The CCR Program
|
CONTINUOUS COMPRESSION
RESUSCITATION
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INTRODUCTION
Bystander cardiopulmonary
resuscitation (CPR) is one of the major elements in
the "chain of survival" for the treatment of patients
in cardiac arrest. Recent reports have indicated a
decrease in the number of laypersons performing CPR. One reason
postulated for this decline in bystander CPR is lay
rescuer reluctance to administer mouth-to-mouth breathing. The
American Heart Association has called for simplification
as a central educational theme in efforts to encourage
more bystander participation. One dramatic step
toward simplification is to eliminate mouth-to-mouth
ventilation for lay rescuers. Although some continue
to voice concern about this approach, others have begun to test
such a strategy in preclinical cardiac arrest models
and have found equivalent outcomes when standard
airway (A), breathing (B), and compression (C) CPR is compared
with continuous chest compression (CCC) CPR. These
trials have all performed ABC CPR specifically as directed
in the American Heart Association guidelines using a
3- to 4-second period for delivery of the 2
ventilations. Two clinical trials have also shown the
benefit of CCC CPR.
A recent report from the United
Kingdom in which 495 laypersons were prospectively
randomized to training in either standard ABC CPR or
CCC CPR demonstrated that extensive interruptions
occur when laypersons stop chest compressions to ventilate.
The average time from stopping compressions to restarting
compressions for the delivery of 2 mouth-to-mouth
ventilations was 16 seconds. Circulation was
interrupted for this period, resulting in no
circulatory support during nearly 60% of the resuscitation time.
The purpose of the present study was to compare outcome
results for single-rescuer standard ABC CPR, with
clinically realistic compression interruptions for
ventilation, versus CCC CPR.
BACKGROUND
Interruptions to chest compression–generated blood
flow during cardiopulmonary resuscitation (CPR) are detrimental.
Data show that such interruptions for mouth-to-mouth
ventilation require a period of "rebuilding" of
coronary perfusion pressure to obtain the level
achieved before the interruption. Whether such
hemodynamic compromise from pausing to ventilate is enough
to affect outcome is unknown.
METHODS AND RESULTS
Thirty swine (weight 35±2 kg) underwent 3 minutes of
untreated ventricular fibrillation before 12 minutes
of basic life support CPR. Animals were randomized to
receive either standard airway (A), breathing (B), and
compression (C) CPR with expired-gas ventilation in a
15:2 compression-to-ventilation ratio or continuous
chest compression CPR. Those randomized to the
standard 15:2 group had no chest compressions for a period
of 16 seconds each time the 2 ventilations were delivered.
Defibrillation was attempted at 15 minutes of cardiac
arrest. All resuscitated animals were supported in an
intensive care environment for 1 hour, then in a
maintenance facility for 24 hours. The primary end
point of neurologically normal 24-hour survival was
significantly better in the experimental group
receiving continuous chest compression CPR (12 of 15
versus 2 of 15; P<0.0001).
CONCLUSIONS
Mouth-to-mouth ventilation performed by single
layperson rescuers produces substantial interruptions in chest
compression–supported circulation. Continuous chest
compression CPR produces greater neurologically
normal 24-hour survival than standard ABC CPR when
performed in a clinically realistic fashion. Any
technique that minimizes lengthy interruptions of
chest compressions during the first 10 to 15 minutes of basic
life support should be given serious consideration in
future efforts to improve outcome results from
cardiac arrest.
(Circulation.
2002;105:645.) © 2002 American Heart Association, Inc. |
