Tuesday, April 01, 2008

The American Heart Association Endorses "Hands-Only" CPR

In a shift away from the decades old recommendation that CPR include mouth-to-mouth resuscitation as well as chest compressions, the American Heart Association endorsed "hands-only" CPR in the latest issue of the journal Circulation.

According to the SFGate,
The new guidelines recognize that recent research has shown no real advantage to conventional mouth-to-mouth CPR in outside-the-hospital cardiac arrest cases. In addition, studies show that bystanders are often reluctant to perform mouth-to-mouth resuscitation on strangers, but are more likely to try rapid chest compression.

"We think that if we can double the number of bystanders who attempt CPR, we can save tens of thousands of lives every year," said Mary Fran Hazinski, a nurse at Vanderbilt University Medical Center and spokeswoman for the American Heart Association.
Some 900 people die every day from cardiac arrest and three quarters of those happen outside the hospital; the chances of survival outside a hospital setting hover around 5%. Unfortunately, while survival rate does increase if one is in the hospital, it's not by a staggering amount (and certainly not close to as effective as people believe CPR to be).

Apparently the new recommendation reflects three major studies that show little improval in survival rates with or without mouth-to-mouth resuscitation, and the hope is that more people will be inclined to perform CPR, even if "wrong", if they're not worrying about giving mouth-to-mouth as well as chest compressions.
These new guidelines are aimed at untrained bystanders, or to those who have been trained in CPR but are unsure they can perform it adequately. The message is, if there is any doubt, provide "hands only" CPR.

Although survival rates for cardiac arrest hover around 10 percent with CPR, Hazinski noted that rates have been pushed as high as 30 percent in cities, such as Seattle, that combine high bystander participation with a strong system of professional emergency medical response.
On a personal note, I feel like listing the Seattle rates are misleading, not in the least because Seattle has several major medical universities and teaching hospitals, as well as multiple medical assistant, nursing, and other programs. It's very hard to go more than a few feet without hitting someone with at least some medical familiarity in the city.

On top of that, however, I'm concerned at the general guideline shift. If it were just above, then perhaps it would be fine - I doubt we'll really see a huge increase in survival rates (especially when you consider long term, rather than short term, survival), but it will probably help a few people. The thing is, the guidelines are much more complex:
Heart Association guidelines

Q: Why is the Heart Association changing its guidelines?

A: Studies show that bystanders are reluctant to attempt conventional CPR, which involves chest compression and mouth-to-mouth resuscitation. New research shows that chest compression alone works just as well as traditional CPR. The thinking is, more people will try CPR if they don't need to include mouth-to-mouth breathing.

Q: Does this apply to all cases?

A: No. The new guidelines apply only to adult victims shortly after they collapse and have no pulse. They do not apply to children or drowning victims.

Q: Why not drowning victims?

A: Chest compression alone works only if there is oxygenated blood left in the body, but drowning victims have already consumed most of the oxygen in their bloodstreams. They need the air provided by mouth-to-mouth resuscitation.

Q: Why not children?

A: Cardiac arrest in children is rare. Most children whose hearts have stopped are suffering from respiratory arrest, from choking or conditions such as asthma. Like a drowning victim, they don't have oxygen in their bloodstreams.
So instead of "provide chest compressions", there becomes a list of people it's "safe" to give manual chest compression only to, and others that need the "fuller" form of CPR. I think instead of providing encouragement for people to get involved, the added complexity - did the person drown? Did they collapse from an asthma attack? Other breathing difficulty? How old is the person? - is going to discourage the general public from getting involved, especially those that were not inclined to jump in and help in the first place.

To encourage participation like this, rules/guidelines need to be clear and simple to remember - see the FAST acronym for remembering the signs of a stroke, and what to do. Simple, and successful.

I certainly hope that the new guidelines will help people, but I'm afraid that, in the end, the complexity is such that it will have no overall effect.


Anonymous said...

I agree with you ingeneral, but the FAST acronym for stroke has one major PROBLEM: it's not accurate. People may have a stroke and none of the "FAST" signs.
In 80% of cases, a stroke can be completely treated if drugs are given within 3 hours of symptoms onset. It's essential to go to the hospital as fast as possible if you suspect stroke.
The symptoms of stroke are distinct because they happen quickly:
* Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
* Sudden confusion, trouble speaking or understanding speech
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden severe headache with no known cause

More info here:

Kelly Hills said...

Sure anonymous - unfortunately, there's no way to boil anything in medicine down to one all encompassing acronym. But I think FAST does walk a nice line between memorable but containing information without being utterly overwhelming. I don't see the new AMA CPR regulations being anything other than overwhelming (hell, I've been high level first aid certified for years, and even I pause when reading the new CPR guidelines - I know there's no way in hell the automatic response/training is going to be able to "correctly" judge who should receive chest compressions and who needs forced air; not in the heat of the moment!)