Doctor sparks debate over CPR

[PairofMedics]

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.

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.

OK, here's the basic problem. As we breathe we not only take in oxygen, we off-gas waste products that if they were allowed to accumulate beyond tolerable levels would kill us in a matter of minutes. Now, hold your breath...60 seconds? 90 seconds? Now consider this...in cardio-pulmonary arrest the victim is not breathing. Brain death begins after 4-6 minutes without oxygen. Consider that the average response time from initial call to 911 to arrival at location of incident is 5 minutes. You now have about 1 minute to begin adequately ventilating the victim to not only provide oxygen, but remove carbon dioxide and other gasses and toxins from the blood. Continuous chest compressions only recirculates acidotic, de-oxygenated blood around the body and to the brain, causing systemic hypoxia most noticably indicated by that nasty smurf-blue color of the face, neck and head and mottling of the rest of the body. You must include ventilations during CPR or you are doing nothing but pushing on a dead guys chest. I have participated in hundreds of actual resuscitations, so I know the proven FACTS that are involved. FACT: resuscitation proceeds along a necessary path of Airway, Breathing, and THEN Circulation. FACT: Cardiac arrests in infants and children are overwhelmingly caused by RESPIRATORY problems to the tune of over 95%. FACT: The American Heart Assocation has visited and evaluated continuous chest compressions, and has repeatedly rejected it for it's lack of attention the oxygen requirements of the body in general, and the brain specifically. When we resuscitate patients in the field we are no longer giong for a pulse, we are going for a survivability and quality of life that allows the patient to walk out of the hospital and back into his or her life and to their family. Make no mistake, working a cardiac arrest even under the best circumstances is a messy, nasty, emotionally charged event. When I work one it is full tilt begining to end...all out with every resource I have and to not properly ventilate the person whose life I am trying so hard to save makes it a waste of my time and their life. As for standards...do you want the electrician you hire to wire your house to do it his way, or to code?

 

[H2Andy]

PairofMedics, you are obviously very emotionally engaged in this issue, and you
have strong feelings about it.

other people do too. and sometimes, there's going to be disagreement.

there's not much we can do on this board about the issue itself. we can't change
the protocol. we can't change how the AMA stands on this issue.

we're just talking about it, learning about it, hearing what people have to say.

it's just a dive board

As for standards...do you want the electrician you hire to wire your house to do it his way, or to code?

i don't think this is the issue. of course we want the thing done to code.

the issue is, do we want to change the code? will changing it make it better?

if we never changed anyhthing, we'd still be living in caves, with no electricity.

 

[PairofMedics]

PairofMedics, you are obviously very emotionally engaged in this issue, and you
have strong feelings about it.

other people do too. and sometimes, there's going to be disagreement.

there's not much we can do on this board about the issue itself. we can't change
the protocol. we can't change how the AMA stands on this issue.

we're just talking about it, learning about it, hearing what people have to say.

it's just a dive board



i don't think this is the issue. of course we want the thing done to code.

the issue is, do we want to change the code? will changing it make it better?

if we never changed anyhthing, we'd still be living in caves, with no electricity.

Oh by all means, if the science is there to back it up things get changed. As a paramedic just comming out of school I had more basic knowledge than most doctors at the beginning of the 20th century. I welcome advances in medicine with open mind and open arms...I have seen some of those myself. However the science regarding this issue is solid and actually makes sense. THere have been more advances in medicine in general and emergency medicine at point in the last 40 years than in the previous millenium. Did you know that Alexander the Great employed the first battlefield ambulances? We've gone from horse and cart to Lear Jets at 43000 feet and 500 knots. And even leeches are still in use today here in the USA. If it isn't broken, don't fix it...improve it. CCC essentially eliminates entirely half of CPR. An average resuscitation takes 30-45 minutes ON SCENE, before you are able to package for transport. If CPR is initiated prior to our arrival it has usually been done for 10-15 minutes. That's a long time to go without oxygenation. The only way that CCC would be remotely feasible is with a secured, advanced airway such as endotracheal intubation...which can't happen until WE get there and as such is fundamentally, scientifically and logically unsound. Breathing is just as important in a cardiac arrest as it is to a diver...you die if you don't do it. I present this arguement not to anger or agitate, but to educate and inform. I believe it is an essentail mission of any paramedic to impart his knowledge to others to the betterment of all. Most of the time I teach CPR for free. I am passionate about the issue, because I'm passionate about what I do and I hope that by presenting my arguement it will inspire and provoke those who read it to research the subject themselves and explore the subject resulting in education. Changing the electrical code is fine, but one guy can't just change it all by himself now can he? Especially if he's wrong. There are appropriate ways to influence change, even in medicine. CNN is NOT one of them.

 

[PairofMedics]

Tim, since the AED was designed for layperson usage, anyone who has been trained to use one anywhere in the world may use an AED. Also, fesderal law mandates that before an AED can be placed anywhere, someone in the area of placement MUST be trained in it's usage. You'd be surprised to know how many people have been trained on AEDs. They're great tools and I'm happy to see them out there.

 

[H2Andy]

this topic interests me too, at a much lower educational level than you,
as a rescue diver (trained to do first response CPR)

i was trained to do the 15 chest compressions followed by 2 breaths (in adults),
and that's what i'll do if i ever have to

this looked like something worth looking into, though

 

[archman]

I'm at an intermediate level, having had a wide diversity of different training over the years for a wide diversity of different duties. I've heard the pro's and con's regarding various techniques for so long, I don't particularly care anymore.

But I do know that the lay-public in the U.S. is strongly opposed to performing any sorts of mouth-to-mouth nowadays, and that trend looks like it'll do nothing but escalate. If the public refuses to perform "classic CPR", let's be done with it already. Give them an alternative they won't balk over. I'd rather have someone doing pure compressions on a victim, rather than sitting on the sidelines paranoid about disease transmission. I've seen enough of this the last several years, and it's disheartening.

 

[TheAvatar]

As a paramedic just comming out of school I had more basic knowledge than most doctors at the beginning of the 20th century.

Guess what? It isn't the beginning of the 20th century and there were no paramedics then anyway.

As a Medic Just out of school you have 1 maybe 2 years of education and training. A doctor today has 8-12 years of school and training. You are only allowed to practice as a Paramedic under the medical direction and protocols established by a MD/DO. But I guess you know more about "Science" than that highly regarded cardiologist.

 

[archman]

Don't insult one another, it's against the Terms of Service for using this Board. I will prune and cull anything that's blatantly offensive. Keep critiques constructive and moderately civil... I have a great deal of experience knowing how heated health care providers can get with one another. Been there myself.

 

[ParamedicDiver1]

This is a heated discussion. Bottom line is, that ARC and AHA won't change its standards unless the science backs it up. So, if enough clinical trials prove that CCC is an effective alternative for laypersons versus CPR, then it will change, if scientific research does not support the claim, then it won't. I personally know a local agency here in the Houston area that is participating in the trial, and as long as the clinical trial protocols are followed they have a defense against liability (defense, not immunity). As far as the paramedics that are participating, they are following their established protocols based on their medical director. I have seen some of the preliminary data and it is very interesting, but until it is an established standard, it will remain just what it is...a test in progress.

 

[derwoodwithasherwood]

Guess what? It isn't the beginning of the 20th century and there were no paramedics then anyway.

I understood PairofMedics' post to be an example of how medical knowledge has grown. In other words, even a paramedic of today knows more than a doctor of yesteryear. I believe the implication was that a doctor of today is lightyears ahead of the turn-of-the-century doctor.

I didn't think he meant he knew better than a modern doctor.