45 Minutes of CPR...

[Rick Murchison]

A few key points here that look like they bear re-emphasis...

1. Hands-Only™ CPR is ONLY solo CPR. If there are two of you, one gives rescue breaths while the other gives chest compressions. Continue compressions while rescue breaths are given.

2. The 30/2 ratio is ONLY solo CPR. If there are two of you, one gives rescue breaths while the other gives chest compressions. Continue compressions while rescue breaths are given.

3. The operable phrase from the guidelines when considering Hands-Only™ CPR is

in the first few minutes of an out-of-hospital sudden cardiac arrest.

No amount of circulation will prevent death by suffocation if there's no breathing for more than just a few minutes.

4. Less important, but worth remembering, is that the Hollywood versions of CPR are 99% BS in technique and in result. When you start CPR the victim is usually already dead. Even with shock available within 10 minutes, the recovery rate is less than 1 in 20. If you ever have to do CPR, DO NOT feel like you've done a poor job if your victim is one of the 19+.
--
WRT the original post. The victim really is one of the luckiest men alive, and the four folks who were able to keep CPR going for 45 minutes did a SUPER HUMAN feat!

Rick

 

[TSandM]

I would rarely continue a code for 45 minutes, but then again, I have a great deal more information than these rescuers did. I know what the cardiac rhythm is, and I can apply shock and drugs very quickly. When I discontinue a code, everything that there is to be tried has been tried, sometimes more than once. These guys were in a totally different situation . . . they had nothing available to them except CPR. In that setting, and assuming resuscitation was begun promptly, I'd probably keep going for a much longer time, especially if help was coming.

 

[robertarak]

Great effort, regardless of outcome.

It is worth restating that current guidelines for drowning or SCUBA related events is still CPR with resuscitation.

 

[boulderjohn]

Sorry, I shouldn't have said EFR. I should have said that I re-took Standard First Aid and CPR, which was through my employer and not diving related. I just figured they could all be grouped together under EFR.

Just a technical note:

EFR is not a generic term. It is the name of a specific agency teaching first aid, including CPR. It is associated with PADI, so one would expect its instructors to be dive-oriented, but the course can be taught to individuals or groups who have no association with diving.

 

[egibler]

Excerpt from the AHA Hands Only CPR FAQ page:

Given the above recommendation by the AHA, I'm shocked that the EFR course, geared for scuba divers, would teach Hands-Only™ CPR. Scuba diving is an in-water sport where, in many cases, it's difficult to rule out "drowning or collapse due to breathing problems." I suppose it would be OK to make divers aware of the trend towards Hands-Only™ CPR (particularly in non-scuba-related instances), but the above exclusionary conditions should be emphasized so as not to confuse the diving community.

Actually, EFR is not particularly geared towards scuba divers. It only mentions in passing drowning or water related situations. Maybe one sentence in the entire user manual and I think nothing at all in the training DVD.

It's a much more general sort of 'what do you do if you find Grandma unresponsive in the kitchen?' or 'what should you do if there's an accident in the warehouse and multiple people are hurt.'

 

[Duke Dive Medicine]

From the journal "Circulation", which is the basis for the American Heart Association training material (Circulation. 2010;122:S676-S684) (italics mine):

Trained Lay Rescuer
All lay rescuers should, at a minimum, provide chest compressions for victims of cardiac arrest. In addition, if the trained lay rescuer is able to perform rescue breaths, he or she should add rescue breaths in a ratio of 30 compressions to 2 breaths. The rescuer should continue CPR until an AED arrives and is ready for use or EMS providers take over care of the victim (Class I, LOE B).

Also:
Chest compressions are the foundation of CPR (see Figure 2). All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims. Because of their importance, chest compressions should be the initial CPR action for all victims regardless of age. Rescuers who are able should add ventilations to chest compressions. Highly trained rescuers working together should coordinate their care and perform chest compressions as well as ventilations in a team-based approach.

The emphasis is that UNTRAINED rescuers should stick to compression-only CPR because it minimizes "time off the chest" or interruptions in compressions, which has been shown to maximize survival potential. This part of the new CPR guidelines encourages even people with no formal CPR training to at least provide compressions. This covers the vast majority of situations in which lay, untrained rescuers will find themselves, i.e. EMS and advanced life support are a phone call away. The rationale is that there's enough O2 left in the lungs even without ventilation to carry the victim over until advanced help arrives. As Rick stated, the returns on this diminish the longer resuscitation is carried on.

These rescuers were clearly trained, and as such, the recommendation is that they provide compressions and ventilations in a 30:2 ratio, again with the emphasis on minimizing time off the chest. Good, solid chest compressions with minimal interruption, along with early defibrillation, are the best tools for maximizing survival potential. These guys obviously did a bang-up job if they kept the diver in a shockable rhythm for 45 minutes.

I just took the Red Cross CPR , First Aid & AID class - this month Jan 2011 and its 30 chest compressions then Mouth to Mouth 2 full breaths- then back to Chest compressions- - every commercial boat would do good to have a defibrillators onboard-they have come way down in price just over $1100USD-used ones can be had for $600USD- I would not run my Dive boat with out one onboard

CaptRam, you deserve the highest kudos for keeping an AED on board your boat.

 

[johnbeckham192]

The new standard for CPR is continious compressions with no stoping for pulse checks.The AHA just revamped the standards here in the US. Also advocates'push hard,push fast
'rather than counting compressions.
The new standards will be out to the public soon

 

[bleeb]

I would rarely continue a code for 45 minutes, but then again, I have a great deal more information than these rescuers did. I know what the cardiac rhythm is, and I can apply shock and drugs very quickly. When I discontinue a code, everything that there is to be tried has been tried, sometimes more than once. These guys were in a totally different situation . . . they had nothing available to them except CPR. In that setting, and assuming resuscitation was begun promptly, I'd probably keep going for a much longer time, especially if help was coming.

Maybe it didn't come across the way it was intended, but I'm a little surprised about the way in which some of the (non-medical professional) posters here have been talking about deciding to stop CPR being a personal decision on the part of the lay rescuer. During my recerts, it's almost always been emphasized that you have a responsibility to keep going until medical professionals with adequate instruments and equipment tell you to stop, unless you were physically exhausted with no one to relieve you, continuing would put you in danger, or was extremely obviously hopeless (such as complete loss of all blood from uncontrollable bleeding). IIRC.

Personally, as someone who is not a medical professional, if professionals were not going to arrive within a useful time, I'd think rescuers would want to be exhausted and a defibrilator had failed multiple times in order to feel like they'd done everything they could.

That being said, +1 on congratulations to the rescuers in this incident for managing to continue CPR for that long.

 

[BoltSnap]

I would rarely continue a code for 45 minutes, but then again, I have a great deal more information than these rescuers did. I know what the cardiac rhythm is, and I can apply shock and drugs very quickly. When I discontinue a code, everything that there is to be tried has been tried, sometimes more than once. These guys were in a totally different situation . . . they had nothing available to them except CPR. In that setting, and assuming resuscitation was begun promptly, I'd probably keep going for a much longer time, especially if help was coming.

Whenever you go on a dive trip, your fellow divers should pay your way to go with them. I would!!

 

[medic5]

As a paramedic for 30 plus years and an American Heart Association (AHA) CPR Instructor for 20+ years I think I have the background to respond.

First of all, if you are not trained in CPR please take a course. You should take a refresher course every two years to maintain AHA certification and every 1 year for Red Cross Certification. The AHA comes out with new recommended treatment guidelines every 5 years and the newest ones came out in October of 2010. All AHA instructors have until April 1, 2011 to become updated on the changes and all courses which begin after April 1, 2011 must use the new guidelines. Until April your course may have the old or the new guidelines.

While the AHA requires recertification every 2 years their new guidlelines stress the need for skill review on a regular basis, approximately once every 6 months. This does not mean that the certification card will be for less than 2 years, only that it is well established that if you only look at the material once every 2 years it is unlikely that you will be proficient when the time comes to use the knowledge.

The premise behind hands only CPR is based upon the fact that a normally healthy person who suffers cardiac arrest will have sufficient oxygen in their system to sustain them for 7-9 minutes (obese, pregnant and children less) without additional ventilations. For this reason, if you see someone collapse and go into cardiac arrest, if you only did chest compressions, there would be sufficient oxygen in the system for a number of minutes. Presumably an ambulance would show up and they would take over CPR and include ventilations. This concept allows a 911 dispatcher to give directions over the phone of how to do compressions and it allows for some basic CPR courses (those geared towards the lay rescuer) to only teach compressions. Coordinating compressions and ventilations is actually a little challenging and intimidating to the law public. In the case posted here hands only, or compression only, CPR would probably not have been effective due to the long time it took for trained medical personnel to arrive.

The most current change in CPR involves the change from ABC to CAB. The old process had us open the airway, look listen and feel (LLF) for breathing, if there was no breathing we gave 2 breaths, and then we checked for a pulse. If there was no pulse we began CPR compressions at a ratio of 30:2 for an adult. This "old" process delayed by about 15 - 30 seconds the initiation of chest compressions as we were checking for breathing and giving 2 breaths before we considered initiating chest compressions.

The new CAB process has us initially check for responsiveness while simultaneously quickly looking at the chest to see if there is any adequate breathing. If the patient is not responsive and is not breating adequately we now check a pulse. If there is no pulse we begin chest compressions at a ratio of 30 compressions to 2 breaths. In this manner the first breaths do not occur until after the 30 compressions have been compelted.

With the new process all chest compressions should be rapid (at least 100 per minute), deep (2 inches deep), completed while allowing for full chest recoil, and we should minimize any interruptions in chest compressions. As soon as an AED is available it should be used.

Please understand that this post is not intended to be a mini CPR course nor is it designed to be a formal update to the new procedures. Please, please take a real CPR course. As the OP identified, CPR does save lives. Also, don't be concerned about performing CPR the "old way". If that is all you know then go for it. The new changes may save a few more lives but the old process is still very effective.