Study finds CPR often not done right.

Byline: From Register-Guard and news service reports

CPR is often performed inadequately by doctors, paramedics and nurses, according to two studies of resuscitation efforts during cardiac arrest.

Whether a stricken patient is in the hospital or on the way, the guidelines for administering cardiopulmonary resuscitation frequently are not followed.

Among the problems commonly cited: Rescuers did not push hard enough or frequently enough on the victim's chest to restart the heart and breathed air into the lungs too often - either mouth-to-mouth or through breathing tubes.

Both studies used an experimental monitor that assesses CPR quality, and both received funding from Laerdal Medical Corp., a Norwegian company that developed the device with Philips Medical Systems.

The studies appear in today's Journal of the American Medical Association.

The researchers explained that skills learned in the classroom can fall by the wayside in the stress-filled chaos of a real-life emergency. Also, they noted that chest compressions strong enough to break ribs are sometimes required, and rescuers can tire quickly.

In one of the studies, involving 67 adult patients at the University of Chicago, doctors and nurses failed to follow at least one CPR guideline 80 percent of the time. Failure to follow several guidelines was common.

``Patients who had it perfectly done were in the distinct minority,'' said Dr. Benjamin Abella, one of the researchers.

The other study involved 176 adults with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden; Akershus, Norway; and London. Chest compressions were done only half the time, and most were too shallow.

More than 600,000 people die from sudden cardiac arrest each year in North America and Europe. The heart suddenly stops beating, either because of a heart attack or other underlying heart disease.

In Eugene and Springfield, doctors, nurses and paramedics are required to get regular training to keep their CPR skills sharp, training officials said.

Emergency medical technicians in the Eugene Fire Department are required to undergo CPR training every two years to keep their certification from the American Heart Association, said Karen Anderson, the department's emergency medical services training officer.

The medics also get regular training each quarter to review and practice different skills, including CPR, she said.

Likewise, McKenzie-Willamette Medical Center and Sacred Heart Medical Center follow the American Heart Association guidelines, which require recertification in CPR skills every two years.

"The repetition helps you get updated on any new changes, and the repetition helps keep it fresh in your mind," said LuAnne Boettiger, staff development director at McKenzie- Willamette.

Anyone involved in direct patient care at Sacred Heart has to demonstrate proficiency in CPR after attending training every two years, said Rick Maddess, a clinical nurse educator at the hospital.

"There's going to be people who do it properly, and people who don't, all over the world," he said. "I can say, here, we make sure everyone knows how to do it."

At the Oregon Pacific chapter of the American Red Cross in Eugene, CPR training is valid for one year only, spokeswoman Jenny Carrick said.

"People forget," she said. "It's not anything you use on a daily basis. To keep your skills fresh, it's really important at least once a year to go back through the training."

The Red Cross offers different training regimens for medical professionals and members of the public, she said. She said members of the public should not be daunted by the fact that even the pros sometimes don't follow CPR guidelines.

Even applied incorrectly, CPR is better than doing nothing at all and can save a life, she said.

Current AHA guidelines advise lay people that if all they want to do is chest compressions - and not mouth-to-mouth resuscitation - until paramedics arrive, that will circulate enough oxygenated blood to help the person, Maddess said.

The device used in the studies - a combination heart monitor and defibrillator - includes a small sensor that attaches to the patient's chest and evaluates depth of chest compressions and other aspects of CPR. The monitor includes an automated voice that provides on-the-spot coaching, telling rescuers when chest compressions are not strong enough or frequent enough. But that feature was not used during the studies.

Both studies were too small to determine whether using the device saved lives, but the Chicago researchers said it could improve patients' survival chances.

``Without a device that gives you feedback in the heat of the moment, you can't drive an airplane that way - and we can't take care of sick critical patients without the appropriate monitors,'' said the study's leader, Dr. Lance Becker, director of the university's emergency resuscitation research center.

The device is approved for experimental use in the United States, and the manufacturer is seeking Food and Drug Administration permission to sell it commercially in this country.

The studies will be taken up at a medical conference next week in Dallas that could lead to an update of the CPR guidelines, American Heart Association spokesman Vinay Nadkarni said.

Register-Guard reporter Tim Christie contributed to this report.

CPR TRAINING

For information on CPR training offered by the Oregon Pacific chapter of the American Red Cross, call 344-5244 or go to oregonpacific. redcross.org