Our Greatest Wealth Is Health

Andrew Siegel, M.D.   Blog # 93

The majority of people who experience sudden cardiac arrest (when the heart stops beating) will be dead within a few minutes of the arrest or, if they survive, will suffer permanent central nervous system damage because of inadequate blood flow to the brain.

A new and modified method of CPR called “Hands–Only CPR” can substantially increase the survival rate of those undergoing cardiac arrest, without the necessity for mouth-to-mouth breathing.   It is a relatively easy technique that can be performed by most anyone with little training.

According to the American Heart Association, despite the newer guidelines that make it much easier to perform CPR, less than one third of cardiac arrest victims receive the potentially life-saving procedure from bystanders.   Hands–Only CPR involves repeated chest compressions to maintain blood circulation until the time emergency help arrives. The difference in the newer CPR guidelines is that instead of focusing on airway, breathing, compressions (A, B, C), the order has been changed to focus on compressions, airway, breathing (C, A, B). The previous standard was to ensure an open airway, tilt the head back, lift the chin, pinch the nose, seal the mouth, and administer mouth-to-mouth resuscitation. The problem with this was its focus on breathing as opposed to circulation.  The crux of the issue is that after cardiac arrest, there is usually plenty of oxygenated blood present, but a non-functioning circulatory system to pump the oxygenated blood.

So, if you witness a person collapsing, the first thing to do is to call 9–1–1 for help. Secondly, shake the person and evaluate to see if they are breathing. If they are unresponsive, have no pulse and are not breathing or not breathing normally, lock your hands together and push hard and rapidly on the center of the chest 100 times or more.  The chest compressions should be 1 ½-2 inches in depth. If the situation was not a cardiac arrest and the collapse occurred for other reasons such as low blood sugar in a diabetic, the victim will usually perk up when sufficient pressure is placed on the chest.  In the event of this happening, leave the patient alone and wait for emergency help.

The bottom line is that you do not need to waste time pulling the victim’s head back and giving mouth-to-mouth because of the presence of plenty of oxygenated blood which is simply not moving; thus chest compressions become the greatest priority and can be delivered in a manner that is much less invasive and potentially risky than mouth-to-mouth breathing.  Hands-Only CPR can dramatically increase survival for sudden cardiac arrest patients.

Of course, if the victim fails to respond, and no breathing or heart beating ensues and help has not yet arrived, then it comes time to add airway and breathing to the regimen.  Generally, two breaths followed by 30 chest compressions (at a rate of 100/minute) will be adequate, with stopping every two minutes to see if breathing and pulse have returned.

How to Do the New CPR:

The following is a step-by-step guide for the new CPR:

1. Call 911 or ask someone else to do so.

2. Try to get the victim to respond; if they do not, roll the person on his or her back.

3. Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.

4. Press down so you compress the chest at least 1½ to 2 inches in adults and children and 1½ inches in infants; 100 times a minute is optimal.

5.  If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.

6. Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.

7. Continue compressions and breaths — 30 compressions, two breaths — until help arrives.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

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Tags: cardiac arrest, cardiopulmonary resuscitation, CPR, myocardial infarction

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