Experts Fail to Perform CPR Correctly

Medical personnel often don't follow recommended technique, studies show

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By
HealthDay Reporter

TUESDAY, Jan. 18, 2005 (HealthDayNews) -- Cardiopulmonary resuscitation (CPR), the emergency treatment for people who suffer cardiac arrest, isn't being done by medical professionals the way it's supposed to be done, studies in the United States and Europe find.

Guidelines say the chest should be compressed about 1.5 inches 100 times a minute, and that mouth-to-mouth breathing should produce a ventilation rate of 12 to 16 breaths a minute to keep people alive in the life-and-death minutes after the heart stops beating. The two studies -- one in a hospital, one out of hospital -- showed that medical personnel trained to follow those rules often don't.

One study of 176 people who went into cardiac arrest outside of hospitals in three European countries found that paramedics and nurse anesthetists had an average compression rate of 64 times a minute, with an average of 11 ventilations per minute.

The other study, monitoring CPR given to 67 patients at the University of Chicago Hospitals, found that in 26 percent of the cases, compression rates were below 90 per minute and that 37 percent of the compressions were too shallow. And ventilation rates were usually too high, more than 20 per minute in 61 percent of the cases, a frequency that has been shown in previous studies to reduce the chance of survival, the researchers said.

Both studies appear in the Jan. 19 issue of the Journal of the American Medical Association, and the leaders of each have different suggestions for improvement.

Better and more frequent training courses might be the answer, said Dr. Lars Wik, an anesthesiologist at Ulleval University Hospital in Oslo, Norway, and lead author of the European report.

"Data from previous studies show that the retention of the ability to do CPR declines rapidly after a course is taken, for professionals and lay people," Wik said. "They do pretty well right after the course, then performance declines rapidly after two or three months."

The techniques that are being taught should also be evaluated, Wik said.

"How do we know that we are focusing on the important part of CPR when we do the initial training and refresher courses?" he asked. "We really should look at how we have done this before and try to move to more simple algorithms [rules]."

Doctors at the University of Chicago see an answer in better equipment -- specifically, the device they used to monitor CPR performance in the study.

It is essentially the same device now used by emergency medical personnel -- a defibrillator that gives a shock to get the heart beating again, but with the addition of a microchip that gives feedback so compression frequency and depth as well as ventilation rate can be adjusted, said Dr. Benjamin Abella, an assistant professor of medicine and lead author of the U.S. report.

"The evidence is that training alone will not fix the problem," Abella said. "In our study, the people doing CPR were trained to perform CPR perfectly on a mannequin. Training alone will not work because the setting of a cardiac arrest is too chaotic and anxiety-producing, with too many things going on."

A larger-scale study of the device is under way, said Dr. Lance Becker, a professor of medicine at the University of Chicago, and another author of the report. The study is designed to see whether the device will improve adherence to CPR guidelines and improve survival rates. Results will not be available for at least a year, he said.

Meanwhile, the message for lay people who see someone go into cardiac arrest -- something that happens at least 1,000 times a day in the United States -- is to do the best they can at CPR, all the physicians agreed. "Something is always better than nothing," Becker said.

"Call 911 and start CPR," Wik said.

More information

The basics of CPR and when and how to do it are offered by the American Heart Association.

SOURCES: Lars Wik, M.D., Ph.D, anesthesiologist, Ulleval University Hospital, Oslo, Norway; Benjamin Abella, M.D., assistant professor, medicine, University of Chicago; Lance Becker, professor, medicine, University of Chicago; Jan. 19, 2005, Journal of the American Medical Association

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