Cardiopulmonary resuscitation (CPR) has been proven to be the most effective way to prevent deaths from out of hospital cardiac arrest, be it from medical or traumatic causes. The knowledge of CPR by laypersons can not be overemphasized. Minerd (2006) states: Rescuers seldom arrive during the first four minutes of cardiac arrest, when immediate defibrillation is the crucial intervention, the study authors added. Instead, most arrive during the “circulatory” phase of arrest, between four and 10 minutes after the heart stops.
In the past, knowledge of the maneuvers of CPR were limited to hospital employees, armed forces medics, paramedics, coast guard rescue staff, lifeguards, and Boy scout volunteers. In recent years there has been a steady rise in medical-oriented dramas, increasing the awareness of the basic maneuvers of CPR and the importance of doing it. Furthermore, basic CPR courses have been added to university curriculums, adding to the understanding of CPR and its importance. However, many changes have been made from the classic CPR protocol, and studies have been done.
This paper aims to describe recent revisions in CPR practice. REVIEW OF RELATED LITERATURE The American Heart Association (2005) advocated a new chest compression-ventilation ratio of 30:2 in all age groups save for newborns. Laypersons need not check for pulses in nonresponding adult victims (AHA, 2005) and provide rescue breathing with chest compressions (Denoon, 2007). Minerd (2006) described Cardio-cerebral Resuscitation (CCR), a method emphasizing fast and forceful chest compressions over rescue breathing, with a corresponding tripled survival rate.
Morley (2000) noted the abandonment of ventilator support for CPR was also mentioned, as was a new method of CPR with the victim face down. Babbs (1999) studied the benefits of alternating chest and abdominal compression and decompression alongside a new plunger-like device. Vasopressin as an alternative to epinephrine was also mentioned, which was proven 25 more effective by Perina (2005). DISCUSSION The AHA in their publication Circulation (2005) noted: Sudden cardiac arrest (SCA) is a leading cause of death in the United States and Canada.
Although estimates of the annual number of deaths due to out-of-hospital SCA vary widely, data from the Centers for Disease Control and Prevention estimates that in the United States approximately 330 000 people die annually in the out-of-hospital and emergency department settings from coronary heart disease. About 250 000 of these deaths occur in the out-of-hospital setting. The annual incidence of SCA in North America is &0. 55 per 1000 population. The numbers, though impressive, still deter some to initiate CPR. CPR saves time between the actual attack and the arrival of proper authorities. According to emedicinehealth.
com, “One way of buying time until a defibrillator becomes available is to provide artificial breathing and circulation by performing cardiopulmonary resuscitation, or CPR. ” Most laypersons are not trained in CPR, those trained are usually not singled out for their proximity to possible heart attack victims, and less than 8% training for that reason (Braslow, 1998). One of the major reasons of delay in administering CPR is the unwillingness of bystanders to place their mouths over sick persons (DeNoon, 2007). Morley (2000) saw the need to create a protocol eliminating mouth to mouth resuscitation citing that no benefit existed in doing it.
Recently, chest compressions (100 per minute) have been emphasized over ventilation. Ventilation (or mouth to mouth) delays lifesaving chest compressions (DeNoon, 2007), which aids in circulating blood to vital organs. Minerd (2006) reinforces this with evidence that survival rates triple in doing cardiocerebral resuscitation, a similar protocol emphasizing chest compressions. However, DeNoon (2007) notes that the benefits lie only in the fact that eliminating the need for mouth to mouth ventilation encourages bystander participation, leading to more victims getting CPR and increased survival.
Another technique being experimented on is the use of alternating chest and abdominal compression during CPR. The abdomen is compressed as the pressure on the chest is relaxed, and vice versa. Still another is the use of a device similsr to a bathroom “plunger” in doing CPR. Both adjunctive techniques , both physiologically rooted, show benefit (Babbs, 1999). In CPR, vasopressors are used to stimulate and increase heart rates of victims, and traditionally epinephrine is used. However, vasopressin is becoming an alternative agent, with increased 24-hour survival rates (Morley, 2000).
Perina (2005) notes a 25% increase in survival rates with the use of vasopressin against epinephrine. BIBLIOGRAPHY American Heart Association. (2005). Part 3. Overview of CPR. Circulation. 2005;112:IV-12 – IV-18. Retrieved March 23, 2007 from AHA database. Babbs, C. 1999. CPR Techniques That Combine Chest and Abdominal Compression and Decompression. Circulation. 1999;100:2146. Retrieved March 23, 2007 from AHA database. Braslow, A. et al. 1998. Layperson CPR. Circulation. 1998;98:610-612. Retrieved March 26, 2007 from AHA database. CPR. Retrived March 23, 2007 from Emedicinehealth database.
DeNoon, D. 2007. CPR: Mouth to Mouth not Much Help. Retrieved March 23, 2007 from WebMD database. Minerd, J. 2006. New Cardiac Resuscitation Protocol Improves Survival. Retrieved March 23, 2007 from http://www. medpagetoday. com/EmergencyMedicine/EmergencyMedicine/dh/3091. Morley, P. 2000. Recent Advances in Cardiopulmonary Resuscitation. Critical Care and Resuscitation. 2000;2. Retrieved March 23, 2007 from http://www. jficm. anzca. edu. au/pdfdocs/Journal/Journal2000/J2000%20(c)%20Sept/Editorials. pdf. Perina, D. 2005. EMS and Cardiac Arrest. Retrieved March 23, 2007 from Emedicine database.