Guidelines to use hands only could turn traditional resuscitation on its head
Sydney Morning Herald
Thursday February 4, 2010
TO BREATHE, or not to breathe: that is the question.The International Liaison Committee on Resuscitation, which includes representatives from the Australian Resuscitation Council, is about to issue recommendations for new CPR guidelines that could change the way we bring people back to life.The debate is over growing evidence that chest compressions alone are the best response in some circumstances. The committee, with the American Heart Association, is co-ordinating an evidence-based review of resuscitation science, to be presented at a conference this month in Dallas, Texas.Providing ventilations during CPR has no added benefit in terms of survival, compared with providing chest compressions alone, studies suggest.The Australian Resuscitation Council recommends a cycle of 30 chest compressions delivered at a rate of 100 a minute, followed by two breaths. Two rescue breaths should be delivered initially if breathing is not normal. Where a rescuer is untrained or not willing to perform CPR, continuous chest compressions alone should be administered.But the American Heart Association recommended in 2008 that bystanders - trained or untrained in CPR - should at least provide hands-only CPR. It found that hands-only CPR may decrease the time spent on CPR and increase the number of chest compressions. Those trained in hands-only CPR took less time to begin CPR than rescuers trained in traditional CPR (requiring breathing and compressions). This finding was attributed to the "additional cognitive or emotional burdens associated with attempting the more complex psychomotor task of traditional CPR". In short - mouth-to-mouth resuscitation can cause people to freeze, wasting valuable time. This is partly because it is viewed as a complex process and also because people may be repelled or fearful of the idea. Performing chest compressions is seen as less confronting.Associate Professor Paul Middleton, chairman of the Australian Resuscitation Council (NSW), says research shows that during CPR "we often over-ventilate anyway, including professionals". "Paramedics and doctors can do 30 ventilations a minute, when it is supposed to be six times a minute," he says. "This stops blood from coming back into the chest because of increased pressure. Just tilting back the head, which will open the airways, and then starting compressions is effective. CPR has become a lot simpler. It works, but we know someone needs to start CPR as soon as possible, without stopping and just keep going "The council points out that hands-only CPR is not enough in cases of cardiac arrest involving children; in cases due to drowning or airway obstruction; in hospital cardiac arrests; and resuscitation attempts beyond three to four minutes. It has resisted altering the guidelines as a result of the new studies because it says they are observational and survival rates are no better than those achieved with conventional CPR. Recommendations stemming from the US meeting will be made later this year.DON'T JUST STAND THERE- DO SOMETHINGClear Airway-Check for hazards-Call 000-Place person on their back-Remove foreign matter from mouth (and nose of baby)-Place on side if there is a lot of foreign matterCheck breathing-Look, listen, feel for breathing-If normal breathing is present place patient on their side. If absent-Place patient on their back -Tilt head back (not for infants or injured)-Lift jaw and pinch nostrils-Give two breaths whilst watching rise and fall of chestChest compressions- Adult. Place one hand over centre of chest (sternum). Compress sternuim 4 to 5 cm (one third the depth of the chest) 30 times Continue with two breaths to 30 compressions-Child. Position two fingers on sternum. Depress sternum about one third the depth of chest. Continue with two breatjs to 30 compressions.
© 2010 Sydney Morning Herald
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