13th Aug, 2010

The “New CPR”

You may have recently seen on NBC Nightly News and/or on CNN some new information on CPR rescues. They have described a “new CPR” that focuses on chest compressions rather than mouth-to-mouth breathing.

Researchers from Japan, Sweden, Norway, Canada and the United States have discovered something extremely exciting. Their studies consistently indicate that chest compressions are by far, the most important part in most CPR rescues.  These studies have shown that the time it takes to breathe for cardiac arrest victims often actually lessens their chance of survival. I say most rescues, because when respiratory arrest causes cardiac arrest (for example, cases of drowning or drug overdose), rescue breathing is valuable. However, when cardiac arrest is sudden (which is much more common), rescue breathing does not really help.

Kenneth Gundersen from the University of Stavanger, Norway has studied the effect of compression interruptions on the probability of a return of spontaneous circulation. He found that for every second without the blood perfusion generated by chest compressions, there is a negative impact on the chance of a successful rescue. Gundersen concluded, “The first priority when witnessing a cardiac arrest is to make an emergency call. Beyond this our results show that performing powerful chest compressions with minimal interruptions is of utmost importance. The quality of CPR matters and everyone should practice their CPR skills at regular intervals.”

Likewise, Jim Christenson, M.D., a clinical professor of emergency medicine at the University of British Columbia reported that even short pauses in chest compressions were quite detrimental.

Bentley J. Bobrow, M.D., of Mayo Clinic, Scottsdale, found that the blood flow produced by chest compressions is so minimal that any interruption of the compressions is extremely harmful, especially for neurological outcomes. The term “minimally interrupted cardiac resuscitation (MICR)”, coined by Bobrow and colleagues, emphasizes the importance of uninterrupted chest compressions.

The American Heart Association calls it “Hands Only CPR” and in 2008 added it to their CPR classes. Not only is this new rescue likely to be more effective, it is much easier to teach and remember. In addition, more people will be willing to try to help if they know that they do not have to do mouth to mouth breathing as part of the rescue. However, they do need to know that it is extremely important to push HARD (as much as 125 lbs. of pressure) and FAST (100/minute or the rate that you sing, Row, Row, Row Your Boat.) You could also sing the Bee Gee’s song “Staying Alive” or Queen’s song, “Another One Bites the Dust”. The last one probably shouldn’t be sung out loud!:)

In order to help increase public awareness of “Hands Only CPR”, I recently had some T-shirts made that say, THE NEW CPR – Until I say “Stop, that hurts” – JUST PUSH HARD AND FAST.” On numerous occasions people have stopped me and said how much they liked my shirt and wanted to know more about the changes.

If you are interested in “THE NEW CPRT-Shirt, I would be happy to send it to you for $15.00 and postage.

The American Heart Association really made a wonderful decision when they developed the BLS online version of offering testing. For the experienced rescuer, this method of doing some of the work online and then completing the testing with the skills test is so convenient. People no longer have to take a 2 to 4 hour review course where the time and place may be very difficult to work into ones schedule. Now most of the work can be done at home, the office or the internet cafe at a time of ones choosing. It can also be broken up into small segments to fit the complicated life that so many people live in today’s world. Everyone that I have spoken to has found that portion of the retraining to be easy to work with and to understand.

I have found that most people can complete the skills test in a half an hour or less. How can you beat that for convenience?

The use of the bag valve mask (Ambu bag) is still the most difficult part of the manikin test.  However the most common mistake that I must correct is the “Head Tilt, Chin Lift”.  I am always surprised that so many people fail to tilt the head back before they check for breathing and then the other group that do tilt the head back to check for breathing but do NOT keep it back when actually breathing into the manikin! Folks, please remember your ABCs! Remember, that ‘s Airway, Breathing, Compressions! The tongue may be what is blocking the airway and either preventing the victim from breathing or preventing you from breathing into the victim.

Anyway, kudos to American Heart for developing this new method for recertifying.  It certainly makes it much easier for the experienced professional to save time but still prove that they know what to do in a CPR rescue.

2nd Feb, 2009

Let me introduce myself

I grew up in Warren, a little town in northwestern Pennsylvania. After graduating in 1974 from the College of Wooster in Ohio (social work major), I moved to the Washington, DC area and have lived here ever since. I worked at Chestnut Lodge, a psychiatric hospital, for thirteen years. I was hired as a psychiatric technician but soon started teaching a variety of subjects for the nursing orientation, specializing in Non Violent Crisis Intervention and the use of a therapeutic restraint technique called Cold Wet Sheet Pack. I also served as the milieu therapist and helped develop team building for the nursing staff on problem units. My last position at the Lodge was as the nursing department’s staffing coordinator.

While working at the Lodge in 1985, I took my first CPR class. Within a year I became an instructor and taught part time for one of the very first companies in the DC area that specialized in providing CPR instruction to both the general public and to companies. I found that I enjoyed teaching so much, I quit my job at Chestnut Lodge and started Heartline CPR, Inc. in September 1989. I have now taught over 30,000 people in these life saving techniques.

My students have included people from a wide variety of professions and backgrounds. I have taught White House Communication people and neighborhood lifeguards, day care workers and construction workers, dentists and candy store clerks, cardiologists and cardiac patients families, expectant parents and hospice workers, employees of the World Bank and employees of a blood bank, as well as staff from virtually every local hospital from the NIH clinical center to St. Elizabeth’s.

I hope to use this blog to continue to pass on my experience and passion to others who enjoy learning and teaching CPR. I hope you will join me and share with me this exploration of how and what to teach in future CPR classes.

It would be really great to hear from anyone who has taken my CPR or First Aid class over the years or have worked at Chestnut Lodge.