Doctor sparks debate over CPR
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Sorry if I missed someone already saying this... and sorry that it is so long...
This guy's research is not news. ARC and AHA has recognized the problem with bystander rescue being the reluctance to perform mouth-to-mouth ventilations since the ECC 2000 conference. Instructors are taught to teach 15-2 but to spend time discussing the possibility of compression only. It is meant to encourage action and also to explain why EMS dispatchers may coach CPR only over the phone. Certainly in the case of prolonged delay of advanced care some air needs to be delivered to the patient as the oxygen in the blood will eventually be reduced below an efficient level but compressions are certainly better than no action at all.
No pulse check???? I beg to correct those of you who have stated that the agencies have eliminated pulse checks. "Signs of Circulation" were meant to teach rescuers that movement and color are other indicaters of circulation that may shorten or eliminate the time spent trying to locate a pulse. Bystanders were spending too much time searching for a pulse that in an injured or ill person may be difficult to locate despite the fact that other indicaters demonstrated the presence of a pulse. However they are now instructed to spend "no more than 10 secs" feeling for it.
And, harsh though it may sound, instructors are now encouraged to explain to their students that in the absence of pulse and respiration the patient is "technically" dead. That CPR is taught to maintain the body's organs until advanced care can intervene and revive. I also spend time talking about rescuer stress and recommend counseling after a rescue attempt because too many lay rescuers believed that CPR would start a heart when that is the exception not the rule. The old concept that CPR started hearts lead to huge sense of failure in lay rescuers.
It is my opinion that in the near future CPR instructors will teach both methods but I will wait to see if research provides any proof that compressions alone, in all circumstances, are more effective. He may be right. All science evolves as new theories are tested.
This guy's research is not news. ARC and AHA has recognized the problem with bystander rescue being the reluctance to perform mouth-to-mouth ventilations since the ECC 2000 conference. Instructors are taught to teach 15-2 but to spend time discussing the possibility of compression only. It is meant to encourage action and also to explain why EMS dispatchers may coach CPR only over the phone. Certainly in the case of prolonged delay of advanced care some air needs to be delivered to the patient as the oxygen in the blood will eventually be reduced below an efficient level but compressions are certainly better than no action at all.
No pulse check???? I beg to correct those of you who have stated that the agencies have eliminated pulse checks. "Signs of Circulation" were meant to teach rescuers that movement and color are other indicaters of circulation that may shorten or eliminate the time spent trying to locate a pulse. Bystanders were spending too much time searching for a pulse that in an injured or ill person may be difficult to locate despite the fact that other indicaters demonstrated the presence of a pulse. However they are now instructed to spend "no more than 10 secs" feeling for it.
And, harsh though it may sound, instructors are now encouraged to explain to their students that in the absence of pulse and respiration the patient is "technically" dead. That CPR is taught to maintain the body's organs until advanced care can intervene and revive. I also spend time talking about rescuer stress and recommend counseling after a rescue attempt because too many lay rescuers believed that CPR would start a heart when that is the exception not the rule. The old concept that CPR started hearts lead to huge sense of failure in lay rescuers.
It is my opinion that in the near future CPR instructors will teach both methods but I will wait to see if research provides any proof that compressions alone, in all circumstances, are more effective. He may be right. All science evolves as new theories are tested.
PairofMedics
Guest
As a critical care and FlightMedic and AHA CPR instructor, I find this "doctor" to be arrogant beyond comprehension, and dangerous to anyone who he can influence. He has betrayed the trust given him by those whom he serves. But the paramedics who he has convined to alter they're performance in the field should take heed...they are performing outside the standard of care, and are not performing to the level that any other prudent paramedic in the same situation...which may be the last thing they hear from a jury when they lose a patient and this practice comes out during a trial. This is why we have standards...to prevent cowboy medicine that ends up being scarry dangerous for eveyone involved. I perform to the same standards here in South Florida that another paramedic would perform to in New York, California or Idaho. The CPR class you take in one state is the same you would take in another state and even most of the world. The differences between one operation and another may be a choice on different medications in certain situations...but even those choices are made according to the standards set by the appropriate governing body. My medical director may prefer drug A for a condition, and somewhere else in the state another medical director prefers drug B. No problem, because thay both meet the STANDARD. This guy has opened up eveyone involved with his misguided endeavor to serious liability not only in civil court, but also jeapordizes their licensure and very career, not to mention the life of the person they tried to save.ReneeC:
liberato
Guest
The standard of care does seem to be in flux right now. We will know soon enough because 2005 is one of the years (every 5 years) were current scientific data is evaluated by a science advisory board of the International Liaison Committee on Resuscitation (ILCOR) sponsored by the American Heart Association. They publish consensus documents and guideline updates at the end of the year. We will then know if the guideline changes that began in 2000 will continue. The staus quo does seem to be under attack and not just from one rogue doctor.PairofMedics:
American Heart Association: Comments on 2005 ILCOR Evidence Evaluation Worksheet
From the editors of Resuscitation 63 (2004) 123-130):
"There is growing [evidence] that chest compression-only CPR is acceptable, probably more beneficial, and certainly more achievable in the early period of resuscitation after cardiac arrest due to a primarily cardiac cause. We wonder if those compiling the International Consensus on Science for 2005 will have the courage to advocate these changes...."
"There is growing [evidence] that chest compression-only CPR is acceptable, probably more beneficial, and certainly more achievable in the early period of resuscitation after cardiac arrest due to a primarily cardiac cause. We wonder if those compiling the International Consensus on Science for 2005 will have the courage to advocate these changes...."
Heimlich Institute: Letting History Make the Case and Correcting Medical Mistakes
After teaching CPR for heart attacks and drowning for 40 years, the American Heart Association announced it no longer requires mouth-to-mouth for the treatment of heart attacks. This year, the AHA instructs 911 emergency telephone operators that they are not to teach callers faced with heart attack victims to use mouth-to-mouth; they are to teach only chest compressions. In addition, the AHA now no longer requires professional or lay rescuers to use mouth-to-mouth for heart attacks. The change, published in AHA Guidelines 2000, came after proof the death rate increased when mouth-to-mouth is used, according to a seven-year study conducted by the University of Washington.
I'm not a healthcare professional (nor do I play one on TV); I'm just a Scuba & EFR Instructor.
The points being brought up in this discussion are VERY thought provoking!
The points being brought up in this discussion are VERY thought provoking!
I disagree completely with your premise that Dr Ewy is practicing "cowboy" medicine and exposing everyone to standards of care violations. Post # 44 by liberato answers this quite well. I contacted the ASHI the next day after I saw this story on the news. I had also read about this procedure sometime ago. The ASHI representative indicated that this has been around for quite awhile and is being evalutaed by all the certifying agencies. I thnk the continuous chest compressions thing is the way to go for the lay person or even the higher trained personnel that don't have the equipment to provide more definitive care.PairofMedics:
All one needs to do is look at the mechanics of this method and M t M and one will realize this is a better method.
No offense, but nothing you have said in this long harangue about Dr. Ewy even *attempts* to demonstrate that he is wrong on the merits. His recommendations are either based in good science, or they are not. He obviously thinks they are based in good science, and he has compiled a lot of data to show that CCC-CPR actually produces better results than the standard treatment that is currently being taught.PairofMedics:
If he is right, people who are following the current standard are allowing people to die who might have been saved. So then who is more "arrogant"? The person who insists on following the standard procedure, because it is "standard," even if it doesn't work? Or the "cowboy" doctor who is also Director of the University of Arizona Sarver Heart Center, chief of cardiology at the UA College of Medicine, one of a handful of people in the world to be named a "CPR Giant" by the American Heart Association, and whose recommendations are actually being implemented not only in Tucson, but in Chicago, Dallas, Los Angeles, New York City, Philadelphia, Richmond, San Francisco, and Seattle, because they have been demonstrated to work:
"In a study published in May 2000 in the New England Journal of Medicine, University of Washington researchers analyzed the results for 241 patients who got chest-compression-only CPR and 279 who received mouth-to-mouth along with chest compressions when treated at the scene. Survival rates up to the time of hospital discharge were better among the compression-only group: 14.6 percent survived, compared to 10.4 percent of those who also got mouth-to-mouth."
That is almost a 50% improvement in survival rates.
Dr. Ewy's point is that the objective is to save lives. You seem to be arguing that the objective is to avoid being sued. If CCC-CPR produces better results, it *should* be the standard, whether it is yet the standard or not. There was a time when bleeding people with leeches was the standard for all kinds of maladies, but somehow we got beyond that - by keeping minds open to good science, and by adopting better methods when they are proved to be effective.
James Goddard:
Kind of off topic, but...
In our AED course we were told that by state law NO ONE (including doctors etc..) were allowed to use the unit we had been given as it was a "prescription" device - Our aiport has a unit, but last I heard none of the staff were trained to use it - can someone shed some light on the truth of this? I'd rather make use "illigally" of an available AED rather than not use it... just curious...
Aloha, Tim
We might get spun off into another thread, but your question is a good one.kidspot:
Good Samaritan laws wrt AED's vary significantly from state to state, and Hawaiis seems more restrictive than many. A brief state-by-state summary can be found at this site:
http://www.momsteam.com/alpha/features/cardiac_awareness_center/good_samaritan_laws.shtml
We probably should all get familiar with the good Sam laws in our own state.
PairofMedics
Guest
knotical:
AEDs do require a prescription and training to use them. However they are designed to be extremely simple and have audible instructions to keep you focused and on track. The use of AEDs is part of most CPR training programs...I know because I teach it, and have taught it to everyone from kids to grandmothers and professionals inbetween. All doctors have to go through CPR on a professional level and are thus quite competent to operate an AED. Next chance you get pull it off the wall and open it up. It will become quite obvious how simple they are to operate.
As for the Good Samaritan laws...as long as you are doing your best to save the life of another you are immune from prosecution in both civil and criminal courts.
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