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Use your hands as an “Artificial heart lung machine” : The greatness of hands only CPR !

Posted Aug 17 2009 10:37pm

Cardiopulmonary resuscitation (CPR)  is  the major discovery of last century  that has saved many lives over the years. In spite of  this , there has been lot of debate over the exact methodology adopted  .The much published techniques  of Basic cardaic  life support (BCLS)  which is in vogue for over 2 decades has failed to deliver the  results  as  one would have expected.

The main reason identified was ,  the protocol seemed too complex and people hesitated to do the  mouth to mouth breathing in a stranger. Many were not confident about doing  proper chest compression and  inter spaced with breathing support.( The ratios  of chest compression : ventilation 30:2 /15: 2 tend to be too cumbersome in an emergency !)

Many of the  potential  resuscitators  preferred to  become silent spectators !

The world bodies ACC/AHA/ILCOR has been watching this evolving pattern and behaviour . Mean while when we looked into the data of survivors of cardiac  resuscitation  , we  realised even an  improper  and inadequate CPR had some positive  effect on survival . How was this possible ?

There have been  innumerable instances of  individual and institutional reports   about  many lives that  have been saved  simply  by compressing the chest  after cardiac arrest or  at least  kept the person alive  and breathing to  be taken  for advanced cardiac life support.

cpr hands only ilcor lancet

This simple experience has since become strong evidence when Lancet got it published in 2007 . Subsequently the ILCOR/ACC have also adopted a new advice namely compression only CPR

Read complete ILCOR  recommendations http://circ.ahajournals.org/content/vol112/24_suppl/

Excerpts from the above article reproduced

Compression-Only CPR

The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest.In surveys healthcare providers well as lay rescuers  were reluctant to perform mouth-to-mouth ventilation for unknown victims of cardiac arrest.

In observational studies of adults with cardiac arrest treated by lay rescuers, survival rates were better with chest compressions only than with no CPR but were best with compressions and ventilation . Some animal studies  and extrapolation from clinical evidence suggest that rescue breathing is not essential during the first 5 minutes of adult CPR .

If the airway is open, occasional gasps and passive chest recoil may provide some air exchange. I n addition, a low minute ventilation may be all that is necessary to maintain a normal ventilation-perfusion ratio during CPR

Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths .

Final message

In this world of hi tech life support devices like LV  assist systems, implantable defibrillators robotic surgery  ,  it is  heartening  to note a pair of human hands can save a human life  or  at least sustain a life till the advanced emergency service reach the patient.

The fact that hands can act as a artificial heart lung machine at least  for few minutes  could be the greatest invention for the mankind by the mankind.

cpr hands only cpr lancet ilcor

* Note of caution

Under ideal conditions both chest compression  ,  proper airway , and assisted breathing is always better than simple chest compression .This blog wants to convey the point chest compression  alone could  also be  a effective CPR measure .

References

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60451-6/abstra

Newyork times  reports chest compression  only  CPR

cpr hans only newyork times

Click below to read the article .

http://www.nytimes.com/2007/03/17/health/17cpr.html


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