CPR! quick question!

[sweetieann]

I have a question that, believe it or no, I have gotten various different answers to.

If you witness a cardiac arrest, and an AED is immediately available to you, do you begin CPR first or use the AED first? (I always thought that if the arrest was witnessed, you defib first. If it wasn't witnessed, you start CPR first).

What are your thoughts?

[shiccy]

CPR first, AED after two minutes. Rationale is if you DIDN'T witness the arrest you're not doing anything 'pulmonary' with an AED, only cardiac. With CPR you're expanding and contracting the lungs, providing some (though minimal) oxygenation. Please remember the ambu bag if you have it!

Finally, CPR can be started while the AED is being opened, the patches are being unwrapped and applied, etc. You probably can get a good 1.5minutes to 2 in the time the AED is ready and raring to go :)

[canesdukegirl, BSN, RN]

Yes, start CPR first while someone is getting the pads out to apply. Then shock if indicated.

[vampiregirl, BSN, RN]

It will be very interesting to see what the new CPR recommendations are, they are scheduled to be released later this year.

In the county that I also work as an EMT, we have a protocol that uses minimally interrupted chest compressions (MICC). Basically the science behind it indicates that 2 minutes of uninterupted compressions are done whenever it is not a witnessed arrest so that enough ATP is generated to make effective use of a shock. This same theory applies to all CPR.

If it's a witnessed arrest, we shock immediately. The thought process behind this is that there's a chance that there will be a shockable rhythm that will fizzle out if not addressed immediately.

If you google MICC, there's lots of interesting info and data. The AHA site also has lots of great info on the rationale of why certain steps are done.

[SummitRN, BSN, RN]

Officially, CPR agencies (AHA, ASHI, ARC, etc) are teaching that you should (for adults):

1. Attempt to rouse the patient with verbal and painful stimuli

2. Call for help

3. Check breathing

4. Open airway and give two breaths

5. (assuming breaths go in) Check circulation

6. Perform CPR until AED is available, do not discontinue CPR unless:

a. AED says "do not touch the patient"

b. You are the only one present

Many local agencies have different protocol:

1. Attempt to rouse the patient with verbal and painful stimuli

2. Call for help

3. Check breathing

4. Open airway and give two breaths

5. (assuming breaths go in) Check circulation

6. If the arrest was unwitnessed by a HCP, give 200 compressions (2 minutes) then:

7. Perform CPR 30:2 @100/m until AED is available, do not discontinue CPR unless:

a. AED says "do not touch the patient"

b. You are the only one present

I fully expect the new CPR protocol which is due out in about two weeks to closely reflect the above. There is a lot of good evidence that has been built up for this protocol. It keeps the MAP (as it were) high and perfuses the heart tissues rebuilding ADP->ATP and reducing ischemia making the heart less irritable and more likely to have the AED convert VF to a perfusing rhythm. (Note, this theory doesn't work as well in arrest secondary to hypoxia (choking, drowning, etc)).

To answer the specific question where the AED is arms reach from the core pt, refer to your agency's protocol. You'll either be giving 200 compressions followed by the AED, or going straight to the AED, but hopefully you'll have enough hands to do CPR until the AED is ready because you called a code, right?

SummitAP

AHA & ASHI CPR Instructor

[mcknis]

I don't know about everyone else, but I always carry my AED in my fanny pack. I am ready at a moments notice! But seriously, yes shock ASAP. CPR is still the gold, yet failing, standard. Will truly be interesting to see what the new guidelines are!