CPR May Kill?!

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

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 :)

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Specializes in ICU.

Isn't that part of why they are now advocating a ratio of 15 compressions to 2 breaths whether you are a single operator of two operators?

Try googling ILCOR

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Specializes in ER.

The heart pumping isn't going to do much good if there's no oxygen on board.

And....you can't kill someone who's getting CPR-they are already dead. (D'uh!)

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What is CPR used for? I thought it was for pts who stopped breathing/having a pulse. To me, you can get much worse than this. They are dead if you DON'T do CPR at all, so you give it your best shot!

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Very interesting article! I work as a tech in level 1 trauma center and I have been trained to to 80 to 100 compessions a minute. Realistically, i probably accomplish 60-70. During a code, I have been told that I am doing them to fast (60-70) and I should do them slower. Now when I work a code with someone different, I have been ask to speed up my rate. SO whats the deal?

now 75% of the arrests that have come thru the doors have been DOA with PEA"s so I guess it doesn't matter how fast or slow Im doing them,right :uhoh21: ?

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My understanding is from the time someone is pulseless and breathing, if CPR isn't started RIGHT then, EMS is going to have a tough time bringing them back by the time they get there.

Even if someone drops dead with a witness it can take 10-15 minutes or more for someone to call for help and for that help to arrive. At that point, nobody's coming back, but EMS still has to try. At least here they do. So no matter how many breaths they give, the person is dead anyway.

I agree with the others though, once you code, the worst has already happened.

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The title of this thread "CPR may kill" is a bad choice of words. You can't kill a dead person. Most poor outcomes have a lot more to do with the fact that the person has just been gone too long for CPR to help. Not to mention the fact that the person usually dropped over in first place due to a deadly condition that can't be reversed by anything.

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Specializes in Burn/Trauma ED.
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.

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.

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Specializes in Obstetrics, M/S, Psych.

I did hear about this the other day and I think we will find this is an important finding.

What they are saying is they have discovered that hyperventialation is a big problem, though they did not explain why very well. Maybe it is a respiratory alkalosis thing? (This is not my area!) It's not enough to just say "any CPR is better than nothing because they are dead anyway". They are saying it needs to be done correctly, is all. We would never say "give them all the insulin you can" with a person in a diabetic coma.

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Specializes in ICU.

Here is the full report from the AHA link that I posted above - it is interesting because it is obviously the source for the article posted by the OP but look at the difference - especially in how it is titled.

Journal Report

04/05/2004

Number of breaths given during CPR may be linked to survival

DALLAS, April 6 - Researchers have identified a factor that may improve cardiac arrest survival rates according to a first-of-its-kind study of paramedic responses reported in today's rapid access issue of Circulation: Journal of the American Heart Association.

Researchers found that some ambulance crews giving cardiopulmonary resuscitation (CPR) exceeded the American Heart Association's recommendation of 12 to 15 breaths per minute when treating cardiac arrest victims.

"The overall survival rate in the United States from cardiac arrest is about 5 percent," said lead author Tom P. Aufderheide, M.D., professor of emergency medicine at the Medical College of Wisconsin in Milwaukee. "Excessive ventilation may be contributing to that poor outcome."

The observational study included 13 cardiac arrest victims. Examining data from the first seven patients, the researchers found the average maximum ventilation rate was 37 breaths a minute, roughly 250 percent to 300 percent greater than the rate the American Heart Association recommends. After a CPR retraining program was instituted, the average ventilation rate for the next six patients dropped to 22 breaths per minute.

He suggested 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.

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.

"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, 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.

Although the small study focused on cardiac arrests in only one city, the researchers strongly believe that hyperventilation could occur nationwide.

As a result of their findings, the authors urge that all hospitals and emergency medical services assess whether hyperventilation is a problem in their units. If it is, they suggest reducing ventilation during CPR to 12 breaths a minute.

Co-authors are Gardar Sigurdsson, M.D.; Ronald G. Pirrallo, M.D., M.H.S.A.; Demetris Yannopoulos, M.D.; Scott McKnite, B.A.; Chris von Briesen, B.A., E.M.T.; Christopher W. Sparks, E.M.T.; Craig J. Conrad, R.N.; Terry A. Provo, B.A., EMT-P; and Keith G. Lurie, M.D.

NR04 - 1236 (Circ/Aufderheide)

####

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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...........

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