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Developed by the University of Arizona Sarver Heart Center Resuscitation Research Group • Are the most common cause of death in the United States • Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often cardiac arrest • Since most occur out of the hospital • Out-of-hospital cardiac arrest is a major public health problem Heart Attack vs. Cardiac Arrest Heart Attack: • Blockage in coronary artery Cardiac Arrest: • Electrical issue, heart stops pumping • Person usually conscious • Person is unconscious • Upper body discomfort or pain • Often no previous symptoms Primary vs. Secondary Cardiac Arrest Primary • Heart stops pumping • Blood in arteries full of oxygen • Unexpected witnessed collapse Secondary • Heart stops pumping due to lack of oxygen • Drowning, Drug Overdose, Lung Failure (severe asthma or emphysema) Out-of-Hospital Cardiac Arrest The majority of all out of hospital cardiac arrests are Primary Cardiac Arrest Unexpected, witnesses (seen or heard) collapse in an individual who is not responsive Chest Compression Only CPR Ann Emerg Med. 1997 Jul;30(1):69-75. What is Chest Compression Only CPR? • A new method of resuscitation developed through extensive research at The University of Arizona Sarver Heart Center for primary cardiac arrest • Continuous forceful chest compressions to circulate the person’s blood to their brain and heart • Mouth-to-mouth breaths may actually be harmful Why isn’t Rescue Breathing Necessary? During Cardiac Arrest: –Lungs are full of air –Blood is full of oxygen –Circulating the oxygenated blood is the key Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest? • People less likely to perform • Causes interruption of chest compressions: stops blood flow to the brain • Increased pressure in the lungs and chest decreasing blood return to the heart Aufderheide TP et al.., Death by hyperventilation: a common and life-threatening problem during CPR. Crit Care Med 2004;32:S34551 Aufderheide TP et al.., Hyperventilation induced hypotension during CPR Circulation 2004;109:1960-5 Why Chest Compression Only CPR? • It saves more lives • More likely to survive over: – Doing nothing – Traditional CPR Bobrow, et al. JAMA October 2010 What Stops People from Doing CPR? Fear / Concern Solution Mouth-to-Mouth Chest Compressions Only Harming the Person Better than dead Legal Consequences Good Samaritan Law Won’t Perform Properly Easier to Do Physically Unable Do Your Best / Call For Help Coons SJ, et al. Resuscitation 80;334-340:2009 This study was designed and funded by the Sarver Heart Center The University of Arizona College of Medicine and SHARE Survival to Hospital Discharge Bystander CPR in Arizona (2005 to 2010) Witnessed & Shockable Out of Hospital Cardiac Arrest 40% 30% 25% 20% 33.7% 15% 10% 17.6% 17.7% No CPR Traditional CPR 5% 0% Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010 CCO CPR When to use Chest Compression Only CPR? Chest Compression Only CPR • Someone who unexpectedly collapses, and is unresponsive. • Vast Majority Traditional CPR • Obvious Breathing Problems: – Drowning – Drug overdoses What to do: Are You Alright? Check: Shake & Shout Call: 911 & send someone for an A.E.D. (if available) Compress: Chest compressions at 100 Per Minute Are They Breathing? • Gasping is a sign of cardiac arrest • Majority of people with cardiac arrest gasp • Can be a sign of minimal but adequate blood flow to the brain. • DO NOT stop chest compressions if they gasp How to Do Chest Compression Only CPR With the victim on the floor: 1. Kneel beside them 2. Place the heel of one hand on top of the other 3. Lock your elbows 4. Aim for the middle of the chest (on the sternum between the nipples) 5. Push hard and fast (try for 100/min.) 6. Take turns with another person when tired. Chest Compressions: Rate and Depth 100 2 inches Compressions per Minute in depth • Allows the heart to refill • Beat of “Staying Alive!!” • After each compression, take all weight off the chest Bystander CCO CPR Improves Chance of Survival from Cardiac Arrest Survival (%) 100% CCO CPR 80% CPR 60% No CPR 40% 20% 0% EMS Arrival 0 1 2 3 4 5 6 7 8 9 Time between collapse and defibrillation (min) Nagao, K Current Opinions in Critical Care 2009 EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008. What to do: Are You Alright? CHECK Shake & Shout “Are you all right?” CALL 911 COMPRESS Chest Compressions at 100 Per Minute If available; Send for an A.E.D. AEDs They may look different, but they all function the Same! Open and Follow Instructions • • • • • Turn AED ON Apply Pads to Bare Chest Plug in Pads (if necessary) Analyze Patient (CLEAR!) Push Shock to defibrillate, if directed (CLEAR!) • Immediately resume CPR The Universal Symbol •Safe •Easy •Voice Prompted Save your Breath… Save a Life How to Do Chest Compression Only CPR With the victim’s back on the floor: 1. Kneel beside them 2. Place one hand on top of the other 3. Lock your elbows 4. Aim for the middle of the chest (on the sternum between the nipples) 5. Push hard and fast (try for 100/min.) 6. Take turns with another person when tired. Chest Compressions Only Blood Flowing To The Brain Compressions + Breaths (30:2) Pausing for breaths means No Blood Flow Blood Flowing To The Brain Ewy GA, et al. Circulation. 2007;116(22):2525-30. Three-Phase Model of Resuscitation Percent 100 Myocardial ATP 0 Circulatory Phase Electrical Phase 0 2 4 6 8 Metabolic Phase 10 12 Arrest Time (min) Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8 14 16 18 20 SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6. Survival to Hospital Discharge Bystander CPR in Arizona (2005 to 2010) All out-of-hospital cardiac arrests 25% 20% 15% 113/849 52/666 10% 5% 0% 150/2,900 5.2% No CPR 7.8% Traditional CPR Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010 13.3% CCO CPR