pushing hard and fast

Thursday, October 7, 2010

Organized medicine is like a big ship. It takes time to change course even when there is urgency to do so. And so goes the tale with traditional CPR. While the press has reported that chest compression alone is good enough when a person suffers cardiac arrest and there is no need to do rescue breathing, that message is not being taught routinely by the American Heart Association. The latest study published in the Journal of the American Medical Association, confirms what has been known on the street: chest compression alone will save almost twice as many lives as classic CPR (13% vs. 7%),

For generations, the American Heart Association has taught that CPR requires special skill to try to resuscitate whose heart has stopped. Instructors were adamant in teaching hand placement and chest compression techniques, opening mouths and providing rescue breathing. The timing was thought to be critical. If only one person was doing CPR, it was 15 chest compressions then 2 breaths; two people went 5 and 1.

But the CPR philosophy changed. Automatic external defibrillators (AEDs) showed up and life saving electricity could be brought to the victim’s side in shopping malls, airports and almost anywhere that people congregated. The classic command of “you, call 911” expanded to include ‘you, find an AED”. The goal was to keep blood flowing until electricity could get there and shock the heart back into a beating rhythm. The problem was that people still wouldn’t do CPR.

Often CPR was not started because bystanders feared they would cause harm if they couldn’t remember the complicated recipe. Some people feared that they might get an infectious disease like AIDS or hepatitis from mouth to mouth resuscitation even though the risk was low. Victims had to wait for an ambulance response and the minutes without blood circulating the brain and other organs caused irreparable damage.

The new approach to CPR gets rid of the breathing issues and asks that the bystander starting pushing hard and fast on the chest. It’s nice but not critical to get the hand positioned properly, but the concern about causing complications has gone away. Thinking about the situation, how much more damage can one cause a person who is already dead. Any help is better than none and the new approach allows opportunity to help without the performance anxiety getting in the way.

The key to saving the next life is to have a community filed with people who are willing to get involved. Ideally, every person should be taught the basics of life support from an early age. Schools, cubs and brownies, little league or anywhere kids get together should begin the education and it should be repeated routinely from workplace orientation to church picnics to senior citizen center coffee. And while the heart association needs to get up to speed in developing a simpler curriculum, it’s up to us to become our brother’s keeper.

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