New Life saving technique
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Jason Rees
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The thought of a defibrillator arriving 20 minutes after the fact is depressing. Alot of businesses, especially gyms, are doing the right thing and providing defibrillators on site in strategic locations. Unfortunately, alot of businesses still don't. They need to get on board.
Life begins & ends cold, naked & covered in crap.
A little over a year ago I and a couple other GIS students completed a project at the request of one of the small towns in Nebraska to use GIS to determine the best locations in the town for four or five defibrillators the town council was considering purchasing. The criteria they gave us were:
- the locations had to be public and accessible 24 hours
- every part of the town had to be within a certain time-distance of a defibrillator (in terms of how quickly someone on foot could get to the defibrillator) and I think the criteria they set was 10 minutes, which would mean up to 20 minutes for the round trip
- if possible they wanted a closer time-distance for a sports field and a retirement home.
We got it worked out pretty well with five defibrillators as I recall, including having one at the field and another at the retirement home. The council accepted our plan, although I have not heard if they followed through on it or not.
I thought in innovative that the town was wanting to take the initiative to make defibrillators available to everyone. Given that most small towns in Nebraska are experiencing an aging population as the young adults tend to move away, it only makes sense though.
- the locations had to be public and accessible 24 hours
- every part of the town had to be within a certain time-distance of a defibrillator (in terms of how quickly someone on foot could get to the defibrillator) and I think the criteria they set was 10 minutes, which would mean up to 20 minutes for the round trip
- if possible they wanted a closer time-distance for a sports field and a retirement home.
We got it worked out pretty well with five defibrillators as I recall, including having one at the field and another at the retirement home. The council accepted our plan, although I have not heard if they followed through on it or not.
I thought in innovative that the town was wanting to take the initiative to make defibrillators available to everyone. Given that most small towns in Nebraska are experiencing an aging population as the young adults tend to move away, it only makes sense though.
Glenn
Defibrillators (and circulation of oxygen) are the only things that work reliably in this situation, and I'm definitely a supporter, but one wonders what the cost per life saved will be. Maybe there's some data out there, or a projection at least? The USA is big on what I call rescue fantasies, acting with cutting edge expensive technology at the last possible moment instead of thinking on a population basis how to respond. For example, many (but not all) authorities recommend that the USA legislate away much of its very high salt diet. Predictions are that this would save thousands of lives by preventing illness:
The New England Journal of Medicine
Volume 362:590-599 February 18, 2010 Number 7
NextNext
Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease
Kirsten Bibbins-Domingo, Ph.D., M.D., Glenn M. Chertow, M.D., M.P.H., Pamela G. Coxson, Ph.D., Andrew Moran, M.D., James M. Lightwood, Ph.D., Mark J. Pletcher, M.D., M.P.H., and Lee Goldman, M.D., M.P.H.
Background The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.
Methods We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications.
Results Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
Conclusions Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.
Instead of calculating the cost of lives saved by defibrillators and hoping the one you buy will someday be used and perhaps work, we could be thinking prevention.
http://wiki.answers.com/Q/What_is_the_p ... ibrillator
Still, I'd like one around when I VF. A family friend had a cardiac arrest from VF in an airport on a rare trip out of Virginia. He was in that airport 0.03% of the year, and had he died anywhere else, he'd have stayed dead. Instead, he was shocked back to life, now has an implanted defibrillator, and is still teaching college.
The New England Journal of Medicine
Volume 362:590-599 February 18, 2010 Number 7
NextNext
Projected Effect of Dietary Salt Reductions on Future Cardiovascular Disease
Kirsten Bibbins-Domingo, Ph.D., M.D., Glenn M. Chertow, M.D., M.P.H., Pamela G. Coxson, Ph.D., Andrew Moran, M.D., James M. Lightwood, Ph.D., Mark J. Pletcher, M.D., M.P.H., and Lee Goldman, M.D., M.P.H.
Background The U.S. diet is high in salt, with the majority coming from processed foods. Reducing dietary salt is a potentially important target for the improvement of public health.
Methods We used the Coronary Heart Disease (CHD) Policy Model to quantify the benefits of potentially achievable, population-wide reductions in dietary salt of up to 3 g per day (1200 mg of sodium per day). We estimated the rates and costs of cardiovascular disease in subgroups defined by age, sex, and race; compared the effects of salt reduction with those of other interventions intended to reduce the risk of cardiovascular disease; and determined the cost-effectiveness of salt reduction as compared with the treatment of hypertension with medications.
Results Reducing dietary salt by 3 g per day is projected to reduce the annual number of new cases of CHD by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. All segments of the population would benefit, with blacks benefiting proportionately more, women benefiting particularly from stroke reduction, older adults from reductions in CHD events, and younger adults from lower mortality rates. The cardiovascular benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels. A regulatory intervention designed to achieve a reduction in salt intake of 3 g per day would save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Such an intervention would be cost-saving even if only a modest reduction of 1 g per day were achieved gradually between 2010 and 2019 and would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
Conclusions Modest reductions in dietary salt could substantially reduce cardiovascular events and medical costs and should be a public health target.
Instead of calculating the cost of lives saved by defibrillators and hoping the one you buy will someday be used and perhaps work, we could be thinking prevention.
http://wiki.answers.com/Q/What_is_the_p ... ibrillator
Still, I'd like one around when I VF. A family friend had a cardiac arrest from VF in an airport on a rare trip out of Virginia. He was in that airport 0.03% of the year, and had he died anywhere else, he'd have stayed dead. Instead, he was shocked back to life, now has an implanted defibrillator, and is still teaching college.
--Ian
I think both approaches are needed, prevention and correction. Not all defib use is related to poor diet after all. The practicality of the situation however is that it is easier to make defibrillators available then it is to get people to change their diets. Companies/governments put out a defibrillator and it is there to use, and they can readily point to it as an accomplishment. They educate about diet changes and it may or may not be followed, with verification of accomplishments being dicey at best.IJ wrote: Instead of calculating the cost of lives saved by defibrillators and hoping the one you buy will someday be used and perhaps work, we could be thinking prevention.
Glenn
I'm not thinking of companies asking employees to change their diet, which agreed, that ain't gonna do much. BUT some companies have had success giving financial incentives to those who quit smoking, exercise, lose weight, etc. My company (UC San Diego) gives me a financial incentive to take a health survey and recommends that I... change nothing. But I'll gladly take the 100 bucks. Others probably receive needed advice.
I was actually suggesting that we legislate health. Not by making salt illegal, not by burdensome taxes, but by providing favored tax status to companies that reduce the salt burden in their foods, by providing some level of taxation to overly salted foods, and by improving warnings on salty foods (that mention the increased cost). [rant on] Here in America we worry a lot about our constitutional right to obliviously eat food that is dangerous and indistinguishable in price and quality from healthier foods, because that is of course a valid and considered "choice" and "freedom" that we cherish, so we can thumb our noses at common sense and health and then receive expensive medical therapy as an entitlement later on. Meanwhile, in Europe, it has been possible for the government to simply outlaw transfats with no consequences to consumers, who are healthier and not yet walking around in shackles by a police state.
To me, this is just a parallel to water safety. Did anyone throw a rights tantrum when the government required that our public water supply be reasonable free of poop and toxins? [rant off]
That was directed at no one in particular, I just wish we had out act together as a society on such issues. Anyway, yeah, defibrillators are still cool. Having shocked a few lethal rhythms to survivable ones, it's satisfying. On the other hand many of those people died anyway, but what can ya do (prevent!).
I was actually suggesting that we legislate health. Not by making salt illegal, not by burdensome taxes, but by providing favored tax status to companies that reduce the salt burden in their foods, by providing some level of taxation to overly salted foods, and by improving warnings on salty foods (that mention the increased cost). [rant on] Here in America we worry a lot about our constitutional right to obliviously eat food that is dangerous and indistinguishable in price and quality from healthier foods, because that is of course a valid and considered "choice" and "freedom" that we cherish, so we can thumb our noses at common sense and health and then receive expensive medical therapy as an entitlement later on. Meanwhile, in Europe, it has been possible for the government to simply outlaw transfats with no consequences to consumers, who are healthier and not yet walking around in shackles by a police state.
To me, this is just a parallel to water safety. Did anyone throw a rights tantrum when the government required that our public water supply be reasonable free of poop and toxins? [rant off]
That was directed at no one in particular, I just wish we had out act together as a society on such issues. Anyway, yeah, defibrillators are still cool. Having shocked a few lethal rhythms to survivable ones, it's satisfying. On the other hand many of those people died anyway, but what can ya do (prevent!).
--Ian
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Bill Glasheen
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- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
And yet you argue more... and help make my point.IJ wrote:
I'm calling bullschit on your calling bullschit on me calling bullschit on you. To recap, a novel recommendation was discussed, and you said
Look, I provided YOU with the references, did I not???? To wit...
Ian quoting reference wrote:
cardiac-only resuscitation by bystanders is the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest, especially those with apnoea, shockable rhythm, or short periods of untreated arrest.
- What part of "witnessed out-of-hospital cardiac arrest" do you not understand?
- What part of "bystander" do you not understand?
Oh yea... I have that schit sitting right in my back pocket, Ian! So I'm to believe that airway management isn't airway management? And last I heard, pure oxygen being delivered at the entrance of an airway isn't such a bad thing. You've read about my "almost" dissertation topic, didn't you? (High frequency ventilation)Ian quoting reference wrote:
Initial airway management was limited to an oral pharyngeal device and supplemental oxygen
And still yet... Where are the data on the time in-between initial CPR intervention and the arrival of rescue personnel and/or a defibrillator? The first-principles argument FOR compression-only CPR after WITNESSED CARDIAC ARREST is that there's still some residual oxygen in the blood, and chances are rescue personnel are just around the corner.
Bullschit back at you, bro!
If I'm the one on the ground and the bystander isn't capable of thinking, I'd rather they just leave me alone. Go away and let Jason take care of me.
- Bill
Bill, you first said you couldn't figure out this new "trend" and wondered if it were all about cooties. Then you said that if there was a real world implementation gap under stress (gas pedal analogy, anyone?) those trying were spazzes, and the only specific you gave was agreement with JR which was that this model helps "compromised" respondants do the "bare minimum." You'd give the breaths if it were you, ie, ignore the recommendations.
Forgive me if that sounded like a blanket dismissal to me, because you didn't go into specifics about type of arrest or respondant. The closest we came to that was a quoted piece about "witnessed cardiac arrest with a shockable rhythm on arrival of the paramedic/firefighters." That was in a preceeding post, not one you specifically noted. Your comments were general, and did NOT endorse cardiocerebral resuscitation (CCR) under any circumstances. You only expressed doubt, and an intent to ignore. This is why I somehow got the impression all that data about the superiority of CCR would matter to you. You MIGHT have said, "I agree that CCR is better for witnessed arrest with untrained (and by that we mean, trained in this new CCR but not healthcare provider) providers, but not in unwitnessed arrest," but you didn't. You also MIGHT have said, "It appears it also worked when TRAINED healthcare professionals did it in the Kellum study" but didn't--and the only reference to witnessed arrest in the abstract refers to intubation timing, with both witnessed and unwitnessed arrest patients initially treated WITHOUT breaths.
In any case, the Garza study I cited refers to "all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests 36 months before and 12 months after the protocol change" without reference to wtinessed and unwitnessed arrest. And the pig study exposed animals to increasing increments of untreated arrest, up to 6 minutes, and found a benefit. Do you think, perhaps, that someone is going to survive untreated arrest more than 6 minutes, and in this subset of patients, of which one in a billion is going to have a good outcome, that rescue breathing assisted CPR is going to perhaps double their odds? Then puff away. If someone had any respiratory arrest long enough to have cardiac arrest and none of it was witnessed, they are in bigtime trouble no matter what you do.
I'm still not sure what your problem is; maybe don't repeat yourself, but be clear. The guidelines in question, per you and per Jason, don't change things for healthcare providers but change things for those trained to respond to arrests (CCR vs traditional CPR). This is because CCR shows better response rates for people with any meaningful chance of recovery (the only people really worth attempting either on). So with what is your quarrel? Why does that trend mystify you? I am mystified that you are mystified by adoption of a treatment that appears to work. If you would like to keep criticizing it, you could clarify if there are ANY situations
Here's something else worth considering: people will do better with a machine analyzing their rhythm and shocking them if needed than with humans analyzing their rhythm because of stress responses and overthinking. Yet you would prefer a bystander who is "incapable of thinking" (do you mean, stupidly following guidelines?) do nothing, in the hopes that perhaps there's a healthcare provider about to appear? What does that even mean? You think JR's gonna let a bystander work on you if he's there? You think you'd be better without the movement of blood and air provided by CCR? Again.... mystified. CCR works better in situations where survival is plausible, and for others, survival is implausible. Why so harsh on it?
Forgive me if that sounded like a blanket dismissal to me, because you didn't go into specifics about type of arrest or respondant. The closest we came to that was a quoted piece about "witnessed cardiac arrest with a shockable rhythm on arrival of the paramedic/firefighters." That was in a preceeding post, not one you specifically noted. Your comments were general, and did NOT endorse cardiocerebral resuscitation (CCR) under any circumstances. You only expressed doubt, and an intent to ignore. This is why I somehow got the impression all that data about the superiority of CCR would matter to you. You MIGHT have said, "I agree that CCR is better for witnessed arrest with untrained (and by that we mean, trained in this new CCR but not healthcare provider) providers, but not in unwitnessed arrest," but you didn't. You also MIGHT have said, "It appears it also worked when TRAINED healthcare professionals did it in the Kellum study" but didn't--and the only reference to witnessed arrest in the abstract refers to intubation timing, with both witnessed and unwitnessed arrest patients initially treated WITHOUT breaths.
In any case, the Garza study I cited refers to "all adult primary ventricular fibrillation and pulseless ventricular tachycardia cardiac arrests 36 months before and 12 months after the protocol change" without reference to wtinessed and unwitnessed arrest. And the pig study exposed animals to increasing increments of untreated arrest, up to 6 minutes, and found a benefit. Do you think, perhaps, that someone is going to survive untreated arrest more than 6 minutes, and in this subset of patients, of which one in a billion is going to have a good outcome, that rescue breathing assisted CPR is going to perhaps double their odds? Then puff away. If someone had any respiratory arrest long enough to have cardiac arrest and none of it was witnessed, they are in bigtime trouble no matter what you do.
I'm still not sure what your problem is; maybe don't repeat yourself, but be clear. The guidelines in question, per you and per Jason, don't change things for healthcare providers but change things for those trained to respond to arrests (CCR vs traditional CPR). This is because CCR shows better response rates for people with any meaningful chance of recovery (the only people really worth attempting either on). So with what is your quarrel? Why does that trend mystify you? I am mystified that you are mystified by adoption of a treatment that appears to work. If you would like to keep criticizing it, you could clarify if there are ANY situations
Here's something else worth considering: people will do better with a machine analyzing their rhythm and shocking them if needed than with humans analyzing their rhythm because of stress responses and overthinking. Yet you would prefer a bystander who is "incapable of thinking" (do you mean, stupidly following guidelines?) do nothing, in the hopes that perhaps there's a healthcare provider about to appear? What does that even mean? You think JR's gonna let a bystander work on you if he's there? You think you'd be better without the movement of blood and air provided by CCR? Again.... mystified. CCR works better in situations where survival is plausible, and for others, survival is implausible. Why so harsh on it?
--Ian
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
Ian
I grew up on the coast (Tidewater/Hampton Roads). Drownings are common there. And people could be "drowned" for extended periods of time before intervention, and survive. (Think preservation via cold.) With drownings, airway management is essential. CCR just doesn't apply - period.
I've lived through several generations of CPR and CCR, and have been at the scientific meetings where the myriad techniques were argued. I've also seen several generations of breath resuscitation.
Now throw in the fact that defibrillators are getting to be common. We have one about 20 feet from where I teach karate.
I've also seen the animal research, and have done literally hundreds of defibrillations in the dog lab.
Let's just say that a healthy skepticism is a good thing. And I've been more than clear about the narrow niche in which CCR appears to be "superior" to CPR. It's not complicated.
- Bill
I grew up on the coast (Tidewater/Hampton Roads). Drownings are common there. And people could be "drowned" for extended periods of time before intervention, and survive. (Think preservation via cold.) With drownings, airway management is essential. CCR just doesn't apply - period.
I've lived through several generations of CPR and CCR, and have been at the scientific meetings where the myriad techniques were argued. I've also seen several generations of breath resuscitation.
Now throw in the fact that defibrillators are getting to be common. We have one about 20 feet from where I teach karate.
I've also seen the animal research, and have done literally hundreds of defibrillations in the dog lab.
Let's just say that a healthy skepticism is a good thing. And I've been more than clear about the narrow niche in which CCR appears to be "superior" to CPR. It's not complicated.
- Bill
It's getting more clear.
Yes, drownings are different. Very different. Cannot mistake the different scenarios here; we haven't gone into drownings.
Yes, defibs are becoming more common. The guideline authors are aware, I'm sure. They're still, unfortunately, generally NOT present, and I'm actually not aware of any reason why their presence would chance my feelings on reviving an arrest victim. The closer a defib is, the more likely the patient is to receive a shock while the rhythm is still shockable, and while the myocardium can still respond. If one moves a defib closer and closer to a potential patient, CCR becomes progressively more important. In the extreme case that a patient dies in front of a defib unit, say, in the cardiac care unit, then the optimal therapy would be chest compressions only and only for the amount of time it took to apply the device and shock. If there was only one provider, if the device were immediately available, then NOTHING except prompt defib would probably be ideal. We did have an ICU patient who coded and who was wide awake by the time we arrived in mere seconds, to find the RN standing there appropriately pleased with herself and still holding onto the two paddles she had instantly revived the guy with.
I'm all for healthy skepticism, but at this point with the citations given I think it's hardly fair to say that CCR "appears" to be superior to CPR in a niche. It IS superior in several studies which include real world settings and that NICHE consists of almost all the patients who have a reasonable chance of survival: witnessed arrests / shockables. Seems harsh to say only negative things about this valuable therapy.
Yes, drownings are different. Very different. Cannot mistake the different scenarios here; we haven't gone into drownings.
Yes, defibs are becoming more common. The guideline authors are aware, I'm sure. They're still, unfortunately, generally NOT present, and I'm actually not aware of any reason why their presence would chance my feelings on reviving an arrest victim. The closer a defib is, the more likely the patient is to receive a shock while the rhythm is still shockable, and while the myocardium can still respond. If one moves a defib closer and closer to a potential patient, CCR becomes progressively more important. In the extreme case that a patient dies in front of a defib unit, say, in the cardiac care unit, then the optimal therapy would be chest compressions only and only for the amount of time it took to apply the device and shock. If there was only one provider, if the device were immediately available, then NOTHING except prompt defib would probably be ideal. We did have an ICU patient who coded and who was wide awake by the time we arrived in mere seconds, to find the RN standing there appropriately pleased with herself and still holding onto the two paddles she had instantly revived the guy with.
I'm all for healthy skepticism, but at this point with the citations given I think it's hardly fair to say that CCR "appears" to be superior to CPR in a niche. It IS superior in several studies which include real world settings and that NICHE consists of almost all the patients who have a reasonable chance of survival: witnessed arrests / shockables. Seems harsh to say only negative things about this valuable therapy.
--Ian
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
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Jason Rees
- Site Admin
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- Location: USA
Update
Conventional Cardiopulmonary Resuscitation Is Better Than Compression-Only CPR for Children with Noncardiac Causes of Arrest
Among patients aged 1–17 years with primary cardiac arrest, conventional CPR and compression-only CPR similarly improved outcomes over no bystander CPR, but for children with noncardiac causes of arrest, conventional CPR was better.
Compression-only cardiopulmonary resuscitation (CPR) has been shown to be as effective as conventional CPR for adults, in whom most arrests are of primary cardiac origin (JW Emerg Med Mar 30 2007), but is compression-only CPR useful for children, who are much more likely to arrest from respiratory causes? Researchers in Japan analyzed data from a nationwide, prospective observational database for 5170 children (age, ≤17 years) with out-of-hospital cardiac arrest (71% noncardiac etiology, 29% cardiac etiology). Bystander CPR was provided to 47% of children; 30% received conventional CPR, and 17% received chest compressions only without rescue breathing.
The primary endpoint was favorable neurological outcome (defined as Glasgow-Pittsburgh cerebral performance category 1 or 2) 1 month after arrest. Multiple logistic regression analysis revealed that favorable neurological outcome was significantly more likely for children who received bystander CPR than for those who did not (4.5% vs. 1.9%), for patients aged 1–17 years than for infants younger than 1 year (4.1% vs. 1.7%), for those with ventricular fibrillation as the initial rhythm than for those with other rhythms (20.6% vs. 2.3%), and for those with witnessed arrest (by family or others) than for those with unwitnessed arrest (6.7% and 10.3%, respectively, vs. 1.3%). In children aged 1–17 years, rates of favorable neurological outcome were significantly higher with conventional CPR than with compression-only CPR among patients with noncardiac causes of arrest (7.2% vs. 1.6%), but rates did not differ by type of CPR among patients with cardiac causes of arrest. Neurological outcomes were poor in infants (age, <1 year), regardless of type of CPR or etiology of arrest.
Comment: Bystander CPR, particularly for witnessed arrest, greatly improves meaningful survival in adults and children. Compression-only CPR is a reasonable alternative for adults and might increase the likelihood that CPR is performed. However, children's arrests are usually from noncardiac causes, and conventional CPR clearly is superior to compression-only CPR in such cases. For a bystander, determining a cardiac versus a noncardiac cause for an arrest is almost impossible, so the recommendation is clear: Conventional CPR for children up to age 17!
--Ref JournalWatch email update today
My thought: if we think someone is down from an aspiration/other lung event, we believe conventional CPR is better. For those who are thinking, it may be possible to determine how someone went down. For example, if you find a pulseless 16 year old athlete on a baseball field, commotio cordis and arrythmias ARE still more likely and you may want to emphasize compressions over ventilations. If you find a pulse 20 year old pulseless after partying at a fraternity, you may suspect an aspiration event and alcohol and prefer conventional CPR. Age isn't the primary determinant here, just a risk factor for type of arrest one has. When panicked / undertrained however, just follow the guidelines.
Among patients aged 1–17 years with primary cardiac arrest, conventional CPR and compression-only CPR similarly improved outcomes over no bystander CPR, but for children with noncardiac causes of arrest, conventional CPR was better.
Compression-only cardiopulmonary resuscitation (CPR) has been shown to be as effective as conventional CPR for adults, in whom most arrests are of primary cardiac origin (JW Emerg Med Mar 30 2007), but is compression-only CPR useful for children, who are much more likely to arrest from respiratory causes? Researchers in Japan analyzed data from a nationwide, prospective observational database for 5170 children (age, ≤17 years) with out-of-hospital cardiac arrest (71% noncardiac etiology, 29% cardiac etiology). Bystander CPR was provided to 47% of children; 30% received conventional CPR, and 17% received chest compressions only without rescue breathing.
The primary endpoint was favorable neurological outcome (defined as Glasgow-Pittsburgh cerebral performance category 1 or 2) 1 month after arrest. Multiple logistic regression analysis revealed that favorable neurological outcome was significantly more likely for children who received bystander CPR than for those who did not (4.5% vs. 1.9%), for patients aged 1–17 years than for infants younger than 1 year (4.1% vs. 1.7%), for those with ventricular fibrillation as the initial rhythm than for those with other rhythms (20.6% vs. 2.3%), and for those with witnessed arrest (by family or others) than for those with unwitnessed arrest (6.7% and 10.3%, respectively, vs. 1.3%). In children aged 1–17 years, rates of favorable neurological outcome were significantly higher with conventional CPR than with compression-only CPR among patients with noncardiac causes of arrest (7.2% vs. 1.6%), but rates did not differ by type of CPR among patients with cardiac causes of arrest. Neurological outcomes were poor in infants (age, <1 year), regardless of type of CPR or etiology of arrest.
Comment: Bystander CPR, particularly for witnessed arrest, greatly improves meaningful survival in adults and children. Compression-only CPR is a reasonable alternative for adults and might increase the likelihood that CPR is performed. However, children's arrests are usually from noncardiac causes, and conventional CPR clearly is superior to compression-only CPR in such cases. For a bystander, determining a cardiac versus a noncardiac cause for an arrest is almost impossible, so the recommendation is clear: Conventional CPR for children up to age 17!
--Ref JournalWatch email update today
My thought: if we think someone is down from an aspiration/other lung event, we believe conventional CPR is better. For those who are thinking, it may be possible to determine how someone went down. For example, if you find a pulseless 16 year old athlete on a baseball field, commotio cordis and arrythmias ARE still more likely and you may want to emphasize compressions over ventilations. If you find a pulse 20 year old pulseless after partying at a fraternity, you may suspect an aspiration event and alcohol and prefer conventional CPR. Age isn't the primary determinant here, just a risk factor for type of arrest one has. When panicked / undertrained however, just follow the guidelines.
--Ian
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Bill Glasheen
- Posts: 17299
- Joined: Thu Mar 11, 1999 6:01 am
- Location: Richmond, VA --- Louisville, KY
