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

[Summit]

ERDoc that was some great info!

Please post here more.

[Ridryder 911]

Will the number of compressions really matter if we are performing in-effective compressions ?

Studies Trials Abstracts

CPR often done inadequately by doctors, paramedics, studies suggest

By

Jan 18, 2005, 14:43

Courtesy the EMS House of DeFrance http://www.defrance.org

CPR is often performed inadequately by doctors, paramedics and nurses, according to two studies of resuscitation efforts during cardiac arrest.

Whether a stricken patient is in the hospital or on the way, the guidelines for administering cardiopulmonary resuscitation frequently are not followed.

Among the problems commonly cited: Rescuers did not push hard enough or frequently enough on the victim's chest to restart the heart, and breathed air into the lungs too often — either mouth-to-mouth or through breathing tubes.

Both studies used an experimental monitor that assesses CPR quality, and both received funding from Laerdal Medical Corp., a Norwegian company that developed the device with Philips Medical Systems.

The studies appear in Wednesday's Journal of the American Medical Association.

The researchers explained that skills learned in the classroom can fall by the wayside in the stress-filled chaos of a real-life emergency. Also, they noted that chest compressions strong enough to break ribs are sometimes required, and rescuers can tire quickly.

In one of the studies, involving 67 adult patients at the University of Chicago, doctors and nurses failed to follow at least one CPR guideline 80 percent of the time. Failure to follow several guidelines was common.

"Patients who had it perfectly done were in the distinct minority," said Dr. Benjamin Abella, one of the researchers.

The other study involved 176 adults with out-of-hospital cardiac arrest treated by paramedics and nurse anesthetists in Stockholm, Sweden; Akershus, Norway; and London. Chest compressions were done only half the time, and most were too shallow.

More than 600,000 people die from sudden cardiac arrest each year in North America and Europe. The heart suddenly stops beating, either because of a heart attack or other underlying heart disease.

The combination heart monitor and defibrillator used in the studies includes a small sensor that attaches to the patient's chest and evaluates depth of chest compressions and other aspects of CPR. The monitor includes an automated voice that provides on-the-spot coaching, telling rescuers when chest compressions are not strong enough or frequent enough. But that feature was not used during the studies.

Both studies were too small to determine whether using the device saved lives, but the Chicago researchers said it could improve patients' survival chances.

"Without a device that gives you feedback in the heat of the moment, you can't drive an airplane that way — and we can't take care of sick critical patients without the appropriate monitors," said the study's leader, Dr. Lance Becker, director of the university's emergency resuscitation research center.

The device is approved for experimental use in the United States, and the manufacturer is seeking Food and Drug Administration permission to sell it commercially in this country.

While other studies have found CPR techniques lacking, the JAMA studies are the first using a monitor to evaluate "what's going on during real cardiac arrests and in real people," said American Heart Association spokesman Vinay Nadkarni. "It's outstanding information."

The studies will be taken up at a medical conference next week in Dallas that could lead to an update of the CPR guidelines, Nadkarni said.

The studies add to evidence that the guidelines need to be simplified so that they "can be readily used in the real world," Drs. Gordon Ewy and Arthur Sanders, emergency medicine specialists at the University of Arizona, said in an accompanying editorial.

Be safe,

Ridryder 911

[shookwell]

glucose has to be broken down into ATP in order to be utilized as an energy source for the cell

Glucose is broken down into carbon dioxide, not ATP. The process of breaking it down into CO2 (or lactic acid in the absence of oxygen) changes AMP into ATP, and that stores the energy until it is used.

[THE_DITCH_DOCTOR]

Yes one of the product is CO2, but ATP is yielded as a product of the reaction and the most significant of them from a physiological aspect. But since you've decided to be anal about it. Here goes:

If I remember correctly (and I should seeing as I am a biology major and I have to know this for most of my classes) it's something along the lines of:

GLYCOLYSIS

Glucose ----->2 mol pyruvic acid

(I'll skip how ATP is converted into ADP during this breakdown and how glucose-6-phosphate, inorganic phosphates, NAD and NADH all play roles in this for the sake of brevity)

I

I

I

V

TRICARBOXYLIC ACID CYCLE (aka Citric acid cycle or Krebs' Cycle)

Pyruvic acid-----*acted upon by Coenzyme A-----> CO2 + NADH + Acetyl-Coenzyme A -----> the coenzyme A seperates from the acetyl group yielding a citric acid molecule---->broken down into a CO2 molecule, a 5-carbon molecule and 2 hydrogen ions which bind with NAD to form NADH which enters the electron transport system for later use in the production of ATP----->The five carbon molecule is then broken down, yielding another CO2 molecule, 2 more hydrogen ions (which bind with NAD to form NADH, and enter the electron transport system) and an ATP molecule as well as a four carbon molecule, and so on....it continues back around, yielding off a couple of other pairs of hydrogen ions before coming full circle and starting the cycle over again. Granted it's a whole lot more complicated than this (with lots of other chemical reactions going on, other intermediate chemicals and other factors, but this is more than sufficient to prove what I am saying).

So you see not all of the glucose is transformed into CO2 in this cycle so the next time you want to discuss cellular physiology look me up.

[Bart]

Similar changes are being considered in Australia by our Resuscitation Council. At first glance I was skeptical, but on examination it makes sense. Insufficient perfusion is in large part responsible for many bad outcomes from CPR. Given that a small amount of air is exchanged by the actions of the compressions I can see how the rate of full respirations could be reduced to allow for better perfusion. Yes, I would follow the new protocol with a clear conscience.

[shuttledude]

If that becomes the new standard, then there it is. We at the operator level have to trust the Forces That Be, within reason, to re-evaluate and improve protocols periodically. Is it a pain in the arse to un-memorize stuff and learn new stuff? Oh yes. But that's why we BLS folks make the big bucks, right?

Besides, what are you going to tell the prosecutor, that you thought your system would work better than the published, established procedures?

I foresee folks losing count around 30-something, though. fifty is a bit up there for the layperson. Maybe 25:1?

[Richard B the EMT]

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

What mcad64 said.

[OperaGhost]

I believe this technique is currently being tested in Tucson AZ. I was very skeptical at first, but after reading more about it, it actually makes a lot of sense, and preliminary test results are quite favorable.

[Ridryder 911]

OMG ...NO not the KREBS cycle....! Where is my old partner B.T. when I need him.... one of the few Paramedics who loved discussing Krebs cycle for hours & hours...(actually I worried about him on this and the MAO inhibitor discussions) until, I found out he just finished his endocrinology fellowship..

Be safe,

Ridryder 911

[AZCEP]

To throw a wrench in the works, one of the doctors at the AZ Heart Institute in Tuscon published a study that is in favor of 200 uninterrupted compressions in the space of two minutes before any ventilations.

This has actually proven to be useful for the patient that has been in an unwitnessed arrest for longer than 4 minutes before EMS arrival.

Our medical director is actively pushing for more of our arrest patients to receive this type of CPR, and is also pushing it in the ED.