WOuld you follow th 50:1 CPR if it were to come into effect?

[Woody76559]

All this time I thought we released carbon DIoxide instead of carbon MONoxide. Big difference.

As far as the 50:2, you will still circulate some oxygen throughout the circulatory system even without continuous ventilations or with the current standards. Just remember this, folks: This is an ever changing field. As a result, we must adjust, adapt and overcome all that is presented. It's not gospel yet, so don't let it worry you too much. We just have to adjust and be aware.

[THE_DITCH_DOCTOR]

Just a quick note, ATP is a chemical, not a cell. It's adenosine triphosphate (in no way related to the cardiac medication adenosine by the way). It is the basic unit of energy for all cells (glucose has to be broken down into ATP in order to be utilized as an energy source for the cell) and it is very rapidly expended during cardiac arrest- this is the reason why VF will become finer and finer before finally ceasing all together- the cells become less active as they burn up their ATP reserves and therefore are unable to contract effectively.

This is the kind of issue that indicates why we need to move away from training EMS personnel and towards educating them. This debate would be much more fruitful if everyone understood the underlying physiology.

Once again, I reiterate the evolutionary theory called the Red Queen theory applies very well to EMS: "You have to run as fast as you can, just to stay where you are."

[shorthairedpunk]

my bad 50:2

[Ridryder 911]

Before we discuss new changes, look at the whole picture. I just attended a roll-out on Emergency Cardiac Care for the 2005 standards. Lot of the talk is just that......talk. Even if it is in the print. There will be some differences in treatment & procedures than in the past. Also, dissecting between the common laymen & rescuer standards.

Be safe,

Ridryder 911

[noahmedic]

Man, as a biology major reading this thread makes me laugh.

"You might as well put them on Carbon monoxide instead of O2

lol."

And I always thought we exhaled carbon dioxide. One little oxygen atom can make all the difference in the world

"If you read the full article you would also know that the reasoning is that

the cells needed to actually get the heart to start

pumping on it's own (ATP) aren't being activated until about compression

15, and then quickly die off when compressions stop."

This one might have just have been a typo, but as someone else said ATP is a chemical within the cells, not a cell itself.

I realize that a bachelor's degree in science is not required to do this job, but how much better caregivers would we all be if we knew the background science of our jobs?

[vs-eh?]

*sigh*

People need to read the study and see it in clinical practice, REAL FIELD EXPERIENCE, REAL PATIENTS HAVING A BETTER CHANCE, before shrugging it off...

I have said this before....

Toronto EMS currently does this method (actually even LESS ventilation's *gasp*) when running an arrest be it ALS or BLS...

If the arrest is UN WITNESSED by EMS/Police/Fire then CPR is initiated (barring obvious death criteria) COMPRESSIONS ONLY for 2 mins, this is then followed by 1 min of "traditional" CPR following 15:2 ratio. This is done by ALS or BLS crews as you are attaching the monitor/setting up/whatever. YOU DO NOT STOP COMPRESSIONS to even look at the rhythm. If CPR was preformed for at least 2 mins prior to your arrival and it is deemed "good" CPR by paramedics (usually by Fire/Police) then traditional ACLS can be started.

The key theme here is too keep blood flowing and do not interrupt CPR for any length of significant time if possible (i.e. > 10 secs). I don't recall if the article mentions it (been awhile) but there is an exponential increase in mortality at like 10 sec intervals if CPR is interrupted.

Witnessed arrests by EMS/Police/Fire follow traditional ACLS measures. Even if the arrest is witnessed (but not by above services) the same "upfront" CPR is started.

Won't change? I have done it on the road and seen it work as have many others. Are all the patients discharged or those who do regain pulses not living as a vegetable? I dunno, but I can say that regaining a pulse is step one to recovery. During this trial period (approx 7 months now) if anything through the grape wine, return of pulses seems to have increased significantly in prehospital cardiac arrest.

[RichmondMedik]

amazing what a few adjuncts can do to the QUALITY of cpr -- AUTOPULSE -- SMARTBAG and a medical director on the cutting edge -- if we were to believe half the posts and opinions out here there would never be any changes to any of the treatments we perform .....

I believe Richard has on the bottom of his post -- treat people the way you are suppose to in your area -- just cause it is different doesn't make it right,wrong or indifferent -- just happens to be the way it is done

EDUCATION -- find out what the latest that is being done in the area you are interested in -- who are the names doing the research ?? Pepe??Ornato???Halperin?? or go to the granddaddy of them all CASTELLI -- what has he found for the what 4th or 5th generation of families involved in his study

The last code I ran we had 2 students that couldn't believe the drugs we pushed-- how we shocked with the autopulse running -- how little we ventilated -- and it was the first one they were involved in that achieved ROSC

how are we going to know what works unless the studies are tried and info passed along ???

Paul

[Guest]

If the new recommendations fall into a Course that I have to take as an EMT-B, yes I'll follow them.. but how many people lose count on the 15:2 ratio now? 50:1 seems a little difficult to appropriately follow.

[Guest]

Rules are Rules and they are there for a reason. So for that I might not agree totally with decision's but I would follow them

[ERDoc]

Just a few abstracts from a few studies that might help to enlighten the conversation a little (I know it is a little wordy, sorry about that):

Resuscitation. 2005 Jun;65(3):325-8. Epub 2005 Jan 24.

A comparison of CPR delivery with various compression-to-ventilation ratios during two-rescuer CPR.

Hostler D, Guimond G, Callaway C.

University of Pittsburgh, Department of Emergency Medicine and the Affiliated Emergency Medicine Residency, 230 McKee Place, Suite 500, Pittsburgh, PA 15213, USA.

BACKGROUND:: The number of chest compressions required for optimal generation of coronary perfusion pressure remains unknown although studies examining compression-to-ventilation ratios higher than 15:2 (C:V) in animals have reported higher C:V to be superior for return of spontaneous circulation and neurologic outcome. We examined human performance of two-rescuer CPR using various C:V. METHODS:: Thirty six EMT-Basic students in their final week of training performed two-rescuer CPR using C:V of 15:2, 30:2, 40:2, 50:2, and 60:2 on a recording resuscitation manikin. Compression and ventilation variables were recorded by computer while the number of pauses for ventilations and the hands-off time (time not spent performing chest compressions) were abstracted by hand. Data were analyzed by ANOVA and significant differences from the standard treatment of C:V=15:2 were assessed by Tukey's HSD post hoc test. FINDINGS:: The number of compressions delivered per minute increased with increasing C:V while the hands-off time and pauses for ventilations decreased. All comparisons were significantly different from C:V=15:2 (P<0.001). The ventilation numbers decreased with increasing C:V although mean minute volume exceeded 1l for all C:V. INTERPRETATION:: A 15:2 compression-to-ventilation ratio when performed during two-rescuer CPR results in 26s of hands off time each minute while only delivering 60 compressions. Alternative C:V ratios of 30:2, 40:2, 50:2, and 60:2 all exceed the AHA recommended 80compressions/min while still delivering a minute volume in excess of 1l.

Ann Emerg Med. 2002 Dec;40(6):553-62.

Survival and neurologic outcome after cardiopulmonary resuscitation with four different chest compression-ventilation ratios.

Sanders AB, Kern KB, Berg RA, Hilwig RW, Heidenrich J, Ewy GA.

Sarver Heart Center, the Arizona Emergency Medicine Research Center, Department of Emergency Medicine, University of Arizona, Tucson, USA. art@aemrc.arizona.edu

STUDY OBJECTIVE: The optimal ratio of chest compressions to ventilations during cardiopulmonary resuscitation (CPR) is unknown. We determine 24-hour survival and neurologic outcome, comparing 4 different chest compression-ventilation CPR ratios in a porcine model of prolonged cardiac arrest and bystander CPR. METHODS: Forty swine were instrumented and subjected to 3 minutes of ventricular fibrillation followed by 12 minutes of CPR by using 1 of 4 models of chest compression-ventilation ratios as follows: (1) standard CPR with a ratio of 15:2; (2) CC-CPR, chest compressions only with no ventilations for 12 minutes; (3) 50:5-CPR, CPR with a ratio of 50:5 compressions to ventilations, as advocated by authorities in Great Britain; and (4) 100:2-CPR, 4 minutes of chest compressions only followed by CPR with a ratio of 100:2 compressions to ventilations. CPR was followed by standard advanced cardiac life support, 1 hour of critical care, and 24 hours of observation, followed by a neurologic evaluation. RESULTS: There were no statistically significant differences in 24-hour survival among the 4 groups (standard CPR, 7/10; CC-CPR, 7/10; 50:5-CPR, 8/10; 100:2-CPR, 9/10). There were significant differences in 24-hour neurologic function, as evaluated by using the swine cerebral performance category scale. The animals receiving 100:2-CPR had significantly better neurologic function at 24 hours than the standard CPR group with a 15:2 ratio (1.5 versus 2.5; P =.007). The 100:2-CPR group also had better neurologic function than the CC-CPR group, which received chest compressions with no ventilations (1.5 versus 2.3; P =.027). Coronary perfusion pressures, aortic pressures, and myocardial and kidney blood flows were not significantly different among the groups. Coronary perfusion pressure as an integrated area under the curve was significantly better in the CC-CPR group than in the standard CPR group (P =.04). Minute ventilation and PaO (2) were significantly lower in the CC-CPR group. CONCLUSION: In this experimental model of bystander CPR, the group receiving compressions only for 4 minutes followed by a compression-ventilation ratio of 100:2 achieved better neurologic outcome than the group receiving standard CPR and CC-CPR. Consideration of alternative chest compression-ventilation ratios might be appropriate.

I think I've taken up enough space for now. Hope this helps.