Cardiac Arrest, Hypothermia and Resuscitation Science
Lecture 2: CPR the foundation of resuscitation care
Benjamin S. Abella, MD MPhil
Clinical Research Director Center for Resuscitation Science Department of Emergency Medicine University of Pennsylvania
Coursera July 2012
An introductory course for the educated lay public and health care providers
Dr. Abella: conflicts of interest disclosures
Employment: University of Pennsylvania
Research funding: National Institutes of Health Philips Healthcare Medtronic Foundation
Consulting: Velomedix, Inc. HeartSine Technologies
Volunteer: American Heart Association Sudden Cardiac Arrest Association
No equity or intellectual property related to resuscitation science
Refresher from Lecture 1: What is cardiac arrest? Without any blood flow to the lungs or brain, the victim of cardiac arrest is technically dead and appears lifeless
(For brief minutes, may have gasping or seizure activity)
The immediate actions required to restore blood flow:
Refresher from Lecture 1: Survival from cardiac arrest is highly variable Survival from cardiac arrest depends on where you live
From a large research study in 2008, showing survival to hospital discharge for victims of cardiac arrest: S u r v i v a l
t o
d i s c h a r g e
Dallas Pittsburgh Portland Seattle
4.5% 7.0% 10.6% 16.3% Nichol et al, JAMA 2008 Why is survival so variable? CPR is key to variable survival
In a given community:
Lay public factors:
How many people know CPR? How many people deliver CPR? What is the quality of the CPR?
Professional factors:
What is the time to professional CPR delivery? What is the quality of professional CPR?
What do we know about CPR training among the lay public? Many organizations offer CPR training:
American Heart Association American Red Cross local training organizations Millions trained each year, but most are health professionals Performing re-certification Imagine a map showing areas with High or low CPR training rates
No such map exists! What do we know about CPR delivery among the lay public? Approx. 26-38% of cardiac arrest victims receive layperson CPR
In one large study, striking difference between private / public location
Home/private
public
Rate of bystander CPR
0 10 20 30 40 50
26% 45% Weisfeldt et al, 2011
The quality of CPR makes a big difference in survival Study of CPR in New York City
Lay public CPR was observed by arriving EMS professionals
CPR quality was judged as high or low quality
Victims receiving high quality CPR were FOUR TIMES more likely To be resuscitated
Gallagher et al, 1995
Detailed study by Ken Nagao et al (Japan)
In Japan, some regions had emergency dispatch protocols that INCLUDED breaths, and some that OMITTED breaths
Should we provide breaths during CPR? Important to note: study of bystander CPR provided by the public, and the CPR wasnt measured.
Investigators asked: did it matter?
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
80
60
40
20
0
3 0
d a y
s u r v i v a l ,
%
Minutes from bystander CPR to defibrillator Chest compressions only standard CPR with breaths SOS-KANTO et al, 2007 Breaths during public CPR dont help, and they may hurt Better survival with only chest compressions, no matter how long it took to respond! Bystander contacted 9-1-1 survival to hospital discharge 11.5% 14.4% standard CPR (n=960) chest compression alone (n=981) The DETAILS of CPR delivery makes a big difference
CPR with chest compression alone or with rescue breathing
T Rea et al, 2010
Berg et al, 2001 B l o o d
p r e s s u r e
Time = chest compression Why pauses in chest compressions may be a bad thing Berg et al, 2001 B l o o d
p r e s s u r e
Time = chest compression Few compression pauses lead to better blood flow
