It's Back to Basics to Save a Life

Despite new technology and methods, experts say simple CPR works best

SUNDAY, Aug. 23, 2009 (HealthDay News) -- Medics and doctors are used to participating in a flurry of activity when trying to save a person who's had a cardiac arrest -- inserting IVs, placing a breathing tube, performing defibrillation to restart the heart.

But studies now show that none of those techniques saves lives as well as starting ordinary cardiopulmonary resuscitation, or CPR, before introducing more advanced measures such as defibrillation. And what's more, those studies have also found that a truncated version of CPR that tosses out mouth-to-mouth in favor of simple and sustained chest compressions increases survival rates dramatically.

"It's been shown to work, while these other things have not been shown to improve survival," said Dr. Alex Garza, an associate professor of emergency medicine at the Washington Hospital Center and Georgetown University School of Medicine in Washington, D.C. "They were just things we thought would be good."

"The important thing now is to step back, do chest compressions and proceed methodically," he said.

Both the American Red Cross and the American Heart Association have endorsed chest compressions as an acceptable alternative for people who witness a cardiac arrest but aren't trained in CPR.

By simplifying the process, they hope to get more bystanders to step in and perform chest compressions on the ailing person until help arrives. The American Heart Association estimates that fewer than a third of those who suffer cardiac arrest in a public place receive any form of CPR.

Bystanders simply are "worried about making an error, and they forget a lot of the steps," said Dr. Marc Eckstein, associate professor of emergency medicine at the Keck School of Medicine at the University of Southern California and medical director of the Los Angeles Fire Department. "Mouth-to-mouth is complex, and many people are reluctant to perform it. Performing compression only, the results are comparable to full CPR -- and you can teach someone to do it in a matter of minutes."

The compressions need to be applied in the center of the chest at a rate of about 100 a minute -- ironically, about the same rhythm as the Bee Gees' song "Stayin' Alive." One study has found that performing chest compressions while listening to that song improved the CPR technique of physicians and medical students.

"Laypersons with no formal training in CPR, when they're presented with someone in cardiac arrest, can do a pretty decent job with chest compressions," Garza said.

Garza and Eckstein go further than the American Red Cross or the American Heart Association, however, saying that even trained rescuers should focus on uninterrupted chest compressions rather than trying to juggle compressions with mouth-to-mouth or other treatments.

It takes many repeated chest compressions to increase pressure enough to begin driving blood into heart tissue, Garza said. "By the time you got to your 15th chest compression, you'd just gotten to where you were doing some good, and then you'd stop to perform mouth-to-mouth, and it went back to zero," he said.

Both doctors have studied what happens when paramedics change their cardiac protocols to focus more on chest compressions, Garza in Kansas City and Eckstein in Los Angeles. They both found that survival rates improved when paramedics delayed intubating patients, administering medications or performing defibrillation in favor of consistent compressions.

Chest compression CPR is more valuable than defibrillation because rescuers often arrive too late for effective defibrillation, which needs to occur within five minutes of cardiac arrest, Garza said.

"The problem is, most paramedics don't arrive in the first five minutes," he said. By the time rescuers arrive, the body's tissues are starved for oxygen and the heart cells are depleted of energy. "If you attempt a defibrillation at that time, it's less likely to be successful," Garza said. "They're more likely to flat-line."

Airports and casinos boast excellent heart attack survival rates "because there's always a defibrillator within a five-minute walk," Garza said. Security guards are trained in the use of defibrillators, and both types of facilities have excellent closed-circuit monitoring.

If defibrillation isn't available, it's best for bystanders to start providing chest compressions, the experts say. That way, the stores of oxygen still in the blood will continue to circulate and feed the body's tissues, keeping the person's body and brain alive.

"When the heart stops, it's not a problem of not having oxygen in the blood," Eckstein said. "It's a pump problem. You have to circulate that oxygen."

More information

The University of Washington School of Medicine has more on CPR.

SOURCES: Alex Garza, M.D., associate professor, emergency medicine, Washington Hospital Center and Georgetown University School of Medicine, Washington, D.C.; Marc Eckstein, M.D., associate professor, emergency medicine, Keck School of Medicine, University of Southern California, director of pre-hospital care, Los Angeles County/University of Southern California Medical Center, and medical director, Los Angeles Fire Department, Los Angeles; American Red Cross; American Heart Association
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