viewer mail

okay, i'm gonna spend a minute discussing some important questions that came up in a viewer comment regarding the recent cpr post.

first, the aha (american heart association) advisory committee and i want to emphasize that whether you do traditional cpr with mouth-to-mouth or compressions-only cpr, the survival is similar. having said that, another way of looking at it is that, if there is any concern or hesitancy about the mouth-to-mouth part, feel assured that chest compressions only will offer similar benefit. read the aha press release here.

second, remember that this is for out-of-hospital, witnessed cardiac arrest. this is not applicable to witnessed "fainting" (or "falling out" as our hospital population calls it ... incidentally, apparently karen's side of the family had never heard this term. i hear it so often from our patients that i assumed it was common but apparently that's true only in certain populations). if someone faints, typically there is an inciting reason (stood up too fast, gross movie, etc.) and they will "come to" (is this another one of our inner city terms?) fairly quickly. if someone has cardiac arrest, they will NOT spontaneously wake back up. if you are adept at feeling pulses, they will also likely not have a pulse.

third, for the most part, this is for adults only (sort of like an r-rated cpr). most kids, younger folk, drownings, drug overdoses, etc. typically have respiratory arrest and in those cases, oxygen (via your mouth) is the most important factor for survival. so, in kids, lack of oxygen is the problem leading to heart and brain injury. in adults, it's usually the heart problems that lead to the brain and oxygen problems.

next, how long do you do compressions before you perform mouth-to-mouth? i'm not sure if there's an official answer to this but you can probably go at least 4 minutes or more before giving the rescue breaths.

do you ever stop compressions to see if they're breathing? short answer, no. assuming it's true cardiac arrest, your chest compressions will not get their heart kicking again and they will not spontaneously breath until it can get jump-started. this typically occurs via electricity, i.e., shocking someone. either that or correcting other underlying disorders which only the paramedics will be able to potentially do.

what's the best position? there is no official preference for side-by-side compressions or compressions while straddling the person. however, in my opinion, straddling the person may actually be more beneficial because the weight on the abdomen theoretically could help improve blood return to the heart by basically squeezing the blood out of the abdominal organs. not to throw anyone off, but there's even evidence and a push by some people for "abdominal" compressions instead of chest. see this interesting story.

so, in summary ...

1. chest compressions only is an alternative to traditional cpr with compressions and rescue breaths.
2. this method only applies to adults who have witnessed cardiac arrest. anyone with obvious airway problems needs oxygen!
3. continue compressions until ems arrives. if it takes longer than 4 to 5 minutes, consider giving some rescue breaths.
4. don't stop compressions for anything (except rescue breaths). if a patient miraculously starts breathing spontaneously, you will know it and can stop. in general, however, a person will not wake up from sudden cardiac death unless ems or the hospital staff intervenes (unless, of course, an aed--automated external defibrillator--is available).
5. compressions is better than nothing.

hope this helps.