Please take 30-60 seconds to watch the video on this site and learn hands-only CPR. (NYP.org is NewYork-Presbyterian Hospital's site)


https://www.nyp.org/cpr/

And after the COVID-19 crisis is over, go get yourself some hands-on training! Our local fire department does an excellent job of this, yours might as well.

An excellent idea, You never know......

I started in nursing when CPR was brand new, brought back to local hospitals by former army docs. Lots of evolution in technique over the years, especially after the heart association discovered that ACLS certification was a dynamite revenue generator. There were years of having to do a perfect tape on Resus-annie, supervised by militant instructors. Then aids came along, and nobody wanted to perform rescue breathing on strangers, resulting in a thriving industry in CPR masks and ventilation shields. But eventually it was concluded that even the shields did not offer protection from bodily fluid aerosolization, so we saw the development of breathless CPR. Over this period, ACLS standards changed as research demonstrated the futility of intracardiac adrenaline, levophed drips, and precordial thumps. Now the algorithms are simpler, the standards less nit-picky, and the outcomes are better.

Feeling old.
Boomer out-

What are current stats on outcomes? Many years ago, it was somewhere around 30% at best, who would walk out of the hospital.

Personally I have a very consistent record. Two efforts and both DOA.

https://www.heart.org/en/news/2018/09/24...worse-for-women

"More than 350,000 cardiac arrests happen outside of U.S. hospitals each year, with about 90 percent of those people dying.

CPR – or cardiopulmonary resuscitation – can double or triple a person’s chance of survival. In 2014, about 45 percent of out-of-hospital cardiac arrest victims survived when bystander CPR was given.

But only about 46 percent of those who suffered cardiac arrests outside of a hospital in 2017 received bystander CPR."

What we were taught is that if the victim is a child, you can very likely bring them back. With adults, they paramedics teaching us the class told us to do our best but were blunt that the chances were much worse.

Things have changed significantly over the years. When I first became a paramedic it was an extremely rare thing to save someone who was in cardiac arrest. Today we teach our paramedic students that out of hospital cardiac arrest is a survivable event. When you look at all the changes in resuscitative care one thing has time and again shown to make the greatest difference in a positive outcome... a focus on high quality, minimally interrupted chest compressions.

In other words, Hands Only CPR saves lives.

There are many reason why hands only CPR is becoming the standard for CPR. The two most important reasons are research showed laypersons are way more likely to perform CPR on a stranger if they didn't have to do rescue breathing and minimally interrupted compressions significantly improved outcomes by maintaining blood flow to the brain during resuscitation.

Our protocols include minimally interrupted compressions for most adult cardiac arrest patients, patients receive 600-1000 compressions by EMS without a single rescue breath unless they get a pulse back. Compressions will be interrupted just long enough to defibrillate or to move the patient for better access of safety.

Arrests due to trauma, drownings, overdoses etc still have poor survival rates and will continue too for a long time... prevention is the primary "treatment" for this causes. But in arrest caused by cardiac issues... survival rates will continue to increase as more and more laypersons learn hands only CPR, as more dispatch systems instruct their callers to perform hands only CPR and as minimally interrupted compressions into more EMS and ED resuscitation protocols nationally.

UPDATED to add: I ran a quick report of adult cardiac arrests for my agency over the past 365 days. I removed all the patients that we did not attempt resuscitation (obviously dead). Here it is:

• CPR was performed prior to our arrival: 78% of patients (adequately 66%)
• Return of Spontaneous Circulation [ROSC]: 45% of patients
• ROSC sustained to Discharge: 35% of patients
• ROSC in patients where NO CPR was performed prior to EMS: 0.1% (0% to discharge)

These numbers reflect what we see in or region, and if I filter out the overdose and traumatic causes ROSC numbers will increase significantly... The most important lesson I get when I look at these numbers is good layperson CPR prior to EMS arrival makes the biggest difference in outcome.

Question: Besides the obvious, what are the differences between CPR and an electronic defibrillator in terms of survival??

Being 60 years of age (wife is 63), retired, and in a fairly rural area, we've considered purchasing a electronic defibrillator such as this Philips Hearstarting package:

https://www.amazon.com/dp/B00KSAL7LS/ref=cm_sw_r_em_apa_i_1plLEbS13VXDB

An ambulance is probably 15-20 minutes away. If the spouse does CPR, does a defibrillator provide a real benefit? Given the increased availability of defibrillators at workplaces, airplanes, and other locations, my thinking is that they do provide a real benefit. Or, maybe it's to avoid litigation.

A defibrillator does provide a benefit, but it is secondary to good quality chest compressions. Quick answer: It wouldn't hurt to purchase an AED, if utilized as part of hands only CPR and compression are only interrupted as little as possible to utilize the AED can provide a higher chance of return of spontaneous circulation. If significant interruptions in compressions to use the AED the benefits are negated. If you live further from EMS than 10 minutes and you can afford it buy an AED (the one linked above would be my recommendation). However, I would prioritize a good trauma kit with TCCC approved tourniquets and hemostatic gauze before I would buy an AED.

Edited to add: If you have a history of heart problems (or a cool doctor) you may be able to get a prescription for an AED and some insurances will cover them.

The changes to CPR over the years have been dramatic. I first learned how to preform it in the late 80's, at that time survival rate were abysmal. Now that has all changed for the better. To help understanding you need to remember that the body's circulatory system is a closed pumping system, for blood to actual flow you need to bring the system up to working pressure. In the past we never did that, we would get up to pressure and than stop. This is why you want as minimal interruptions as possible! Get the pressure up and keep it up for the blood to circulate, this is why you are performing 200 compressions. The New York website and video is good but I prefer this one from the crew in Florida , https://www.youtube.com/watch?v=4u69rGzWmcQ [url=https://www.youtube.com/watch?v=4u69rGzWmcQ][/url]

So, if the only two people in the house are the victim and the spouse, it sounds like the best option might be to unlock/open the front door, initiate a call 911 using the speakerphone (hands free), and start/continue CPR until help arrives (maybe skip the door). That stopping CPR to unpack, apply, & start the AED would do more harm than good. Is that correct?

Also, when there is no pulse, where exactly do I apply the tourniquet and hemostatic gauze??? (just kidding!!!). Especially given my fear (dread?) of using my little chainsaw, your advice is heard loud and clear.

Let me take resuscitation back even further. In 1959 I took an Advanced First Aid course, learning 'back pressure-arm lift.' In the early 60's I first heard of "external cardiac massage." the coming thing. Finally CPR - mouth to mouth with chest compressions arrived and made a real difference.