CPR May Kill?!

Nurses Safety

Published

Sorry couldn't figure out how to include the link to this, but found it while surfing yahoo. Something to think about anyway.

Well-Meaning Paramedics May Kill with CPR -Study

Mon Apr 5, 5:54 PM ET

WASHINGTON (Reuters) - Well-meaning paramedics may be losing heart patients by trying to resuscitate them too vigorously, researchers reported on Monday.

They found that some ambulance crews giving cardiopulmonary resuscitation, or CPR, were giving more than the American Heart Association (news - web sites)'s recommendation of 12 to 15 breaths per minute.

This may well mean they are doing little good, the researchers report in Tuesday's issue of the journal Circulation.

"The overall survival rate in the United States from cardiac arrest is about 5 percent," said Dr. Tom Aufderheide, a professor of emergency medicine at the Medical College of Wisconsin in Milwaukee, who led the study.

"Excessive ventilation may be contributing to that poor outcome."

His team studied 13 cardiac arrest victims. For the first seven patients, the average maximum ventilation rate was 37 breaths a minute -- much, much more than recommended.

Even after retraining, the paramedics still gave 22 breaths a minute to the next six patients.

One solution might be to use a system that flashes a light every five seconds to let a rescuer know when to deliver another breath of oxygen, Aufderheide said.

During CPR, the chest is compressed, raising pressure and forcing blood out of the heart and into the rest of the body. When the pressure is released the chest expands, which creates a slight vacuum inside.

The body needs this vacuum for blood in the veins to return to the heart most efficiently, said the American Heart Association, which publishes Circulation. Without it, not as much blood returns to the heart.

"The decreased return of blood to the heart reduces the blood going out of the heart, and that may decrease the effectiveness of CPR," Aufderheide said.

"Medical directors of all systems -- all professional rescuers, including EMTs (emergency medical technicians), nurses, doctors, respiratory therapists and anyone else who would do CPR as part of their profession -- need to get this message: Do not hyperventilate," he said.

Thought ya'all might find this interesting.

Pam :)

Specializes in Obstetrics, M/S, Psych.
12 to 15 breaths per minute,eh?

The article didnt mention the results c/ 22b/min

Correct me if I am wrong, normal breathing pattern is approx. 18-22, right?

Why would one administer less than that during a code?

Inquiring minds would like to know...........

12-20 respirations per minute is the normal respiratory rate, but you will find slight variations of the lower end.....20 is maximum normal rate, though.

Specializes in Obstetrics, M/S, Psych.
12 to 15 breaths per minute,eh?

The article didnt mention the results c/ 22b/min

Correct me if I am wrong, normal breathing pattern is approx. 18-22, right?

Why would one administer less than that during a code?

Inquiring minds would like to know...........

12-20 is normal, though you may see some variations, like 14-20. Still 20 is the high normal.

Specializes in Obstetrics, M/S, Psych.

OOPs..sorry for the double post..the page was telling me it wasn't going through!

Please don't quote me on this, but a listserver I am on had a some posts about this, and what I gained was that if you ventilate too often, the changes in intrathoracic pressure that accompany ventilation can inhibit the artificial circulation you are trying produce.

What does that have to do w/ potentially hyperventilating a Pt? Maybe I'm thick, but that article doesn't make any sense to me.

It seems to me that they are saying that an increased RR during CPR can cause less blood to return to the heart. How are those 2 related?

Is it as simple as not doing compressions and ventilations simultaneously? Is that what they're getting at?

And, yeah, what everyone else said. That's a horrible choice in title. They make it sound like death by CPR is a new sort of medical error. Hardly the case.

Just like the previous poster said, it has to do with intrathoracic pressure..."During CPR, the chest is compressed, which increases pressure inside it and forces blood out of the heart and into the rest of the body. On the upstroke, the chest expands, which creates a slight vacuum inside. The body needs this vacuum for blood in the veins to return to the heart most efficiently. Without it, not as much blood returns to the heart."

So...if you are ventialting too often, that means, there is less opportunity for blood to return to the heart on the upstroke of the compression, ventilation should also be delivered on the upstroke of compression, so I guess that is the correlation, the inflation of the lungs, I believe, also provides a little squeeze and helps blood return to the heart.

okay, so what it the correct amount of compression? In the real world......

Specializes in Emergency room, med/surg, UR/CSR.

it is still 15:2.BTW, thanks for the followup article Gwenith, it said pretty much the same thing the other article says. You know journalists though, they get more readers with an eye catching title like the original was.

I just thought the article in of itself was interesting though. Made me think a little.....although that did hurt some! :chuckle

Pam :chuckle

Did you get the number of CPR patients they studied??? 13 whole patients???? That makes it statistically impossible to draw any conclusions. They need to select 100 hospitals all over the US and then study 100 CPRs in each. After that they can get back to me with their findings and I will take them seriously.

Specializes in M/S/Tele, Home Health, Gen ICU.

May be if there are too many breat hs per minute there are not enough compressions to circulate the O2. 13 is not a large enough sample size to be statistically significant, it should be at least 30. Patients who require CPR are already in a lot of trouble and are unlikely to have a good outcome. However as professionals if we are BLS, ACLS, PALS or NRP we shouls perform the alogorithims properly, I,m thinking that adrenaline has a lot to answer to in this case.

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