No more mouth to mouth for heart attack?

[fisherdvm]

Any human volunteer from scubaboard??

 

[60feet]

... The 50% increase in survival rate indicates that providing chest compression is better than doing nothing at all...

Actual rates of survival without brain damage for the 2 methods, quoted from the AP article, 7th paragraph:

"However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR."

So chest compression alone represents a 100% increase (or double) for survival without brain damage over combined CPR... according to this particular study.

 

[Cacia]

I'd not like to see this approach with shallow water black-out, because most of them just need their airway manipulated and rescue breaths, since their hearts are still beating. (and is done quickly in the water, unlike compressions)

 

[fisherdvm]

I'd not like to see this approach with shallow water black-out, because most of them just need their airway manipulated and rescue breaths, since their hearts are still beating. (and is done quickly in the water, unlike compressions)

My original post is concerning heart attack only. Not for other causes.

Again, here is the comment:

"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions,"

 

[Cacia]

OH.

...and how does the layman determine this? by the history of event?

 

[fisherdvm]

No, I didn't intend this post for the layman. They probably can have a sub-CPR class for the layman.

Better chest compression alone than no CPR, that is what I am taught.

Now, we just have to relay this to the lay people, who are not CPR trained. Kinda like that kid that thumped his grampa's chest with a toilet plunger.

 

[mikerault]

"This study indicates that passive air movement during chest compression does not allow physiologically significant pulmonary gas exchange and that room air ventilation alone is not sufficient to maintain mixed venous Po[2]."

I'll remember that next time my pet pig has a heart attack!

However, wouldn't a primate been a better choice as their thorasic cavity is more shaped like ours?

Mike

 

[Wildcard]

One of the guys that did the study is a board member. I recieved several PMs from him about this. Sold me. I was hoping that the last round of CPR/ACLS updates would do this, but they decieded to ease us into it with the 30/2 ratio. Expect it with the 2008 guideline updates.....I have NEVER seen mouth to mouth done correctly so why do it at all? I have done a 180 on this by the way.

 

[fisherdvm]

Here is a quote from an article that questions the benefit of mouth to mouth respiration during CPR:

Before the rediscovery of mouth-to-mouth ventilation in the 1950s and 60s, manual techniques of ventilation were used widely for rescue breathing. The principal advantage of mouth-to-mouth ventilation is that an integral part of it is maintanence of upper airway patency. In this issue of CHEST, Fukui and coworkers (see page 1663) report that, in a rodent model of cardiac arrest, upper airway patency is important for gas exchange during chest compressions. In this model, positive pressure ventilation was not used, but ventilation did occur during spontaneous gasping and also possibly secondary to chest compression. When airway patency was protected with an oropharyngeal device, spontaneous gasping was more than twice as frequent and arterial oxygen saturation higher than without airway protection. Nevertheless, return of spontaneous circulation and 24-h survival did not differ between the two groups. The study suggests that, at least in some animals, spontaneous gasping during cardiac arrest was associated with maintenance of some upper airway tone and patency. It also shows that gasping and gas exchange are improved when airway patency is protected.

Despite any limitations in this study, how does it relate to CPR in humans? Ventilation by spontaneous gasping has some advantages over mouth-to-mouth ventilation. Compared with air, the gas given during mouth-to-mouth ventilation has much more [CO.sub.2] (4%) and less [O.sub.2] (6%), which may affect resuscitation adversely,[7] while gas inhaled during spontaneous gasping has virtually no [CO.sub2] and 21% [O.sub.2]. Mouth-to-mouth ventilation uses positive pressure, which is associated with gastric inflation, regurgitation, and aspiration; inhalation during spontaneous gasping occurs during negative upper airway pressure, which prevents gastric inflation. Finally, transmission of contagious diseases by spontaneous gasping is unlikely.

Whether humans gasp as frequently and as deeply as healthy animals during cardiac arrest and whether the upper airway remains unobstructed are unknown. Because the study by Fukui et al shows improved oxygenation and ventilation when the upper airway was patent, assuring an unobstructed airway should remain a high priority during basic life support. For now, CPR instruction should recommend that, when a victim is gasping spontaneously, if the rescuer is unwilling to perform mouth-to-mouth ventilation, then, at the very least, upper airway patency should be maintained by conventional means in addition to chest compression.[8] The study by Fukui et al is an important contribution to the growing body of medical literature on ventilation during cardiac arrest. Many questions in this crucial area, however, remain to be answered by future research.

 

[Wildcard]

I cant get most BLS fire departments to learn proper airway manuvers, how can we expect lay people to do it properly? They jam an OPA in and think thats all they have to do because they have an "airway" in.