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Science behind chest compressions
This document discusses the importance of effective chest compressions during cardiopulmonary resuscitation (CPR). It notes that recent American Heart Association guidelines have emphasized minimizing interruptions to chest compressions and limiting ventilation rates during CPR. The document explains that chest compressions are critical for increasing survival, especially when collapse to shock time is greater than 15 minutes. It also discusses how excessive or interrupted ventilations can decrease blood flow and notes that observed CPR often involves too many ventilations contrary to guidelines. The key message is that effective, continuous chest compressions with few interruptions and limited ventilations are the most important aspect of CPR.
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Science behind chest compressions
- 1. The Science BehindChest Compressions Matthew Sholl, MD MPH, FACEP Maine Medical Center/MaineHealth
- 2. Curr Op CritCare 2004;10:208-212
- 4. Excellent Chest Compressions arethe Foundation of Survival!
- 5. Recent Changes inACLS? • Most recent AHA changes (2005/2010)attempted to highlight the importance of uninterrupted chest compressions and limited the positive pressure ventilation rate to 8 – 12 breaths per minute Why focus on minimally interrupted chest compressions and limiting positive pressure ventilation?
- 8. What’s The BigDeal? Do Chest Compressions Really Work?
- 13. • While inearly phases of OHCA (< 5 min), no benefit to bystander CPR existed • As time to shock increased, see increasing survival benefit of bystander CPR • No survivors seen if collapse to shock interval > 15 minutes
- 15. The Most ImportantTreatment You Offer… • … is effective chest compressions • Effective means: – Right rate (at least 100) – Right depth (2.5 inches or 5 cm) – Relax – allow for recoil – NO interruptions – Avoid excessive ventilations • Despite our best ALS capabilities, our BLS skills are what appears to be most important
- 16. Cardio-cerebral Resuscitation (CCR) • Basedon the Three Phase Model of resuscitation • Generated in AZ –the AZ Sarver Heart Center Goals: 1. Minimize interruptions of chest compression 2. Provide immediate post-shock chest compressions for prolonged VF – Why is that important? 3. Delay or eliminate endotracheal intubation 4. Minimize all positive pressure ventilation 5. Decrease the time interval to IV Epinephrine
- 17. Benbrow, B –6thAnnual Symposium on Neurologic Emergencies and Neurocritical Care , June 2009, NYC, NY
- 18. A New Horizonfor OHCA… • Two new thoughts on OHCA: 1.Primary and Secondary Injury – Primary injury – cardiac arrest – Secondary injury – brain injury • Even if we can obtain ROSC – still see large numbers of deaths • These deaths predominantly due to hypoxic brain injury – Target of therapeutic hypothermia 2.Three Phase Model for Resuscitation…
- 20. Three Phase Modelof Resuscitation
- 21. Minimizing Positive Pressure Ventilation •Old Paradigm: – ABC’s – M2M/BVM/ETT to deliver high flow O2 • New Concepts: – Positive pressure ventilation increases intrathoracic pressure – Increased intrathoracic pressure decreases venous return – Resultant decrease in coronary and cerebral blood flow • SO… AHA has recommended RR of 8 – 12 breaths/minute
- 22. The Message mayNot Have Been Received….
- 24. • Observational studyof EMS practitioners performing CPR • Measured ventilation rate • Average rate = 37 +/- 3 per minute – Range 15-49 – Recall: BLS/ACLS recommends 8-12 • Second part of the study….
- 25. Disadvantages to Ventilations DuringCPR • Delays/Interrupts chest compressions • Complicated • Stops bystanders from doing CPR • Gastric inflation – aspiration • Increases intrathoracic pressure – Reducing coronary/cerebral perfusion • Animal models show worse outocme
- 26. What Have WeLearned So Far? • OHCA happens to a lot of people!! – One of the top causes of death • There remain opportunities to save lives – Especially through engaging laypersons and both PAD programs as well as by-stander CPR • New ACLS/BLS protocols attempted to improve well preformed, continuous chest compressions with minimal interruptions • Despite these recommendations, still see many interruptions and too aggressive ventilation
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