In cardiocerebral resuscitation after cardiac arrest, witnesses and emergency workers put priority on compressions
11 jan 2009 -- Cardiocerebral resuscitation (CCR) -- an alternative approach to cardiopulmonary resuscitation (CPR) for patients with cardiac arrest -- emphasizes chest compressions over mouth-to-mouth ventilation for bystanders and new protocols for emergency responders, according to an article in the Jan. 13 issue of the Journal of the American College of Cardiology.
Gordon A. Ewy, M.D., and Karl B. Kern, M.D., of the University of Arizona College of Medicine in Tucson, write that CCR has been instituted in areas in Wisconsin and Arizona since 2003, followed by dramatic survival benefits. This protocol suggests that bystanders who witness an adult with a sudden collapse and abnormal breathing do compression-only resuscitation.
Emergency responders arriving during the later, circulatory phase of ventricular fibrillation should do 200 compressions, give a defibrillator shock if needed, and repeat the compressions another 200 times before checking for pulse or rhythm, the authors note. This should be done while providing passive oxygen insufflation. Responders should delay intubation, as this interferes with compressions, the report indicates. However, the authors point out, CPR -- not CCR -- is recommended for people in respiratory arrest.
"In summary, it is critical to consider CCR in its proper context -- not as a replacement for CPR but as a bundle of specific therapies that target a specific patient population," writes Daniel P. Davis, M.D., of the University of California San Diego Department of Emergency Medicine, in an accompanying commentary. "Additional data are clearly required to better define whether this approach should be universally or selectively applied, based on the specific resources available and patient population being treated."