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Chest compression--only CPR beats mouth-to-mouth CPR. (Higher Survival Rate).

MORAN, Wyo. -- Chest compression--only CPR appears to result in a higher survival rate than standard mouth-to-mouth CPR, Dr. Gordon A. Ewy said at a conference sponsored by the American College of Cardiology.

If he's right, then the American Heart Association's CPR guidelines, published just last year, are already out of date.

In addition to presenting evidence that chest compression--only CPR is at least as effective and perhaps more so than standard CPR, Dr. Ewy professor of medicine, chief of cardiology, and director of the Sarver Heart Center at the University of Arizona, Tucson, also argued that encouraging chest compression-only CPR is likely to substantially boost the current low rates of bystander-applied CPR.

Multiple surveys of the general public, nurses, and physicians all show the same thing: Nobody really wants to do mouth-to-mouth resuscitation. But a Sarver Heart Center--sponsored, national 4,000-person survey showed that a much higher percentage of the public would be interested in providing bystander CPR if the procedure involved chest compression-CPR only.

Uninterrupted chest compression preserves the ischemic fibrillating heart. But videotaped studies of standard CPR document that laypeople spend most of their time doing the assisted breathing component, not compressing the chest. Tilting the head, closing the nose, creating a seal, and instilling a breath takes laypeople an average of 16 seconds, he said.

One study demonstrated that standard CPR performed at the conventional ratio of 15 chest compressions to 2 ventilations resulted in a total of 308 chest compressions during the 8-minute period that paramedics take on average to respond. The rate doesn't provide adequate coronary perfusion. In contrast, chest compression--only CPR in which providers paused only to take a deep breath themselves after every 50 chest compressions resulted in 675 compressions in 8 minutes.

Moreover, standard CPR involves fairly complex psychomotor skills. In one hands-on study, 7% of laypeople who completed a standard CPR training course remembered how to do it correctly when asked without advance warning to perform CPR with a training dummy 6 months later. "What's going on out there [in the community] is not the optimal CPR on which the guidelines are based," Dr. Ewy said.

In a recent study in Seattle, telephone instruction in standard and chest compression--only CPR were compared. The investigators randomized 520 bystanders who reported cardiac arrest to instruction in one of the two methods while awaiting the paramedics' arrival.

It took 1 minute on average to instruct bystanders in chest compression--only CPR and 2.4 minutes for standard CPR. Survival was 15% with chest compression-only CPR, vs. 10% with standard CPR (N. Engl. J. Med. 342[21]:1,546-53, 2000).

While this difference didn't achieve statistical significance, it certainly argues that chest compression alone is at least as good as standard CPR, Dr. Ewy said.

In an animal study, Dr. Ewy took the argument a step further, demonstrating that chest compression--only CPR had a 91% 24-hour survival rate in dogs who were first subjected to 3 minutes of untreated ventricular fibrillation. In contrast, survival in dogs given standard CPR was 27%.
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Title Annotation:cardiopulmonary resuscitation
Author:Jancin, Bruce
Publication:Internal Medicine News
Date:Feb 15, 2002
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