Posted tagged ‘cpr’

Simplified CPR – without mouth-to-mouth – can save children’s lives

May 1, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Quick action is essential if someone has a sudden cardiac arrest. You might be in Target, or on a bus, or in a classroom when someone nearby just drops to the ground. Or maybe you’re boating, and you help pull a drowning victim out of the water. What do you do next?

CPR training is a great way to learn the steps, and I strongly encourage it for all parents and everyone else. But we know that many bystanders are unable to perform CPR when it’s needed. There’s panic and indecision and trying to remember what to do. To make it more possible for anyone to help, the old-school ABCs of CPR (Airway, Breathing,  Circulation) have been simplified. The current recommendations for CPR in most situations is just a few steps:

  1. Check if the victim is OK. Ask “Are you OK?” and give a little shake. If the person doesn’t respond, you need to act quickly.
  2. Call for help or call 911.
  3. Start pushing the middle of the chest down, over and over, fast and hard, until help arrives. If someone can bring over an automatic defibrillator, use it.

Those are all the steps. Rescue breathing has been deemphasized (it can still be used by trained people, if CPR is prolonged, or in some other situations.) Checking pulses and breathing isn’t necessary. It turns out that doing something (calling for help and starting chest compressions) is better than doing nothing.

However, there’s been some concern that compression-only CPR may not be as effective for children. Kids don’t have the same kind of arrests as adults (they’re much less likely to have a heart attack, for instance.) A new study from Japan shows that compression-only CPR is probably about as effective as traditional CPR in children – and it’s far better than doing nothing.

In Japan, all out-of-hospital arrests are recorded in a tracking database. Researchers looked at all of these events from 2011 to 2012 in children from age 1 to 18 (infants less than 1 were excluded.) This was at a time when compression-only CPR was being promoted for use by bystanders in Japan. Data had been collected regarding whether CPR was performed, and what kind; and the study authors tracked down all of the child victims to see how they were doing 1 month after their event. A good outcome was considered to be living with with normal or nearly normal neurologic function.

Overall, 2,157 children experienced a cardiac arrest over 2 years. The most common causes were from drowning and trauma. About ½ of the time, no CPR was performed; among the 1,150 who received CPR, 733 had compression-only CPR. The authors were then able to compare the outcomes.

The overall chance of a favorable outcome for all of these children was 10% (which is about what we’d expect for out-of-hospital cardiac arrests.) When the causes and severity of the arrests were controlled, conventional CPR provided a 18% good outcome, compression-only CPR 16%, and no CPR 4%.

So: doing anything was far better than doing nothing at all. It’s still unclear what the “best” CPR for children should be, and further studies will likely work that out. But we know now that simple, compression-only CPR is about as good as full-scale, mouth-to-mouth+compression CPR. If you’re not sure what to do, just push on that chest, fast and hard, until help arrives.

The best way to learn CPR is a hands-on, in-person course with a qualified instructor. There are some good alternatives if you’re in a hurry. The CPR anytime course can teach you the basics online in about 20 minutes. If you don’t have the time for that, watch this brief video about compression-only CPR. Remember, you don’t have to remember everything, and you don’t need to be perfect. Call for help, and then push – hard and fast. You can save a life.

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How to save a life: The new CPR guidelines

November 6, 2010

The Pediatric Insider

© 2010 Roy Benaroch, MD

The American Heart Association recently released new 2010 guidelines for performing CPR—cardiopulmonary resuscitation. It’s easier than ever to learn it, and easier than ever to do it.

CPR is what bystanders are supposed to do when someone collapses and stops breathing. Once the heart stops beating and lungs stop breathing, there isn’t a lot of time before the brain will die. The AHA’s new guidelines encourage anyone—even with no formal training—to get the initial steps of CPR started so there is time for trained help to arrive.

I used to be a CPR instructor, and I’ll informally summarize the current instructions here. Reading this will give you some idea of what CPR is all about, but this is no substitute for taking a CPR course.

  1. You see someone collapse, or come upon someone motionless. Don’t panic. You know what to do.
  2. Make sure it’s safe to proceed—don’t run into traffic, or dive into unknown water, until you’re sure you’ll be safe.
  3. See if the person is responsive. Give a little shake. You get style points for saying “Annie are you OK?”, but anything like that is fine.
  4. If the person moves or is otherwise responsive, don’t proceed with CPR. Make sure the situation is safe. Offer to call the person a cab or ambulance or just fluff their pillow, depending.
  5. If the person is truly unresponsive, your first goal is to get trained help. If other people are nearby, tell them to call 911 and get an AED. If no one else is around, you must go do this before proceeding with CPR.
  6. While someone else is getting help, or after you’ve called 911, start chest compressions. Put your hands in the middle of the victim’s chest and push down, hard and fast. Push down about two inches. Try to remember to relax after each push so the chest can re-expand—don’t keep leaning down. A good rate to push is about 100 beats per minute. The AHA suggests thinking about the beat of The BeeGees Stayin’ Alive. I suppose you could even sing it out loud. If you’re feeling macabre, another good song with that 100 beats per minute rhythm is Queen’s Another One Bites the Dust. I do not suggest you sing that aloud.
  7. Unless you have specific training in rescue breathing, don’t even try mouth-to-mouth. Just keep compressing and singing “Stayin’ Aliiiiiive….” until trained help arrives.
  8. Once trained help comes, or the victim starts to move, stop pushing and get out of the way.

Simple, and it works.

One step deserves a little more explanation: if available, you want to use an AED (Automatic External Defibrillator) as soon as possible. This device is basically an automatic way of using those paddles to shock the heart back into a normal rhythm. The devices are designed to be used by anyone. When you turn one on, it will shout instructions to you about exactly how to apply the pads (it’s one big sticker on the chest), and to yell clear, and once no one is near the victim, to push a big button. The device will figure out if a shock is needed, and give the shock if it will help. Studies have shown that untrained middle school students can use these devices correctly, and they’re often available in public places, stadiums, churches, and sometimes restaurants. If it’s possible to grab an AED and use it, do that after you call 911 and before starting the further steps of CPR. If you’re doing CPR and someone runs up with an AED, stop what you’re doing and follow the AED instructions.

For those of you who’ve taken a CPR course, the newest guidelines include several changes that are meant to simplify the process. Studies have shown that even trained personnel often got caught up in the details of trying to remember the exact instructions, rather than just jumping in an starting. It’s more important to do something than to do something exactly right. The major changes are:

  • Forget ABC (airway, breathing, circulation); it’s now CAB: start compressions first. Compressions are the most important part of keeping people alive. Another reason for the change: at least some onlookers have been reluctant to start CPR because they didn’t want to give mouth-to-mouth. Fine. Just start chest compressions, after calling for help.
  • Checking pulses and breathing, which was de-emphasized with the last set of guidelines, has further been pushed to the back of the bus. If the person is unresponsive, assume breathing and heartbeats have stopped, and don’t waste time trying to check.
  • The rates/rhythms/cycles/orders are the same at all ages from infant to adults. Neonatal CPR is different.

Whether or not you’ve had CPR training before, now is a great time to take the course. Even if you don’t think you know what you’re doing, these simple steps are easy to follow. You don’t have to sing out loud. Call for help, then get pushing: that’s how to save a life.