October 5, 2015
Hand Only CPR: A Better Way to Save Lives?
Out-of-hospital cardiac arrest affects more than 300,000 people annually in the United States. It is certainly something that could happen on the handball court. When this happens, the heart stops beating. A person usually collapses, stops breathing and is unresponsive. Since survival is so strongly dependent on immediate action by bystanders, what if we could increase survival odds through hand only CPR?
Although conventional CPR (chest compression and rescue breaths) can double the survival rates of victims having cardiac arrest, only one third of the victims have someone attempt CPR. The most common barrier to bystander action is the their concern for disease transmission as a result of mouth-to-mouth resuscitation. Another barrier is the fear of harming the victim from inadequate training. Much attention has been given to eliminating the barriers and getting more people to help begin resuscitation.
Hand only CPR (chest compressions only) has increased bystander involvement as well as survival rate. Several studies have shown that hand only CPR can be as effective as conventional CPR in the out-of-hospital setting. As a result, The American Heart Association released an advisory statement supporting hand only CPR in an attempt to increase bystander response to victims suffering from cardiac arrest. In fact, people were more likely to perform hand only CPR over conventional CPR regardless of their basic life support training. A study out of Arizona supports hand only CPR over conventional CPR. After looking at 4,415 adult cardiac arrests outside of hospitals from 2005 to 2009, researchers found that the rate of bystanders attempting CPR increased from 28% in 2005 to 40% in 2009. People were more likely to use hand only CPR.
In addition, victims were more likely to survive. Thirteen percent (113/849) of victims who received hand only CPR survived compared to eight percent (52/ 666) who received conventional CPR. In a recent study in The Lancet, three studies were combined and showed a survival rate of 14% for hands-only CPR versus 12% for conventional CPR. The authors recommended that rescuers should focus on hand only CPR with out of hospital cardiac arrest. So how do you do hand only CPR? First, if someone collapses, call 911 or have someone else call for you. Then get directly over the victim, lock your elbows and push hard in the center of the chest with both hands at a rate of approximately 100 times per minute. If you know standard CPR, then include rescue breaths. If an AED is available, switch it on and follow the instructions. Remember, any attempt at CPR is better than no attempt. According to the American Heart Association, hand-only CPR is recommended for use in adults who suddenly collapse. Conventional CPR is still recommended for “all infants and children, adults already found down or not breathing normally, and any victims of drowning or collapse due to breathing problems.”
Automatic Electronic Defibrillator (AED) Cardiac arrest usually results from an abnormal heart rate called ventricular fibrillation. It can happen to anyone at anytime. A automatic electronic defibrillator (AED), gives a victim an electronic shock that corrects the ventricular fibrillation by interrupting the irregular rhythm of the heart, reestablishing the normal electrical rhythm. An AED is a device that allows a person to monitor the heart rhythm of a victim and delivers a shock if necessary to re-establish the normal rhythm. Using AEDs with CPR quadruples the survival rate compared with using CPR alone. AEDs are easy to use. and all of them come with instructions that should be used. Place one pad on the upper right chest and one pad on the lower left side. If the electrodes are not attached properly, there is usually an error message. When the AED is attached properly, it will prompt you to analyze the rhythm. If the heart rhythm requires defibrillation, you will be prompted to do so. Be certain nobody is in contact with the victim while administering the shock. A simple way to make sure that every is safe is to say “I’m clear, you’re clear, everybody clear!” There are some special considerations with AEDs. If the victim is hypothermic, it may take longer to assess for a pulse (up to 45 seconds). If patients have pacemakers or implantable devices, do not place the AED pads over the device. Some patients use nitroglycerin patches and these should be removed prior to applying the AED pads.