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Tuesday, April 1, 2008

Care for patients is a combination of high tech and high touch and the American Heart Association is working hard to get the touch back into the equation. After years of advocating bystander CPR, cardiopulmonary resuscitation, the P or pulmonary is being dropped and chest compressions may be enough.

Why the change? Because when confronted with a medical crisis like somebody collapsing with sudden death (their heart stops), most bystanders are too frightened to intervene, not certain whether they might do harm. And in today’s fear of getting an infection, doing mouth to mouth breathing on a stranger added to that fear. The idea might be summarized by the axiom: if you can’t do something well, don’t do it at all. For cynical doctors, the answer was: the patient is dead, how much damage can you do?

But in a medical crisis, people who try to help make a difference and patients survive. Studies have shown that bystanders, who had no knowledge of CPR, were given simple instructions by 911 operators to do chest compressions and were able to save lives. It seems that there is enough oxygen left in the blood stream to allow the brain and other organs to survive until medically trained personnel arrive, as long as that blood is circulated and chest compressions does just that.

As usual, there are special situations where breathing for a victim is important, including babies and drowning victims, but the new recommendations make it easier for bystanders to make a difference.

The first steps remain the same:
• Make certain the victim is unconscious and doesn’t have a pulse
• If possible, send one person to call 911, send another to find an AED
• Begin chest compressions
• Don’t stop until the patient wakes up (yes, this does happen), the rescuer gets too tired to continue or help arrives and ask that you stop

The best chance for a sudden death victim to survive depends on the quick use of electricity. An AED, or automatic defibrillator, can shock the heart back into a rhythm where it can beat and sustain life, but until the AED arrives on the scene, chest compressions are a bridge for that life saving.

There is no doubt, that the chance of survival for sudden death is better in certain situations, like in a hospital intensive care unit. But you have a better chance of survival in Seattle, where many people have taken a CPR class, than you do in a city where ordinary citizens have not. Using chest compressions alone is good, but learning the whole package is certainly better and advocating for more AEDs in public places adds to the overall sudden death survival rate in a community.

But the high tech can’t work unless the high touch happens. The new recommendation for chest compressions “hands only” CPR may make that difference between life and death.

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