I have been teaching CPR for more than 20 years and have seen it evolve from an uncertain approach to a victim in cardiac arrest to recognizing cardiac arrest and performing the necessary steps to save the victim regardless of age. Years ago much of the emphasis was on opening the airway and delivering breaths. As we learned more about what happens to the heart in arrest we began to concentrate on delivering more effective compressions and realizing that delivering an effective shock to the heart to stop it so it could try and correct the abnormal rhythm was an essential part of saving a victim whose heart was in an abnormal non-productive rhythm.
Day by day, year by year the art of delivering effective high quality CPR became more and more important to the victim’s survival. Today it is not unusual to expect that immediate high quality CPR and early defibrillation will save approximately 50% of the victims, and result in minimum in hospital and post recovery rehabilitation after the event. This is true for more and more victims of all ages.
The ECCU guidelines for 2015 stress beginning compressions as soon as possible after recognition of cardiac arrest. If the victim is not breathing and you cannot detect a pulse, start compressions. The main focus is on delivering effective compressions to a depth of at least 2 inches but not more than 2.4 inches. Most rescuers are hard pressed to deliver compressions to a depth of more than 2 inches consistently over time. The new guidelines have also determined that a rate or speed of compressions should be more than 100 per minute and are even more beneficial if delivered at approximately 110+ per minute. In my experience, most rescuers can consistentlydeliver compressions at approximately 108 – 110 compressions per minute. Going faster than that could affect the depth of compressions. I searched for a song that you might put in your head to keep you in the proper rhythm. The one that I came up with is Beyonce’s“Single Lady”, especially the chorus portion of the song. If you can match your compressions to it they will be around 110 per minute.The newguidelines stress checking the pulseand looking for chest rise at the same time.If you can’t detect a pulse, or see visible chest rise, start compressions immediately. If you are alone and have a cell phone on you, put it on speaker and dial 911 while continuing compressions and yelling for help.
If you shake and shout and there is no response, shout for help. Then check for pulse and breathing, no, then send one responder to call 911 and the other to get the AED. Wasting time wastes lives.
As soon as the AED arrives use the pocket mask to give breaths. The person arriving with the AED should immediately turn it on and apply the pads while the original rescuer continues compressions. Once the pads are in place and plugged in the AED will analyze and the responding rescuer will take over compressions while the original rescuer delivers breaths.
In the new teaching materials, there is more of an emphasis on team dynamics, which I will cover in the next section of the presentation. Everything is geared to providing high quality CPR and advanced treatment in a smooth professional manner for the ultimate benefit of the victim. Delivering High Quality CPR and working smoothly as a team decreases the amount of time between compression cycles, increases the chance of survival and Return Of Spontaneous Circulation (ROSC) by a factor of 300%. In other words, the chances of survival if all the steps are followed, is 3 times greater than it would have been previously. That is quite an improvement.
One other aspect of the new guidelines deals with Opioids. Today there is an epidemic of opioid use. A good number of people are overdosing on pain killers and doing heroin. Overdosing on Opioids complicates the resuscitation process. Many times it is the opioids and their side effects that cause people to go into Cardiac Arrest. The emergency responder has to be aware of it being a factor. One of the main things to look for is whether the pupils are dilated or constricted. If they are constricted and you are trained to administer Naloxone in any fashion, you should do so in conjunction with performing high quality CPR. The aim is to bring the unconscious person to the stage where they can breathe on their own. The CPR restores circulation and the Naloxone helps to restore breathing. If you are administering Naloxone under protocol directives previously approved by your Medical Director, you should try and bring the person to the point where they are breathing on their own, but are not completely awake. Once you have ROSC, the victim should be transported to the nearest appropriate hospital.
I can personally attest to the fact that the new guidelines do help save lives at a more improved rate. Since the new guidelines went into effect this year, my squad has had 3 medically related CPR calls and all three resulted in saves. In two cases Naloxone was used in conjunction with CPR and accelerated AED use. When I say accelerated I mean that the rescuer continues compressions while the AED is charging and stops on command just before the shock is delivered. By doing it that way you improve the compression lapse ratio and maximize the effect of high quality CPR, and the victim’s survival. Remember, Wasting Time Wastes Lives.