A mouthful of tips on CPR

AN APPLE A DAY - Tyrone M. Reyes M.D. () - September 6, 2011 - 12:00am

You and your buddy are out on the golf course, a good distance away from the clubhouse. He hits a perfect drive straight down the fairway, then suddenly clutches his chest and falls over. It’s evident that he’s gone into cardiac arrest.

Panic-stricken, you don’t know what to do. On television, people perform cardiopulmonary resuscitation (CPR) successfully with mouth-to-mouth rescue breathing, but you’ve never tried it yourself and you’re even a little hesitant to do it. You’re not alone: For many people, mouth-to-mouth can be a deterrent to performing CPR.

With this in mind and based on recent studies suggesting that rescue breathing (ventilation) doesn’t necessarily improve a person’s chances of survival, the American Heart Association in October last year issued a new guideline recommending that bystanders focus only on chest compressions — and to begin them as quickly as possible.

The rationale is that if you experience cardiac arrest and you go down, you still have enough oxygen in your lungs that you don’t need ventilation right away. The idea, then, is to just get the blood circulating and keep it circulating as much as possible, and certainly, compressions are the best way to do that.

Hands-On Assistance

During cardiac arrest, a victim’s chances of survival decline with each passing minute. Previous guidelines stressed the concept of the ABCs of CPR — airway, breathing, and compressions — which instructed people to open a victim’s airway, breathe into his mouth, and then begin chest compressions. But doing so delayed pumping the vital oxygen-rich blood to the victim’s brain by an average of 30 critical seconds, according to the American Heart Association. The new guideline changes the ABCs to CAB, to emphasize chest compression first.

Two studies published in October 2010 — one in The Lancet and another in the Journal of the American Medical Association — found that people in cardiac arrest who received compression-only CPR from a bystander fared better than those who received conventional rescue-breathing CPR or no CPR. Specifically, in The Lancet study, patient survival improved by 22 percent, when bystanders called 911 and were told by the dispatcher to do compression-only CPR. These results followed two studies published in July 29, 2010, in The New England Journal of Medicine (NEJM) that found that compression-only CPR was equally as effective as CPR with rescue breathing.

Conventional CPR required that rescuers repeat a cycle of 30 compressions and then two ventilation breaths, but many times, those rescue breaths are ineffective. The biggest problem is that in performing CPR as a bystander, or even a health-care professional who doesn’t do it every day, it can be difficult to remember chest compressions and ventilations and to do them effectively. It’s easier just to keep your hands on the chest and keep pushing up and down, and it is probably providing circulation more consistently. (See photo “Your Guide to Performing Bystander CPR” for further guidance.)

When An Emergency Arises

If you have someone who is unresponsive and not breathing, first call for assistance or have someone else make the call. Quickly check for a pulse on the side of the victim’s neck, and if you find none, start chest compressions and have someone locate the nearest automated external defibrillator (AED), a device that can deliver a shock to restart the heart.

Continue with the constant compressions at a rate of 100 per minute. Ironically, that rate coincides with the beat of the popular Bee Gee’s song Staying Alive, which is now used as a guide in some CPR training courses. If you listen to Staying Alive and you move to the beat of the tune, you can essentially hit about 100 per minute!

Push down about two inches on the chest with each compression. If somebody else is available, have that person feel for a femoral pulse near the victim’s groin while you perform the chest compression.

If the person remains unresponsive for several minutes or you’re in a remote area where the emergency medical service response time may be greater, the oxygen supply in the victim’s lungs will have run out, and you may need to perform rescue breathing. Ventilation also is necessary if someone becomes unresponsive while choking and you can’t dislodge the object with the Heimlich maneuver.

Learn A Life-Saving Skill

When the American Heart Association gave its blessings to hands-only CPR, it came with a proviso that conventional CPR techniques might still benefit some people. Children and victims of drowning, trauma, airway obstruction, and acute respiratory diseases are specifically mentioned.

Cardiac arrest is often dramatized as taking place in public, but 80 percent of the time, people are at home or in a residential setting during a cardiac arrest. And even in the best of circumstances, the odds of surviving cardiac arrest that occurs outside the hospital are long. In both of the NEJM studies, the rescuers were instructed by dispatchers. In one of the studies, conducted in Sweden, just 100 of the 1,278 people (7.8 percent) who received CPR, either compression only or the conventional kind, were alive 30 days later. Results in the other study were a bit better: 227 of 1,941 (11.7 percent) people who received CPR survived to hospital discharge.

Although the new guidelines make CPR easier even for the layperson or bystander, consider taking CPR class. There, you can learn how to identify if a person is breathing or has a pulse, and receive supervised guidance on how to perform chest compressions and, if necessary, rescue breathing. To find a CPR class near you, contact the Philippine National Red Cross, the Philippine Heart Association, hospitals such as the Philippine Heart Center, or ask your cardiologist.

If you haven’t thought about it, the likelihood of an event like a cardiac arrest happening is greater than you might think. I would encourage anybody to take simple classes. If you want to spend time doing something that could save the life of someone you really care about, take a class. It’s just so basic and so available.

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