Chest Compression Only CPR

1
Chest Compression Only CPR

• Developed by the University of Arizona Sarver
  Heart Center Resuscitation Research Group

2
Cardiovascular Diseases

• Are the most common cause of death in the United
  States
• Unfortunately, the first sign of cardiovascular
  disease is often the last, as the first sign is
  often cardiac arrest
• Since most occur out of the hospital
• Out-of-hospital cardiac arrest is a major public
  health problem

3
Heart Attack vs. Cardiac Arrest
Heart Attack
Cardiac Arrest

• Blockage in coronary artery
• Person usually conscious
• Upper body discomfortor pain

• Electrical issue, heart stops pumping
• Person is unconscious
• Often no previous symptoms

CALL 911 for both
4
Primary vs. Secondary Cardiac Arrest

• Heart stops pumping
• Blood in arteries full of oxygen
• Unexpected witnessed collapse

• Secondary
• Heart stops pumping due to lack of oxygen
• Drowning, Drug Overdose, Lung Failure (severe
  asthma or emphysema)

Primary
5
Out-of-Hospital Cardiac Arrest

• The majority of all out of hospital cardiac
  arrests are Primary Cardiac Arrest
• Unexpected, witnesses (seen or heard) collapse
  in an individual who is not responsive

Chest Compression Only CPR
Ann Emerg Med. 1997 Jul30(1)69-75.
6
What is Chest Compression Only CPR?

• A new method of resuscitation developed through
  extensive research at The University of Arizona
  Sarver Heart Center for primary cardiac arrest
• Continuous forceful chest compressions to
  circulate the persons blood to their brain and
  heart
• Mouth-to-mouth breaths may actually be harmful

7
Why isntRescue Breathing Necessary?
During Cardiac Arrest

• Lungs are full of air
• Blood is full of oxygen
• Circulating the oxygenated blood is the key

8
Why Might Rescue Breathing be Harmful in
Primary Cardiac Arrest?

• People less likely to perform
• Causes interruption of chest compressions stops
  blood flow to the brain
• Increased pressure in the lungs and chest
  decreasing blood return to the heart

Aufderheide TP et al.., Death by
hyperventilation a common and life-threatening
problem during CPR. Crit Care Med 200432S345-51
Aufderheide TP et al.., Hyperventilation induced
hypotension during CPR Circulation 20041091960-5
9
Why Chest Compression Only CPR?

• It saves more lives
• More likely to survive over
• Doing nothing
• Traditional CPR

Bobrow, et al. JAMA October 2010
10
What Stops People from Doing CPR?
Fear / Concern
Solution
Mouth-to-Mouth Harming the Person Legal
Consequences Wont Perform Properly Physically
Unable
Chest Compressions Only Better than dead Good
Samaritan Law Easier to Do Do Your Best / Call
For Help
Coons SJ, et al. Resuscitation 80334-3402009
This study was designed and funded by the Sarver
Heart Center The University of Arizona College of
Medicine and SHARE
11
Bystander CPR in Arizona (2005 to 2010)
Witnessed Shockable Out of Hospital Cardiac
Arrest
40 30 25 20 15 10 5 0
33.7
Survival to Hospital Discharge
17.6
17.7
No CPR
Traditional CPR
CCOCPR
Rates are for ventricular fibrillation from
Bobrow, et al. JAMA October 2010
12
When to useChest Compression Only CPR?
Chest Compression Only CPR
TraditionalCPR

• Someone who unexpectedly collapses, and is
  unresponsive.

• Obvious Breathing Problems
• Drowning
• Drug overdoses

• Vast Majority

When in doubt, do compressions!!
13
What to do

• Compress Chest compressions at 100 Per Minute

14
Are They Breathing?

• Gasping is a sign of cardiac arrest
• Majority of people with cardiac arrest gasp
• Can be a sign of minimal but adequate blood flow
  to the brain.
• DO NOT stop chest compressions if they gasp

15
How to Do Chest Compression Only CPR

• With the victim on the floor
• Kneel beside them
• Place the heel of one hand on top of the other
  
• 3. Lock your elbows
• 4. Aim for the middle of the chest (on the
  sternum between the nipples)
• Push hard and fast (try for 100/min.)
• Take turns with another person when tired.

16
Chest CompressionsRate and Depth
100Compressions per Minute
2 inchesin depth

• After each compression, take all weight off the
  chest

• Allows the heart to refill
• Beat of Staying Alive!!

17
Questions?
18
AutomaticExternalDefibrillators(AEDs)
19
Bystander CCO CPR Improves Chance ofSurvival
from Cardiac Arrest
100 80 60 40 20 0
CCO CPR
CPR
Survival ()
No CPR
EMS Arrival
0 1 2 3 4 5 6 7 8
9
Time between collapse and defibrillation (min)
Nagao, K Current Opinions in Critical Care
2009 EMS Arrival Time based on TFD 90 Code 3
Response in FY2008. Standards of Response
Coverage 2008.
20
What to do

• COMPRESS
• Chest Compressions at 100 Per Minute

If available Send for an A.E.D.
21
AEDs
They may look different, but they all function
the Same!

• Open and Follow Instructions
• Turn AED ON
• Apply Pads to Bare Chest
• Plug in Pads (if necessary)
• Analyze Patient (CLEAR!)
• Push Shock to defibrillate, if directed (CLEAR!)
• Immediately resume CPR

22
The Universal Symbol

• Safe
• Easy
• Voice Prompted

23
Question?

• Save your Breath
• Save a Life

24
How to Do Chest Compression Only CPR

• With the victims back on the floor
• Kneel beside them
• Place one hand on top of the other
• 3. Lock your elbows
• 4. Aim for the middle of the chest (on the
  sternum between the nipples)
• Push hard and fast (try for 100/min.)
• Take turns with another person when tired.

25
Appendix
26
Chest Compressions Only
Blood Flowing To The Brain
Compressions Breaths (302)
Pausing for breaths means No Blood Flow
Blood Flowing To The Brain
Ewy GA, et al. Circulation. 2007116(22)2525-30.
27
Three-Phase Model of Resuscitation
Weisfeldt ML, Becker LB. JAMA 2002 2883035-8
28
SOS-Kanto study group. Cardiopulmonary
resuscitation by bystanders with chest
compression only (SOS-KANTO) an observational
study. Lancet. 2007369920-6.
29
Bystander CPR in Arizona (2005 to 2010)All
out-of-hospital cardiac arrests
Rates are for all cardiac arrests from Bobrow,
et al. JAMA October 2010