions: stops blood flow to the
brain
• Increased pressure in the lungs and chest
decreasing blood return to the heart
Aufderheide TP et al.., Death by hyperventilation: a common and
life-threatening problem during CPR. Crit Care Med 2004;32:S34551
Aufderheide TP et al.., Hyperventilation induced hypotension
during CPR Circulation 2004;109:1960-5
Why
Chest Compression Only CPR?
• It saves more lives
• More likely to survive over:
– Doing nothing
– Traditional CPR
Bobrow, et al. JAMA October 2010
What Stops People from Doing CPR?
Fear / Concern
Solution
Mouth-to-Mouth
Chest Compressions Only
Harming the Person
Better than dead
Legal Consequences
Good Samaritan Law
Won’t Perform Properly
Easier to Do
Physically Unable
Do Your Best / Call For Help
Coons SJ, et al. Resuscitation 80;334-340:2009
This study was designed and funded by the Sarver Heart Center
The University of Arizona College of Medicine and SHARE
Survival to Hospital Discharge
Bystander CPR in Arizona (2005 to 2010)
Witnessed & Shockable
Out of Hospital Cardiac Arrest
40%
30%
25%
20%
33.7%
15%
10%
17.6%
17.7%
No
CPR
Traditional
CPR
5%
0%
Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010
CCO
CPR
When to use
Chest Compression Only CPR?
Chest Compression
Only CPR
• Someone who unexpectedly
collapses, and is
unresponsive.
• Vast Majority
Traditional
CPR
• Obvious Breathing Problems:
– Drowning
– Drug overdoses
What to do:
Are You
Alright?
Check: Shake & Shout
Call: 911 & send someone for
an A.E.D. (if available)
Compress: Chest compressions
at 100 Per Minute
Are They Breathing?
• Gasping is a sign of cardiac arrest
• Majority of people with cardiac arrest
gasp
• Can be a sign of minimal but adequate
blood flow to the brain.
• DO NOT stop chest compressions if they
gasp
How to Do Chest Compression Only CPR
With the victim on the floor:
1. Kneel beside them
2. Place the heel of one hand on top of the other
3. Lock your elbows
4. Aim for the middle of the chest (on the sternum between the nipples)
5. Push hard and fast (try for 100/min.)
6. Take turns with another person when tired.
Chest Compressions:
Rate and Depth
100
2 inches
Compressions per Minute
in depth
• Allows the heart to refill
• Beat of “Staying Alive!!”
• After each compression,
take all weight off the
chest
Bystander CCO CPR Improves Chance of
Survival from Cardiac Arrest
Survival (%)
100%
CCO CPR
80%
CPR
60%
No CPR
40%
20%
0%
EMS Arrival
0
1
2
3
4
5
6
7
8
9
Time between collapse and defibrillation (min)
Nagao, K Current Opinions in Critical Care 2009
EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008.
What to do:
Are You
Alright?
CHECK Shake & Shout “Are
you all right?”
CALL
911
COMPRESS
Chest Compressions at 100 Per Minute
If available; Send for an
A.E.D.
AEDs
They may look different, but they all function the Same!
Open and Follow Instructions
•
•
•
•
•
Turn AED ON
Apply Pads to Bare Chest
Plug in Pads (if necessary)
Analyze Patient (CLEAR!)
Push Shock to defibrillate,
if directed (CLEAR!)
• Immediately resume CPR
The Universal Symbol
•Safe
•Easy
•Voice Prompted
Save your Breath…
Save a Life
How to Do Chest Compression Only CPR
With the victim’s back on the floor:
1. Kneel beside them
2. Place one hand on top of the other
3. Lock your elbows
4. Aim for the middle of the chest (on the sternum between the nipples)
5. Push hard and fast (try for 100/min.)
6. Take turns with another person when tired.
Chest Compressions Only
Blood Flowing
To The Brain
Compressions + Breaths (30:2)
Pausing for
breaths means
No Blood Flow
Blood Flowing
To The Brain
Ewy GA, et al. Circulation.
2007;116(22):2525-30.
Three-Phase Model of Resuscitation
Percent
100
Myocardial ATP
0
Circulatory
Phase
Electrical
Phase
0
2
4
6
8
Metabolic
Phase
10
12
Arrest Time (min)
Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8
14
16
18
20
SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest
compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.
Survival to Hospital Discharge
Bystander CPR in Arizona (2005 to 2010)
All out-of-hospital cardiac arrests
25%
20%
15%
113/849
52/666
10%
5%
0%
150/2,900
5.2%
No
CPR
7.8%
Traditional
CPR
Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010
13.3%
CCO
CPR