Regular readers of "Vital Signs" may be aware of my enthusiasm for getting the word out about how to save a life. In recent columns I have written about the new Cardio Pulmonary Resuscitation (CPR) guidelines and the use of Automated External Defibrillators (AEDs). If you live in Phuket, the fact remains that it's highly unlikely that a person who has a sudden collapse and no signs of life will receive any CPR before arriving at a hospital. It's a fact. Most out-of-hospital cardiac arrest victims in Phuket remain in cardiac arrest, and arrangements are made for a funeral. Doctors and emergency department personnel cannot save a life if no community CPR has been performed and the brain has died because of a lack of oxygen. This brain death occurs within 3-5 minutes, so performing CPR is essential if any hope of survival is to be hoped for.
It is claimed by some experts that it is inaction that is killing people. Bystanders just do not want to do CPR because of the yuck factor. Let's face it, performing rescue breathing on an unconscious or dead person is not exactly romantic. Many potential rescuers claim that they just do not want to do it, and I do not blame them. They are scared, they cannot remember their training, and they do not want to be exposed to potentially dangerous body fluids. So they do what many would do and ignore it or stand around waiting for someone else to start. They don't act, and the person dies.
The American Heart Association (AHA) is aware that many lives could be saved if bystanders would at least attempt to do some form of resuscitation. This is why they use the slogan "any resuscitation is better than no resuscitation at all". A few weeks ago they also announced a major change to the way CPR should be delivered, and the term "hands-only CPR" was coined.
Conventional CPR consists of giving 2 rescue breaths followed by thirty compressions on the chest and continually repeating this cycle until professional help arrives. Hands-only CPR using rapid, deep presses on the victim's chest until help arrives is now being supported by the AHA for adults who have a collapse. The AHA supports these new guidelines by claiming that there is usually enough oxygen remaining in the lungs and that providing rescue breaths delays pushing on the chest. Excerpts from the new AHA guidelines appear below.
"All victims of cardiac arrest should receive, at a minimum, high-quality chest compressions (i.e., chest compressions of adequate rate and depth with minimal interruptions). To support that goal and save more lives, the AHA recommends the following.
"When an adult suddenly collapses, trained or untrained bystanders should--at a minimum--activate their community emergency medical response system (e.g., call an ambulance) and provide high-quality chest compressions by pushing hard and fast in the center of the chest, minimizing interruptions.
"If a bystander is not trained in CPR, then the bystander should provide hands-only CPR. The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over care of the victim....
"If the bystander was previously trained in CPR but is not confident in his or her ability to provide conventional CPR including high-quality chest compressions (i.e., compressions of adequate rate and depth with minimal interruptions) with rescue breaths, then the bystander should give hands-only CPR. The rescuer should continue hands-only CPR until an automated external defibrillator arrives and is ready for use or EMS providers take over the care of the victim."
Not everyone fully agrees with the AHA. The Australian Resuscitation Council (ARC) and the European Resuscitation Council (ERC) have reviewed the studies published since current guidelines were introduced back in 2005, and they have concluded that there is insufficient evidence to make any changes at this time to the way CPR is taught in the community.
Both the ARC and ERC have therefore issued a statement confirming its advice that "CPR should consist of alternating 30 chest compressions, of adequate force and depth, at a rate of 100/minute, with 2 mouth-to-mouth ventilations. The rescuer(s) should ensure that ventilations cause minimal interruption of chest compressions."
So where do the new guidelines and seemingly conflicting recommendations from the experts leave us, particularly those of us who live in Phuket and may not have immediate access to an ambulance or professional care? My recommendation is that if you are unwilling or unable to give rescue breathing, hands-only CPR is much more acceptable than performing no CPR at all.