Talk:Cardiopulmonary resuscitation/Archive 1

From Wikipedia, the free encyclopedia

Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.
Image:CardiopulmonaryResuscitationAdult.jpg
CPR performed on an adult

Most of this page looks like it was copied directly from the external link. There are probably copyright issues. Bummer. -- Merphant

Changes July 27 look good - thanks philb

I've emailed Columbia University about this. -Smack 20:16, 10 Aug 2003 (UTC)
Outcome of the above email to Columbia not reported here. I assume that means they're okay with it. But even if we don't know that for sure, I would not favour trying to remove copyrighted parts of the text unless anyone really makes a fuss. There is too much risk of messing it up in the process. This is lives we could be talking about. --Trainspotter 00:11, 12 May 2004 (UTC)

112 will work in the UK, no need to contrast the UK with continental Europe. Several European countries have alternative numbers and these are listed at Emergency telephone number, but for this page 112 is all that's actually needed. (Personally, I'd instinctively dial 999 in Britain, but that's largely because of learning it before 112 was introduced.) --Trainspotter 23:02, 11 May 2004 (UTC)

added some comment's after look listen & feel for better understanding of CPR by new students --xl5

I've made quite a few changes to this article (although I've not actually changed as much as all the red text in the edit history would have you believe, honest!). I've changed the order of a few things slightly. I also removed a few bits which were repeated over and over throughout the article so that it reads better and in a more logical manner. I've modified the child CPR section so that it follows the same DRABC structure as the adult CPR section - they are after all the same basic procedure, and previously it was hard to relate child CPR to that for adults. ABC is certainly a widespread training mnemonic, and it is virtually impossible to forget the correct procedure if you learn it this way! DRABC is taught a lot in the UK and I think it is good to emphasise the need to check for danger and response before assuming CPR is necessary. Danger is especially important, as you are useless providing CPR if you injure yourself! I altered the bit about getting help slightly, so that you shout for help as soon as you know it is required (when the person is found to be unresponsive, i.e. you know they're not just asleep), and then call for an ambulance once you have determined whether or not the casualty is breathing. This is the method taught in the UK, and if you are on your own it is certainly wise to check the breathing before going to get help - if the casualty is breathing, they would be much safer placed in the recovery position to protect their airway before you go for an ambulance.

Anyway, I hope that I've improved this article somewhat. I also placed emphasis on the importance of CPR training - this stuff really cannot be learned off "paper" alone. I would envisage this article being used more as a reminder for those who have received some training than as a standalone "teach-yourself" guide.

Maybe one day we could have diagrams or photographs to illustrate the article?! Anyone fancy the job?

Tjwood 20:53, 4 Jun 2004 (UTC)

I thought that recent research said that it was better just to do the compressions, and do away with the breaths in between. Apparently, the rescue breaths stop the task of circulating oxygenated blood around the body, and may make bystanders more willing to perform CPR in the first place. There's an article Here. However, the article stated to skip the breaths only if you are reluctant to do them, and that the Japanese research team from which this finding comes only used the 15:2 ratio, rather than the 30:2 ratio adopted a while ago. Nonagonal Spider 04:57, 18 March 2007 (UTC)

Contents

Commerical external links

I've removed some external links added by an anonymous user (68.7.15.227). They were removed by me, then added by the user again. As far as I can tell they are links to commercial sites and as the user has contributed only those links to wikipedia, I think they are just spam. If the user wishes to add them to the page again could they please explain here their justification for doing so? Tjwood 17:48, 10 Jun 2004 (UTC)

Someone just added a link to Atlantic Life Safety, a training company. Noticed this during RC patrol, because they also added another ad-type article. CPR experts, please decide if this should stay in. Thanks. --John Nagle 03:59, 14 August 2006 (UTC)

This page is too complicated

The recent edits have helped but revisiting this page reminds me that it is overly complicated. Experts are generally moving towards simplification of guidelines to focus on the main points... to this end I may now cut a bit... perhaps we could break out into some subpages... eg:

  1. calling for help
  2. First aid airway management
  3. Expired air breathing
  4. External cardiac massage

We could include buckets of esoteric detail in these pages allowing us to keep CPR straight to the point. just a thought Erich 18:02, 13 Aug 2004 (UTC)

I agree, this page is complicated, but the detail is important. Your recent adjustments to the article have helped a bit. If what you are thinking of is a simple summary of CPR procedure, as a reminder for those who know CPR, then maybe we should have a page CPR Summary or something (the subpage idea is good except for the fact that Wikipedia discourages them). A simple flow chart would be one way to lay out a summary but I'm not sure how that would work in Wikipedia.
The trouble with simple summaries is that a layperson who has never had CPR training may read it and then think they know CPR, when of course actual training and practice is the only way to learn it properly.
I also think this article (or any summary article we create) really really needs more illustrations/photographs.
Tjwood 10:40, 21 Sep 2004 (UTC)


I thoroughly support the bunch of recent suggestions to provide a simplify version. We need to have:

  • somewhere a clear, simple summary, while still making the point that there is no real substitute for practical training
  • somewhere else the nitty-gritty detail, but not in such a way that it obscures the simple summary
  • a clear way to navigate between the two

My feeling is that the CPR Summary is a good idea, and then presumably keep the longwinded version on this page, provided that the summary page is linked very prominently from the top of this page and vice versa. I don't so much like the idea of separate pages for calling for help, airway management, etc, because it forces people to chase up a whole bunch of links, rather than have a page to print out and use as handy reference.

In the summary page, let's stick to whatever seems to be the most widespread teaching; it's okay to incorporate bits of teaching from different countries at different points of the procedure, but only if the whole thing is consistent -- a hotch-potch is more to be avoided than national bias.

Realistically, I am not going to get the time to work on this. But a big thank-you to whoever does so.

,,,Trainspotter,,, 22:34, 21 Sep 2004 (UTC)


Okay, I've had a go at creating CPR summary. See my comments at Talk:CPR summary. Tjwood 21:52, 23 Sep 2004 (UTC)

Call for help

I've tried to contribute something about calling for help since I though the section was not very complete, but I realised that the article was organised quite differently than I though. Perhaps we have different systems depending on countries... Do you systematically call for an ambulance when you have an uncounscious patient ? This is what we are trained to do here... Also, we never interrupt CPR unless asked by a physician (typically, patient dead :( ) or by the rescuer who's in charge of the defibrillation (for analysing, shoking, or stoping the CPR if the defibriallation has been successful). Sorry if I've been messy ! Rama 12:03, 29 Nov 2004 (UTC)

I recently took a Norwegian Red Cross first-aid course, and we were told not to be afraid to call the emergency number. In fact, the Norwegian Red Cross has a campaign going currently to try to get people to call ambulances earlier. So yes, it's probably a good idea to call for help when a person loses consciousness, perhaps unless you know what's wrong with him or her. Ask an expert. --Safe-Keeper 23:54, 10 June 2007 (UTC)

Formatting & things

Rama, my compliments on your work here, and the very good drawings (they sure capture the mood!) I'm not sure about the formatting. The disclaimers are unnecessary (there are two on every page), and the uppercase titles are not Wikipedia standard. Would you mind if I changed them? JFW | T@lk 13:17, 1 Dec 2004 (UTC)

Thank you very much. I did not originate the uppercase titles -- I'm actually quite agreed with you that they sort of break the standard formatting, and I'm quite in favour of some change.
Perhaps we want to reduce the "CPR for children" part ? As it is, I think it makes things rather more complicated; why not have a main "CPR for adults" section and reduce the children section to the size of infant ? I don't think the amongt of informations in "children" justifies the size and subdivisions of this part...
Sorry, but which disclaimers are you talking about ?
Speaking of disclaimers, I was thinking about introducing templatised symbols in first aid related articles for thaings like "Lethal danger for the patient", "permanent injury danger", "danger for the rescuer", "Nice thing to do", "tip" (a little bit like "First aid for dummies" would be :p). The idea would be ta make things very clear while unifiying the notations and not over-charging the pages with blinking red bold italic upper-case big disclaimers :) Anyone interested ?
Thanks again everybody for this nice page ! Rama 13:54, 1 Dec 2004 (UTC)

My rewrite

I'm partially done with a big rewrite. These are my aims:

  • Wikipedia is not supposed to address the reader. I'm changing all forms to third person.
  • There are interspersed comments about defibrillation. In the vast majority of CPR scenarios, no defib is accessible.
Forgive me, but I do not believe this is true. In the vast majority of cases, CPR is provided by EMS personnel and/or medical professionals at the hospital. While we'd certainly like to see more citizen bystanders perform CPR, the unfortunate truth is that CPR is not being performed by EMS arrival in the vast majority of cases. Hence, the abysmally low survival rate in most communities. MoodyGroove 23:12, 26 January 2007 (UTC)MoodyGroove
Do you have a source for that? DXRAW 00:20, 27 January 2007 (UTC)
Consider it anecdotal, or original research (for now). It's well known to all emergency responders (although I'm sure many communities keep statistics -- I'll see what I can find). Do you have a source for your comment that "in the vast majority of cases, no defib is accessible"? I'm assuming that you meant that "in the vast majority of cases that a bystander performs CPR in a public setting, no AED will be available"? Since most arrests happen at home? MoodyGroove 00:34, 27 January 2007 (UTC)MoodyGroove
No i dont but that is becouse its not my comment :-) DXRAW 00:37, 27 January 2007 (UTC)
Well, then! :) I'll see if I can find a source. MoodyGroove 01:15, 27 January 2007 (UTC)MoodyGroove
Apart from occasional mention, these belong in a seperate paragraph.
  • There were considerable misspellings ("uncouncious")

Please don't remove my rewrite tag. Editing is free, but I'd like to know where I left off... JFW | T@lk 21:46, 1 Dec 2004 (UTC)

Oups, sorry... I'm afraid I've been editing before this notice appeared ! ^_^;;
Speling mystakes are usualy my fault. Please forgive me.
For the defibrillations part, I'd suggest putting it after the circulation since if makes a nice "ABCD"; that said, I do agree that we'd mainly mention defibrillators as important, mention that one can find them in some public places and in police cars, and link to the appropriate article.
Perhaps we'd need to further simplify some parts, especially the "breath" part -- there is an article about Artificial_respiration should not be duplicated.
I'm adding a few more images, I think we'l be done with these (but if I'm wrong, do tell me)
Thanks again for the nice work and sorry for my clumsiness ! Rama 22:43, 1 Dec 2004 (UTC)
I'd just like to suggest that references to defibrillation remain intact. Defibrillators are increasingly available both in public places and in private homes (I've even seen them being advertised on television). - Nunh-huh 22:48, 1 Dec 2004 (UTC)
Yeah, but there's more to CPR than defibrillation. In the old version, the article started about defibs without even mentioning the ABC algorhythm, let alone the fact that defib is contraindicated in asystole and EMD. JFW | T@lk 13:57, 2 Dec 2004 (UTC)
Just keep in mind, the patients with the best prognosis experience a witnessed arrest, EMS is activated immediately, CPR is initiated immediately, EMS response times are short, the initial rhythm is ventricular fibrillation, and a shock is immediately delivered. It's arguable (but irrelevant) that the defibrillator is the most important link in the chain of survival. A chain is only as strong as its weakest link, and that should be the arc of this article. Best, MoodyGroove 23:12, 26 January 2007 (UTC)MoodyGroove
I agree entirely that the chain is only as strong as its weakest link, but that doesn't make your point. Arrests happen in bed or when you're on your own (so not witnessed, so the chain doesn't even start), or bystanders call an ambulance but don't start CPR (so there is no early CPR). Those are the weak links - once the defib is on the way, everything that is possible will be done, and the fact that the defib can't be used is the result of one or two missing/delayed links. In any case, I agree with JFW that the article should deal primarily with ABC, chest compressions/ventilations etc., with defibrillation coming later (to emphasise its position in the chain, and also in recognition of the fact that Ventricular fibrillation and Defibrillation are both well established articles, whilst the rest of CPR has to fit in here). There's also the ongoing debate which says that CPR is chest compressions/ventilations only, and that other adjuncts (such as defib, intubation, drugs etc.) should come under the heading of "resuscitation" (which is somewhat erroneously, IMHO, redirected to here) --John24601 10:58, 27 January 2007 (UTC)
Do you know what my point is, John24601? (Just caught the Jean Valjean reference). It's about context. If the subject were panning for gold, I would want to include the types of rivers or streams that offered the greatest chance of success. You might argue that it's irrelevant. That panning for gold is about the technique of picking up pebbles and sand from the bottom of a river bed, and swishing it around it a pan, in case gold is there. There are other articles that talk about gold and the types of minerals found on various river beds, you might say. But the point of panning for gold is to find gold. Not to swish water, sand, and pebbles around in a pan. CPR is an important part of the chain of survival. Outside of that context, CPR is useless (although it's certainly worth discussing the new emphasis on chest compressions and 'CPR first' prior to defibrillation with down times > 4 minutes when CPR has not been initiated by the defibrillator's arrival). As for resuscitation redirecting here, you and I are in full agreement that it's inappropriate. MoodyGroove 13:03, 27 January 2007 (UTC)MoodyGroove

Icons system proposal for all first aid-related articles

What would you people think about something like this :

  • Always put a pregnant woman in recovery position on her left side to avoid potentially lethal conpression of the inferior cava vein.
  • Do not put a conscious patient while back injuries in recovery position.
  • Image:Ktip.png The rescuer can use his knees to secure the patient's head while administrating oxygen

To be used with parcimony, of course. Just an idea... Rama 09:45, 2 Dec 2004 (UTC)

Wikipedia:Wikipedia is not a how-to manual. I really think these icons distract from the flow of the text. JFW | T@lk 13:57, 2 Dec 2004 (UTC)
Good point... perhaps for the more indicated for [1]. Rama 16:00, 2 Dec 2004 (UTC)
Did you move it there? I moved content from first aid to here, and then later to Wikibooks, i think its a good idea! JamieJones 15:42, 28 December 2005 (UTC)

NPOV

As far as I'm concerned, the recent changes to this article are not NPOV. The re-write is biased very much towards one specific teaching method of CPR which would not be considered correct by many. (In the UK, CPR teaching specifically states that a layperson should NOT check pulse [[2]]). The article used to acknowledge that teaching methods differed, but this has been removed in favour of a specific method of training. Also, you say that the process I would know as "rescue breathing" is called "insulfation", yet I can't find insulfation (or insulphation) in either Dictionary.com or the Oxford English Dictionary, and there are only 47 references to insulfation on the entire web according to Google ([[3]]), so I'm changing this to "rescue breathing". I don't have much time to alter this article right now but I will be trying to get it back to an NPOV whilst retaining as many of your edits as possible.

Please remember to sign your comments on the talk page. It's most helpful to other editors, and it helps us know when you left your comment. WP:NPOV should have very little to do with an article about resuscitation, since both the US and UK participate in ILCOR. MoodyGroove 22:25, 29 January 2007 (UTC)MoodyGroove

Juicee News Daily

This article is mirrored by Juicee News Daily with attribution, but without the GFDL notice. I have sent them the standard warning letter and am waiting for a reply. Further status is reported here. Cleduc 5 July 2005 01:54 (UTC)

Wikipedia IS NOT instructive

Should the majority of yhis article even exist? All of the stuff that is instructive really shouldn't be here. It even says so here:What Wikipedia is not - Kilo-Lima 16:39, 30 September 2005 (UTC)

Go ahead and slash away. This article should cover the principles of CPR (circulation and oxygenation), not the way it is done. JFW | T@lk 00:30, 2 October 2005 (UTC)
Sections of this article is a how-to, and should be moved to [[Wikibooks:First Aid where is belongs. I'll see what I can do. Since not the entire article is a how-to, I don't think the transwiki process is appropriate. -- Egil 15:55, 29 October 2005 (UTC)
Thanks for the feedback. I'll try moving the CPR how-to type stuff. What is a transwiki process? Let me know about any further edits. JamieJones 14:53, 26 December 2005 (UTC)

I think there a few problems with this page - firstly, there is some confusion over the terms "resuscitation" and "CPR". CPR is a part of most resuscitation attempts, but it is not resuscitation on its own. You wouldn't say that intubation was resuscitation, for exactly the same reason.

I read it over, and in the "myths" part i think it does a good job of explaining several times that cpr is a part of resuscitation; and since the r in cpr stands for resuscitation, i don't think the article is confusing.JamieJones 15:41, 28 December 2005 (UTC)

I think the stats need referencing. I've not met some of them before; and the ones I have seem to be for success of a full resuscitation attempt, not success of CPR per se. --John24601 21:52, 27 December 2005 (UTC)

good call, i'll look for some references JamieJones 15:41, 28 December 2005 (UTC)
  • New stats are good, and are much more in line with what I've seen before; although once again I think we need to be really clear on the difference between CPR and resuscitation - defibrillation, for example, is a resuscitative technique but it is not part of CPR. I know it sounds petty, but I really think that we should create them as seperate pages on wikipedia, treating them as seperate (although obviously interdependent) entities. CPR = chest compressions and ventilation. Resuscitation = CPR, defib, crash drugs, intubation, treatment of underlying causes etc etc.... --John24601 21:43, 24 January 2006 (UTC)

A search for CPR on google brings this article as the first hit containing information on the act of Cardiopulmonary resuscitation (after canadian pacific railway and a local washington directory of CPR schools). Despite the fact that wiki is not a how to depository, a panicing person may click it in search of potentially life saving information. There should be, at the VERY LEAST, a LINK at the top of the page in clear, bold view pointing to a step by step CPR how to. This is an issue that in this case transcends the petty guidlines laid out for what wikipeida is and is not. Lives may hang in the balance and a simple link to a how to will not clutter the article, or in any way cheapen the values of wiki puritans. Bigbrisco 22:08, 10 March 2007 (UTC)

  • Strongly endorse Bigbrisco's statement. Many people use Wikipedia as a first source of information, and are likely to use this article if they need to conduct CPR. Do you know where in your house is a CPR chart? Suggest we keep the article as is, with the header If you need CPR instructions click here, with a link to an acceptable website. Perhaps there could be a new category of Wikipedia articles with clear instructions, locked against editing and perhaps written in large fonts so somebody could deliver CPR away from the monitor. Kransky 09:15, 17 June 2007 (UTC)
Strongly Disagree - Wikipedia is not an instruction manual, nor does it need to link to one at the top of the page. The first action for anyone witnessing cardiac arrest is calling an ambulance. The ambulance controller will talk them through CPR - far more effective than running back to your computer screen. I can't imagine anyone looking up CPR in wikipedia as the first thing they do if someone they know collapses. Owain.davies 09:47, 17 June 2007 (UTC)
Like Owain, I must disagree in the strongest possible terms. A lot of good work has been done to rid this article of the how-to, and to put it back in at this stage would be a travesty. And adding a link (especially one so prominent) would be, as well as breaking policy, contrary to the spirit of all the work that's been put in, and would in any case just look tacky. --John24601 21:25, 17 June 2007 (UTC)

Small Edits and a Suggestion

Just cleared up the "hypothermia seems to protect..." bit; also added a reference.

I think the image should be changed; a photograph of actual people demonstrating/doing CPR would be clearer. Eilu 13:06, 13 January 2006 (UTC)

Agreed. These hand drawn pictures, while good amatuer representations, cheapen wikipedia. Photos or no images at all. Bigbrisco 22:09, 10 March 2007 (UTC)

Who keeps reverting that part about drowning

Please stop. Rescue breating is used on drownings; the Canadian Red Cross First Aid Program (which I teach) does not include the abdominal thrusts you describe. And neither do many swim programs. Please stop putting it in, whoever you are...to others, as i am new to wikipedia, how does one deal with this to avoid a "revert war"? Looks like it's this person: 69.158.140.43 JamieJones talk 18:32, 13 January 2006 (UTC)

Not guilty! In the UK, we have no specific instructions regarding resuscitation of drownings (on general first aid courses anyway - I no longer teach lifeguard courses, but I think the training is the same there - I'll check with my colleagues who do). In almost all cases of drowning, only a very small amount of water has got into the lungs (most of it ends up in the oesophagus and stomach), and so I doubt providing ventilation would have any ill effects - certainly in hospital the first thing we do is intubate and start bagging, we suction out the lungs after we've regained circulation. The drowned patient in cardiorespiritory arrest is as much in need of ventilatory and circulatory support as any other, and hence I see no justification for providing abdominal thrusts on the patient, as in doing so you are tieing yourself up and removing the possibility of providing CPR. We did used to teach abdominal thrusts and backslaps for unconcious patients who you couldn't ventilate (which I guess is where this is stemming from), but they were removed from the syllabus in favour of providing chest compressions for all such cases, thereby expelling foreign objects from the trachea/bronchi whilst simultaneously providing circulatory support, a number of years ago. --John24601 19:39, 13 January 2006 (UTC)

I agree with you that many drowning patients require ventilation and compressions - and the Red Cross did make the change to remove abdominal thrusts in favour of compressions. However, the real question is this: When do you find a patient who is not breathing, but still has a pulse? The answer is, it's unlikely, as a patient with breathing will soon loose their pulse. However, in the interim, it is possible, and, of all scenarios, the easiest and perhaps most common to imagine is a person who just recently drowned, say, they were found less than 2 minutes after their breathing stopped. Someone keeps hijacking the rescue breathing page with regard to this issue; and the same on this page, I think. Anyway, I think we agree then that most regulations (and from my experiences, definitely the red cross) does NOT have us pumping water from drowning patients...just performing rescue breathing/cpr as necessary after a primary survey. Thanks for responding John24601. JamieJones talk 21:45, 14 January 2006 (UTC)
UK lay-person first aiders no longer distinguish between cardiac and respiritory arrest in the unconcious patient (see UK Resuscitation Council 2005 guidelines), so I think it's a bit of a moot point. Are you from the US? I believe that over there they're still teaching pulse check (that's been out since 2000 over here, in favour initially of "signs of circulation" [breathing, coughing, twitching etc..], and now we teach to just start full CPR as soon as a lack of normal breathing [ie/ anything other than breathing both in and out regularly] is established. The position of healthcare professionals attempting BLS has been a bit poorly thought out, there is some inclusion of pulse-check, but AFAIK no talk of what to do in the case of that revealing a respiratory arrest. As for choking guidelines (which I would say should be applied to patients in which drowning has caused an airway occlusion), if patient concious then encourage to cough, if they can no longer cough then alternate 5 backslaps with 5 abdominal thrusts (this is, in effect, the early stage of respiritory arrest - the patient isn't actually breathing but they are concious and upright; so I guess this is basically what you're saying, although in a slightly different way), once unconcious lower to floor and begin compressions at 30:2 immediately, simultaneously calling for an ambulance (if you're on your own you can give CPR for 1 min before calling ambulance in the case of drowning only). There is no indication in the Resuscitation UK 2005 guidelines to provide any kind of specific care other than full CPR for an unconcious drowned patient. --John24601 21:38, 24 January 2006 (UTC)
American Heart Association ECC guidelines are based on ILCOR, same as everybody else. MoodyGroove 15:18, 27 January 2007 (UTC)MoodyGroove

Vandal

This ip 198.176.160.18 vandalized the CPR page. I reverted. Should I do anything else? JamieJones talk 19:17, 8 February 2006 (UTC)

Football player injury

This needs a reference otherwise it should be removed. It's unsubstantiated and awkward in the text. JamieJones talk 23:35, 1 March 2006 (UTC)

Moving the football player injury here until reference is cited.

JamieJones talk 12:39, 3 March 2006 (UTC). Quote was:

Recently a footballer died even though CPR was given to him. Improper posture of the person giving him CPR worsened his condition (he had his knee over the injured player's stomach).


Re:- Success rate

Agree with edit by JamieJones. CPR alone has a near 0% chance of success (only likely to work in cases of witnessed arrest due to hypoxia secondary to choking). The statistic removed (2-15% success for out of hospital CPR), is infact the statistic commonly quoted for the survival to hospital discharge rate of pre-hospital cardiac arrest, and therefore is a measure of the success of an entire resus attempt, from the moment the casualty is found and CPR begun to the moment they leave hospital.. in many cases the cardiac arrest is often not reversed pre-hospital, the CPR just helps to keep the body going until the person gets to hospital and receives ALS, so the "success rate" for CPR alone is almost 0, even though it does play a central part in a successful overall resuscitation. This is yet another example of why I think that CPR and resuscitation should have very seperate pages... --John24601 21:21, 2 March 2006 (UTC)

Links

People keep adding all kinds of their favourite first aid links here. Could we set something up to prevent this? JamieJones talk 04:57, 12 July 2006 (UTC)

ECC, CPR, heart massage

External Cardiac Compression, CPR, and heart massage seem to be closely related. It would be useful to have some information on the other two as well. Rl 13:40, 25 July 2006 (UTC)

They are related, to the extent where nobody agrees on exactly what the differences are. In my book ECC=the physical act of compressing the chest; heart massage = physically squeezing the heart (which to me implies that the chest has been opened up by a surgeon), and CPR = the combination of ECC and expired air ventilation (mouth to mouth). --John24601 16:03, 26 July 2006 (UTC)
That seems to make sense also in the light of what I read so far (and that I found somewhat confusing previously). Thank you! Of course that means that my creating a redirect from heart massage pointing here is misleading at best, and that the one article pointing there (2000 Italian Grand Prix) didn't really mean a heart massage, but ECC or CPR. Rl 07:40, 27 July 2006 (UTC)

Flow Chart = Good?

flow
flow

I made the flow chart when I was taking a Bronze Med class taught by the Canadian Lifesaving Society, and I am certified CPR B. If changes need to be made, please e-mail me and I'll make them, or send you the original so you can edit in OmniGraffle. Jmatt1122 03:57, 27 July 2006 (UTC)

I'm not sure about Canada, but it certainly does not reflect current practise in the UK or USA (or any other country I am aware of), integrating the adult/child/infant sequences also makes it look overly complicated to the point where I'm not sure it's useful. Bearing in mind that Wikipedia is not a how-to, I think it may be better, on the whole, to leave it out. --John24601 06:52, 27 July 2006 (UTC)
Heh, it sure drives the point home that "simplifying CPR for laypersons" should be a priority. I think the flowchart is a useful illustration, but it needs a caption addressing John's concerns. Rl 07:44, 27 July 2006 (UTC)
John, What do you feel are changes that need to be made to the chart? What is current practice in the UK or USA in comparison to procedure described in this chart? Also, seperation of Child/Adult is required, because compression/breathing ratios are different. I think that also compression depth should be included, but this may complicate it further. Please post feedback to changes that should be made, or inaccuracies in the procedure. This should be as universal as possible. Also, a caption or somthing describing that this chart should not be used as a sole purpose of training, but the person should seek a professional if they wish to learn CPR.--Jmatt1122 17:03, 27 July 2006 (UTC)
http://www.resus.org.uk/pages/blsalgo.pdf <- That is the flowchart produced by the Resuscitation Council (UK). It is identical in content to that produced by the European Resuscitation, which in turn is pretty much identical to that agreed on by the International Liason Committee on Resuscitation (ILCOR), which is the world body of experts in resuscitation. That algorithm says adult, however children and babies should be done exactly the same, with a few modifications (1/3 chest depth compression as opposed to 4-5cm in adults; 5 initial rescue breaths before compressions, 1 minute of CPR before calling an ambulance) if they can be remembered - if not, lay rescuers should use the adult sequence. Remember also that this article is on cardiopulmonary resuscitation (see discussion above of exactly what that is), not on basic life support for lay rescuers (which is what the flowchart is) - a fine line, but one that needs adressing. --John24601 18:18, 27 July 2006 (UTC)
So do you believe that this chart should be removed, or modified? And I don't understand why the Canadian Lifesaving Society hasn't changed procedure. Do you know of any other countries that follow 15:2? Also, I have been taught that children require 5:1 with a smaller depth (1-1½" as compared to the adult 1½-2"). Also, my certification is very recent. I don't understand why Canada would be different than almost everywhere else. --Jmatt1122 18:49, 27 July 2006 (UTC)
The guidelines were agreed and published in europe in November 2005. Here in the UK, most training organisations are switching over this month, although some did it as far back as January, and some are still to do it. I guess the situation is pretty much the same worlwide. Certainly, though, by the end of this year there should be nowhere which is teaching the old guielines, which contained 15:2 for adults and 5:1 for children. As for whether there should be a flow chart - my personal opinion is no, but if there is one it should be on a Basic Life Support page, and not the CPR page. --John24601 19:36, 27 July 2006 (UTC)
Does anyone use Mac OS X and OmniGraffle so that I can send them the original, and changes can be made, in accordance with new standards? Either that, or post what exactly should be changed, so I can change it, and add it to the Basic Life Support page, and delete it from here, depending on the decision reached here. --Jmatt1122 21:16, 27 July 2006 (UTC)
Yes, it needs updating, as the protocols have changed. Regardless, it is essentially how to, or at best, not encyclopedic entry about CPR. Your chart shows all the steps in an emergency. I belive it should stay removed; better still, move it to wikibooks. For more info, see What Wikipedia is not. JamieJones talk 04:42, 31 July 2006 (UTC)
Also see "Individual general-knowledge how-tos are being moved from Wikipedia to Wikibooks". JamieJones talk 04:46, 31 July 2006 (UTC)

The real survival rate of an unwitnessed, out-of-hospital sudden cardiac arrest is in a range of 6% to admission and even less to hospital

What is this sentence attempting to say?–♥ «Charles A. L.» 13:11, 5 September 2006 (UTC)

Question Moved From article

Since people take oxygen from the air when they breathe and then exhale carbon dioxide, how does blowing carbon dioxide into a person provide them with oxygen? If anyone could explain that I'd appreciate it.DXRAW 08:28, 11 October 2006 (UTC)

Yes, when you do CPR you yourself are not "holding your breath" and the O2 depletion of the air you breath out is minimal. Atmospheric air contains 20% oxygen and the air you breath out during CPR contains at least 17-18% so it is breathable air. I will refrain from giving the pig-feeding analogy in the interest of good taste.--Justanother 15:08, 20 October 2006 (UTC)

"We talk about first aid ABC."

Does anyone know what this sentence is supposed to mean? I think it needs to be rewritten but I'm not sure enough of its meaning to do it myself. Natalie 22:42, 30 October 2006 (UTC)

It's the last sentence of the first paragraph in the "Importance" section.Natalie 22:43, 30 October 2006 (UTC)
I suppose the editor wanted to spell out where CPR fits in the first-aid mnemonic of ABC. ABC article could use some help too. Happy editing. --Justanother 22:59, 30 October 2006 (UTC)

ok here is what they mean. It accually goes HUNABC

H- Hazards (fire, glass, electrict, gas,)

U- unconshish(spelling?)

N- Number (call 911)

A- Airways (open them)

B- Breathing (is the person breathing?)

C- Curclition (is the heart pumping causing blood to flow through the body and to the brain.)

hope this helps, I also added it to the article -mikeh0303

That sounds to me like something which was developed by an individual trainer in order to teach, it's certainly not something I've ever heard of before. In any case, in several places it does not reflect current practise - opinions anybody before I remove it? --John24601 08:38, 16 November 2006 (UTC)
Not only is it not current, but its not even a good mnemonic. AAAABC is much easier to remember. With the "new" CPR standards, it now stands for Area Awake Ambulance Airway Breathing Compressions (you can also add D and E depending on what level you're teaching, but as the page is CPR, we'll stick to AAAABC) Mike.lifeguard 19:56, 16 November 2006 (UTC)


Regarding the reference to DRABCD on the page, the D is given as standing for Defibrillation, while on the DRABCD page it links to, the D stands for either 'Deadly bleed' or 'Disability'. Either Defibrillation needs to be added to the DRABCD page, or the D on this page needs correcting 138.38.32.86 16:57, 5 February 2007 (UTC)

The circulation/pulse debate

Should either now be in there since the current ILCOR recomendations are to start CPR on absence of breathing? --John24601 08:53, 19 November 2006 (UTC)

I would recommend changing the intro line. It is not really about circulation/pulse IMO (i.e. that a detectable pulse may not be present but minimal circulation may); it is because many lay people cannot accurately find a pulse in cases where a trained person might. I guess the current wisdom is that if there is no breathing at least rescue breathing would be indicated so to simplify matters and reduce wasted time they recomend going straight to CPR. Not sure I agree as CPR is much more likely to injure than rescue breathing, especially in the young or elderly.
Here is the quote from the guidelines for adult victims:

Pulse Check (for Healthcare Providers) (Box 5)

Lay rescuers fail to recognize the absence of a pulse in 10% of pulseless victims (poor sensitivity for cardiac arrest) and fail to detect a pulse in 40% of victims with a pulse (poor specificity). In the ECC Guidelines 2000 the pulse check was deleted from training for lay rescuers and deemphasized in training for healthcare providers. There is no evidence, however, that checking for breathing, coughing, or movement is superior for detection of circulation. For ease of training, the lay rescuer will be taught to assume that cardiac arrest is present if the unresponsive victim is not breathing.

Healthcare providers also may take too long to check for a pulse and have difficulty determining if a pulse is present or absent. The healthcare provider should take no more than 10 seconds to check for a pulse (Class IIa). If a pulse is not definitely felt within 10 seconds, proceed with chest compressions (see below).

--Justanother 13:50, 19 November 2006 (UTC)

I added in a second paragraph to clearly make the point and may modify the first line. Pulse is still a factor, just not for lay people. --Justanother 14:03, 19 November 2006 (UTC)
How about we change it to "Cardiopulmonary resuscitation (CPR) is an emergency first aid protocol for a person in Cardiac arrest", and leave that article to explain its diagnosis? I think that more accurately reflects the situation anyway, as well as removing our difficulties! --John24601 16:22, 19 November 2006 (UTC)
I do not think so because the whole point is that the lay person does not diagnose what happened. It is a procedure that you use if you come across or are involved in a scene where someone is unconscious and has stopped breathing very recently. Better would be to simply say it is used where no breathing is detected and in the next paragraph discuss the pulse thing. --Justanother 17:18, 19 November 2006 (UTC)
CPR is the treatment for cardiac arrest, agreed? How one diagnoses or recognises or whatever cardiac arrest is surely a matter for the cardiac arrest article and not for this one, particularly as it is so complex? I'm sure that articles for other medical treatments do not say how to diagnose the condition they're used for, so why should this one? --John24601 18:20, 19 November 2006 (UTC)
I am not really arguing the point with you. You can say cardiac arrest and follow it with "performed when no breathing is detected . . . " because, unlike first aid for, say, bleeding, burns, broken bones; you just assume that may be what has happened. --Justanother 22:08, 19 November 2006 (UTC)
The point is thought that CPR is not just a first aid measure: it is also part of advanced life support, and is generally a subject which stands on its own. I would tend to disagree with what you say about assuming that a cardiac arrest has hapenned - lack of breathing is, whatever you may personally think, a diagnostic indicator or cardiac arrest every bit as much as lack of pulse is - neither will get it right all of the time. --John24601 14:10, 20 November 2006 (UTC)

Left. No prob. How is it now? --Justanother 14:57, 20 November 2006 (UTC)

looks good :) --John24601 15:53, 20 November 2006 (UTC)

Cannot be pronounced dead

The article currently states "A patient cannot be pronounced dead before he has been brought back to a normal temperature by appropriate means." So a person frozen in ice for fifty years cannot be pronounced dead? What if the patient were brought back to a normal temperature by inappropriate means? He "cannot be pronounced dead" according to the law of which country? Jimp 23:58, 22 January 2007 (UTC)

Regardless of how the patient is rewarmed, the mantra is that the patient isn't dead until the patient is "warm and dead." It's meant to remind the health care professional that hypothermia is a reversible cause of cardiopulmonary arrest, and resuscitative efforts should not be discontinued until the patient is rewarmed. I suppose it doesn't really apply to prehistoric men trapped in the polar ice cap. MoodyGroove 00:23, 23 January 2007 (UTC)MoodyGroove
It makes sense put that way. I wonder how the sentence might be reworded to convey this. Jimp 04:21, 23 January 2007 (UTC)
I don't think doctors will try to resuscitate a caveman. They are not idiots. Doubtful the subject would ever see a hospital, archaeologists would claim the body. Why are we even discussing something this ridiculous? 24.57.60.54 14:25, 14 March 2007 (UTC)

Newly certified in CPR and ready to share what I was taught

I completed a CPR class my hometown (Danville, CA) offered in the quarterly town event & activity guide. The card I now carry in my wallet states CPR and AED For Lay Rescuers in the Community and Workplace. Also, the card notes that my training is based of the 2005 Science & Guidelines and the instructor is certified to teach me the material through ASHI or American Safety & Health Institute.

Since I was looking to share what I just learned, I made an addition to section 3, which is titled CPR training. Below is the quote of what I added.

Another acceptable variation that is taught is known as ABCD which stands for Airway, Breathing, Circulation, and Defibrillation. ABCD is the more common shortform to be taught in elementary, middle, and high schools in America.

The first sentence is repeated exactly as how the instructor said it.

The second sentence is not based on something i can verify. I added it so as not to seem like I was casting the other shortforms to the junk pile. Personally the comment makes sense because ABCD would be simplier because every student in the US education system has learned the alphabet.... If removal of second sentence is the consensus.... then sobeit. Im okay with that. Sfcollegeguy 06:57, 23 January 2007 (UTC)


How often is bystander CPR initiated?

Van Hoeyweghen RJ, Bossaert LL, Mullie A, Calle P, Martens P, Buylaert WA, Delooz H. "Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group." Resuscitation. 1993 Aug;26(1):47-52. PMID: 8210731

Incorrectly performed bystander CPR might compromise survival of the cardiac arrest patient. We therefore evaluated the outcome in 3306 out-of-hospital primary cardiac arrests of which 885 received bystander CPR. bystanders performed CPR correctly in 52%, incorrectly in 11%, 31% performed only external chest compressions (ECC) and 6% only mouth-to-mouth ventilation (MMV). The initial ECG in cases without bystander CPR was ventricular fibrillation in 28% (95% confidence interval: 27-30%); 45% (41-50%) and 39% (29-48%), respectively when bystander CPR was performed correctly or incorrectly; 43% (37-49%) when only ECC was applied and 22% (11-33%) when only MMV was practiced. Long term survival, defined as being awake 14 days after CPR, was 16% (13-19%) in patients with correct bystander CPR; 10% (7-14%) and 2% (0-9%), respectively when only ECC or only MMV was performed; 7% (6-8%) when no bystander was involved; 4% (0-8%) when bystander CPR was performed incorrectly. Bystander CPR might have a beneficial effect on survival by maintaining the heart in ventricular fibrillation by ECC. A negative effect of badly performed bystander CPR was not observed compared to cases which had not received bystander CPR.

_____________________________________

Gallagher EJ, Lombardi G, Gennis P. "Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest." JAMA 1995 Dec 27;274(24):1922-5. PMID: 8568985

OBJECTIVE--To examine the independent relationship between effectiveness of bystander cardiopulmonary resuscitation (CPR) and survival following out-of-hospital cardiac arrest. DESIGN--Prospective observational cohort. SETTING--New York City. PARTICIPANTS--A total of 2071 consecutive out-of-hospital cardiac arrests meeting Utstein criteria. INTERVENTION--Trained prehospital personnel assessed the quality of bystander CPR on arrival at the scene. Satisfactory execution of CPR required performance of both adequate compressions and ventilations in conformity with current American Heart Association guidelines. MAIN OUTCOME MEASURE--Adjusted association between CPR effectiveness and survival. Survival was defined as discharge from hospital to home. RESULTS--Outcome was determined on all members of the inception cohort--none were lost to follow-up. When the association between bystander CPR and survival was adjusted for effectiveness of CPR in the parent data set (N = 2071), only effective CPR was retained in the logistic model (adjusted odds ratio [OR] = 5.7; 95% confidence interval [CI], 2.7 to 12.2; P < .001). Of the subset of 662 individuals (32%) who received bystander CPR, 305 (46%) had it performed effectively. Of these, 4.6% (14/305) survived vs 1.4% (5/357) of those with ineffective CPR (OR = 3.4; 95% CI, 1.1 to 12.1; P < .02). After adjustment for witness status, initial rhythm, interval from collapse to CPR, and interval from collapse to advanced life support, effective CPR remained independently associated with improved survival (adjusted OR = 3.9; 95% CI, 1.1 to 14.0; P < .04). CONCLUSION--The association between bystander CPR and survival in out-of-hospital cardiac arrest appears to be confounded by CPR quality. Effective CPR is independently associated with a quantitatively and statistically significant improvement in survival.

___________________________________________

Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. "Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation." Am J Emerg Med 1985 Mar;3(2):114-9. PMID: 3970766

Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.

_________________________________________________

Wik L, Steen PA, Bircher NG. "Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest." Resuscitation 1994 Dec;28(3):195-203. PMID: 7740189

To evaluate the influence of quality of bystander cardiopulmonary resuscitation (CPR) on outcome in prehospital cardiac arrest we consecutively included patients with prehospital cardiac arrest treated by paramedics in a community run ambulance system in Oslo, Norway from 1985 to 1989. Good CPR was defined as palpable carotid or femoral pulse and intermittent chest expansion with inflation attempts. Outcome measure was hospital discharge rate. One hundred and forty-nine of 334 patients (45%) received bystander CPR. The discharge rate after good BCPR (23%) was higher than after no good BCPR (1%, P < 0.0005) or after no BCPR (6%, P < 0.0005). There was no difference between no good and no BCPR (P = 0.1114). There were no differences in paramedic response interval between the groups, but the mean interval from start of unconsciousness to initiation of CPR (arrest-CPR interval) was significantly shorter in the group receiving good bystander CPR (2.5 min, 95% confidence interval (CI): 1.7-3.3 min) than no good CPR (6.6 min, CI: 5.2-8.0 min) or no bystander CPR (7.8 min, CI: 7.2-8.4 min). Bystanders started CPR more frequently in public than in the patient's home (58 vs. 34%, P < 0.0005). Good bystander CPR was associated with a shorter arrest-CPR interval and improved hospital discharge rate as compared to no good BCPR or no BCPR.

_________________________________________________

Swor RA, Jackson RE, Cynar M, Sadler E, Basse E, Boji B, Rivera-Rivera EJ, Maher A, Grubb W, Jacobson R, et al. "Bystander CPR, ventricular fibrillation, and survival in witnessed, unmonitored out-of-hospital cardiac arrest." Ann Emerg Med 1995 Jun;25(6):780-4. PMID: 7755200

STUDY OBJECTIVE: To assess whether bystander CPR (BCPR) on collapse affects initial rhythm and outcome in patients with witnessed, unmonitored out-of-hospital cardiac arrest (OHCA). DESIGN: Prospective cohort study. Student's t test, the chi 2 test, and logistic regression were used for analysis. SETTING: Suburban emergency medical service (EMS) system. PARTICIPANTS: Patients 19 years or older with witnessed OHCA of presumed cardiac origin who experienced cardiac arrest before EMS arrival between July 1989 and July 1993. RESULTS: Of 722 patients who met the entry criteria, 153 received BCPR. Patients who received BCPR were younger than those who did not: 62.5 +/- 15.4 years versus 66.8 +/- 15.1 years (P < .01). We found no differences in basic or advanced life support response intervals or in frequency of AED use. More patients initially had ventricular fibrillation (VF) in the BCPR group: 80.9% versus 61.4% (P < .01). The interval to definitive care for ventricular tachycardia (VT)/VF was longer for the BCPR group (8.59 +/- 5.3 versus 7.45 +/- 4.7 minutes; P < .05). The percentage of patients discharged alive who were initially in VT/VF was higher in the BCPR group: 18.3% versus 8.4% (P < .001). In a multivariate model, BCPR is a significant predictor for VT/VF and live discharge with adjusted ORs of 2.7 (95% CI, 1.7 to 4.4) and 2.4 (95% CI, 1.5 to 4.0), respectively. For those patients in VT/VF, BCPR predicted live discharge from hospital with an adjusted OR of 2.1 (95% CI, 1.2 to 3.6). CONCLUSION: Patients who receive BCPR are more often found in VT/VF and have an increased rate of live discharge, with controls for age and response and definitive care intervals. For VT/VF patients, BCPR is associated with an increased rate of live discharge.

____________________________________________________

Bossaert L, Van Hoeyweghen R. "Bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest. The Cerebral Resuscitation Study Group." Resuscitation 1989;17 Suppl:S55-69; discussion S199-206. PMID: 2551021

Prevalence of bystander CPR and effect on outcome has been evaluated on 3053 out-of-hospital cardiac arrest (CA) events. Bystander CPR was performed in 33% of recorded cases (n = 998) by lay people in 406 cases (family members 178, other lay people 228) and by bystanding health care workers in 592 cases (nurses 86, doctors 506). Family members and lay people mainly applied CPR in younger CA victims at public places, roadside or at the working place. Sudden infant death syndrome (SIDS) and drowning are highly represented. Health care workers performed CPR mainly in older patients, at public places or at the roadside and especially in case of cardiac or respiratory origin. CA caused by trauma/exsanguination and intoxication/metabolic origin received less bystander CPR (23% resp. 22%). Cardiac arrests receiving bystander CPR are more frequently witnessed and have a shorter access time to the emergency medical service (EMS) system and shorter response time of basic life support (BLS). Advanced life support (ALS) response time is significantly longer. In witnessed arrests of cardiac origin receiving bystander CPR a significantly better late survival was observed. In non-witnessed arrests of cardiac origin early and late survival are significantly higher in patients receiving bystander CPR. In CA events where response time of ALS exceeds 8 min, the beneficial effect of bystander CPR is most significant. Furthermore no deleterious effect of bad technique or inefficient bystander CPR can be demonstrated.

_________________________________________

Jackson RE, Swor RA. "Who gets bystander cardiopulmonary resuscitation in a witnessed arrest?" Acad Emerg Med 1997 Jun;4(6):540-4. PMID: 9189184

OBJECTIVE: To identify characteristics associated with provision of bystander CPR in witnessed out-of-hospital cardiac arrest cases. METHODS: An observational, prospective, cohort study was performed using cardiac arrest cases as identified by emergency medical services (EMS) agencies in Oakland County. MI, from July 1, 1989, to December 31, 1993. All patients who sustained a witnessed arrest prior to arrival of EMS personnel were reviewed. RESULTS: Of the 927 patients meeting entry criteria, the 229 patients receiving bystander CPR were younger: 60.9 +/- 14.7 vs 67.9 +/- 14.7 years (p < 0.01). Most (76.6%) cardiac arrests occurred in the home. In a multivariate logistic model, only the location of arrest outside the home was a significant predictor of receiving bystander CPR [odds ratio (OR) 3.8; 99% CI 2.5, 5.9]. Arrests outside the home were associated with significantly improved outcome, with 18.2% of out-of-home and 8.2% of in-home victims discharged from the hospital alive (OR 2.5; 99% CI 1.4, 4.4). CONCLUSION: Patients who have had witnessed cardiac arrests outside the home are nearly 4 times more likely to receive bystander CPR, and are twice as likely to survive. This observation emphasizes the need for CPR training of family members in the authors' locale. This phenomenon may also represent a significant confounder in studies of out-of-hospital cardiac arrest and resuscitation. —The preceding unsigned comment was added by MoodyGroove (talk • contribs) 15:13, 27 January 2007 (UTC).

_____________________________________________

The article states: "According to American Heart Association, only two thirds of victims of a witnessed cardiac arrest are administered CPR." Can someone please point out to me where the AHA says this? I'll look through my AHA books today and try to find it. Sounds shocking to me. Has not been my experience at all. MoodyGroove 15:29, 27 January 2007 (UTC)MoodyGroove

AED

This article does not mention anything about the use of an AED, which modern CPR courses teach explicitly. You cannot manually stop a heart from fibrillating; and late defibrillation severely reduces survival rate.

Whenever you perform CPR, you should use an AED immediately. Send someone to call emergency services and fetch the AED; if alone, you must schedule this. For adults you normally call emergency services immediately and grab an AED before beginning CPR; for children (under 8 years old), always perform CPR immediately for 5 compression-ventilation cycles before leaving the body to fetch an AED and a phone.

Children do not respond well to cardiac arrest at all; if it takes you 3 seconds to dial emergency services on your cell phone and put it on speaker then do it, but you really need to get started on CPR as soon as physically possible. Do not walk away for 2 minutes to call emergency services and fetch an AED.

Also of note, most people get fatigued after about 2 minutes (about 5 cycles; 30 compressions in 17-23 seconds); if you have two people trained to perform CPR, take turns.

important to note

http://www.webmd.com/heart-disease/news/20070316/CPR-mouth-to-mouth-not-much-help?print=true

CPR without mouth-to-mouth, chest compression only, might be better in some cases

FYI: ILCOR makes CPR standards for a reason. Please don't confuse people - the standard revision cycle is enough. Mike.lifeguard 13:47, 24 March 2007 (UTC)

I say include it. It's not just one study, we've known this for a long time and reference is made to it in, for example, the Resuscitation Council UK guidelines. There are known to be a number of experts involved in the latest round of ILCOR who wanted to give compression only CPR greater prominence. We're not here to tell people how to resuscitate someone, we're here to educate them on the subject of resuscitation: the concern of potentially confusing someone by highlighting research which could be said to contradict official guidelines should not be a consideration here. --John24601 11:47, 26 March 2007 (UTC)
The article should present what CPR *is*. There are specific standards which do not include compression-only CPR, namely those from ILCOR. The average reader doesn't want to sift through the research to decide anything about CPR (and shouldn't). We have experts for a reason, and if they change the standards to include compression-only CPR, then the article would have to be changed. Until then, there's no need for the behind-the-scenes discussion, or research which the experts decided wasn't enough to advocate compression-only CPR. We should really be deferring to their judgment, and our article should reflect their decision as to what constitutes CPR. As I say, it doesn't currently include compression-only CPR, and when/if it does, the article would be changed. Mike.lifeguard 13:23, 26 March 2007 (UTC)
You're quite right that material included should be notable, and not merely some backstreet research project somebody dreamed up. However, making the final recommendation of ILCOR is not the only test of notability. The issue of compression only CPR has been discussed at length in the resuscitation community (including the ILCOR deliberations), is the subject of a number of research studies (not just this one), has been covered widely in the media recently, and, furthermore, is infact mentioned in the Eurpoean Resuscitation Council Guidelines (which come from ILCOR, although I'm not sure if this is a regional variation, as I don't practice in North America - perhaps someone there could inform me). ILCOR is a consensus body, and in reaching a consensus certain things will be left out or given less prominence, this does not mean that they're not notable --John24601 16:25, 26 March 2007 (UTC)
Sorry I must have glossed over that they're included in the European Resuscitation Council Guidelines. That is a regional variation - they're not used in North America, and to do so would open you up to liability. For the record, I'm against including this since it wouldn't meet the standards here, which are set by the same body which sets standards for Europe (so far as I'm aware). I suppose if you had a disclaimer to that effect it would be ok. Nevertheless, I think it complicates matter unnecessarily at best, and is dangerously misleading at worst. Mike.lifeguard 01:17, 27 March 2007 (UTC)
Intrigued, I took a look. There is actually extensive mention of compression only CPR in the north american guidelines, far more than there infact is in the European ones. See [4], which was the journal article in which the 2005 guidelines were first circulated in North America. I don't think it needs to be made clear that it's not in the guidelines, nor is a disclaimer required: the purpose of this article is to educate people on resuscitation, not to teach them how to do it - there is a difference, but one worth maintaining. --John24601 08:55, 27 March 2007 (UTC)

Citation on followup

"CPR is a practical skill and needs professional instruction followed up by regular practice on a resuscitation mannequin to gain and maintain full competency." doesn't need citation. I simply hope everybody knows how important it is to continue practicing it now and then not to forget. Lives kan be lost if one forgets how to do, or feels uncertain how to do it.Mortsggah 05:02, 4 May 2007 (UTC)

Edits by Ioldanach

I have left a note for Ioldanach over his edits, as it seems to be original research, in the absence of any reference (also, parts of it don't quite make sense to my reading). If i don't get a response, I think I'll be forced to change his edit back. Can anyone else shed light on that edit?

Owain.davies 05:47, 4 May 2007 (UTC)

It is true, so I believe. The conventional theory has always been that in cardiac arrest cells become deprived of oxygen and then die. New research has shown that it is infact the re-oxygenation of cells which kills them, and so there have been some trials done regarding slow reoxygenation. However, I've only seen it reported in the media [5], I haven't seen any journal articles or solid research findings. One would presume, however, from the tone of the news article, that there are some somewhere, perhaps we should be looking for them. I think for now it's probably right that it stays out of the main article, until we can get something a bit more solid together. I think we also need to have a think about which article it's best placed in: I'd be tempted to put it in Cardiac arrest or a generic article on Resuscitation, but there again my views on CPR vs Cardiac Arrest vs Resuscitation have never had much support round here, so maybe we'll find a consensus on something quite different! --John24601 08:52, 4 May 2007 (UTC)


damage from chest compressions

I read the article and didn't find much information about the possible damage that can result from chest compressions. This seems to be important information when considering whether it's better to do chest compressions or not on an unconscious person without being sure if they have a pulse. Can anyone contribute here? Khono 04:31, 23 May 2007 (UTC)

You're right, there isn't much in here, but it might be worth adding. As a rule, effective chest compressions will cause damage to the ribs (most usually becoming detached from the sternum), and some trainers will tell you that you are not doing effective enough CPR unless you break some ribs. I think that as a rule the overriding requirement to save life is more important than possible damage. In terms of the unconscious patient, i think it is now generally accepted (although i'll have to look up the source) that CPR does not cause damage in healthy people (and in fact i know that some lifeguards in Australia have done 'live' CPR on each other for training purposes (again need a proper source)).
If it went to court, i imagine that the injured party would have to prove that it was unreasonable to start CPR (because they were talking, for instance), but i imagine only professionals would face prosecution for starting inappropriate CPR.
Apart from all that, generally you just 'know', that the person is arrested. Most people spot it straight off, and if they're not dead, they'll probably let you know pretty quickly! Owain.davies 05:31, 23 May 2007 (UTC)
I don't have any stats, but personal experience suggests that rib fractures are an almost universal feature of any resus attempt lasting more than a couple of cycles. These fractures are generally not complicated though - they're cracks, rather than anything which could punch through the lungs or heart and make a mess. There is some research to suggest a damaging effect of compressions on the heart, too, which is why people likely to require a resuscitative thoracotomy generally shouldn't receive compressions whilst waiting for it. Finally, if someone's heart is beating, if you do compressions, then theoretically if you compress at an exact moment in the cardiac cycle (I think it's the beginning of the T wave on the ECG), you send the heart into VF (this has a fancy name which I forget, athletes sometimes get it if they're hit in the chest by a ball too). There are probably other risks I haven't thought of. Will try to find you some stats for all of these things so we can include them. --John24601 09:07, 23 May 2007 (UTC)
You might find the publication of the standards a useful resource for this type of information. Nevertheless, the experts have decided that the ILCOR/AHA 2005 standards pass a cost-benefit test, which is why we use them. If I remember correctly, the risk of causing VF in the way you describe is so astronomically low as to be effectively 0. Mike.lifeguard 16:36, 24 May 2007 (UTC)
Thanks so much, guys! Just reading these discussion posts makes me feel much more comfortable with the idea of doing chest compressions when I'm not certain they're needed. Khono 01:10, 25 May 2007 (UTC)

Filter?

When attempting to edit the page, I get this message from Wikipedia (translated from Norwegian):

The page you attempted to edit was blocked by the spam filter. This is most likely caused by a link to an external site.

The following text is what activated the spam filter: [Link to defibrillatorhub dot com]

I was attempting to add this to the top of the article: IMPORTANT: Neither this article, nor the WikiBooks how-to, is a substitute for proper training from a certified instructor. Since Wikipedia can be edited by anyone, there may be errors. CPR is never guaranteed to save someone's life - in fact, success rates of CPR alone range from 0-5%. When practicing CPR, be sure not to compress anyone's chest, as you may severely injure them. --Safe-Keeper 23:51, 10 June 2007 (UTC)

I'm not sure I quite understand what's happening. But in any case, we don't need a disclaimer. --John24601 06:24, 11 June 2007 (UTC)

Merge Cardiocerebral Resuscitation in to article

I propose merging Cardiocerebral Resuscitation into cardiopulmonary resuscitation as it is simply a variation in protocol from standard CPR. I think that the merge should take place because:

  • Both the cardiac and pulmonary systems are still engaged during 'CCR', but the tidal volume in the lungs is generated by the movement of the chest (or 'gasping').
  • The definitive paper on this (Ewy, 2004) specifically refers to the technique as "the new cardiopulmonary resuscitation"
  • It was already mentioned in the CPR article, but i shall make it a bit clearer to make it easier for anyone looking for it, after which i feel we will have no need of the article.
  • If the technique does gain widespread acceptance, it does seem unlikely that the naming protocol will change, and i think most people will continue to call it CPR

Anyone have an opinion on this? Owain.davies 08:17, 16 June 2007 (UTC)

I think they should remain separate. Cardiocerebral resuscitation is non-standard, and shouldn't be intermingled with ILCOR/AHA protocols - that would be inordinately confusing. The point is that the technique hasn't gained widespread acceptance; it should be kept clearly separate from the current standards as presented in the CPR article. Also the Cardiocerebral Resuscitation itself is sadly lacking. Mike.lifeguard 22:58, 23 June 2007 (UTC)
Given what you've just said, I think it's entirely appropriate to merge CCR into here, with a redirect from there. Once again, wikipedia is not here to provide instruction or to present the "official" view, we are here to write about the subject of resuscitation, and CCR is a big part of that. The fact that the existing CCR is so small surely indicates that it (at least at the moment) does not deserve its own page, and would be better off here.--John24601 14:59, 24 June 2007 (UTC)


Taking in to account general opinion, articles now merged. I think this makes the main article a better, more rounded reference source! Owain.davies 05:41, 6 July 2007 (UTC)

Edits by Monobeg

Introduction has been changed to be more general. Specifically, the emphasis on first aid has been removed. CPR is primarily a medical procedure that was practiced in hospitals before it was modified as a first aid procedure. I've added a "first aid" heading for the discussion of CPR in first aid. Most of the original content is still in the article, just moved.

"Rescue breathing" and "Mouth to mouth" are both layperson's terms (and only used in some regions) and have been replaced with "artificial respiration", the more general and international term.

"Training" was a bit of a mess (a lot of redundancy and unreferenced facts), but I tried to fix it up a bit. I also moved it under "First aid" as this section mainly refers to layperson training, not professional training. It still needs work. Some statistics would be nice too.

"Cardiocerebral resuscitation" and "self CPR" have both been moved to "controversy". Also, the content of "Cough CPR" has been altered to better reflect the current evidence and expert consensus. Of course, the section should continue to site the opinion of dissenters as this is an important controversy.Monobeg 04:33, 26 June 2007 (UTC)

Reverted edits by 146.235.130.52

I've just removed an edit by this user, which consisted of "However, before CPR is performed you must check for a pulse. If a person has stopped breathing but still maintains a steady heart rythmn rescue breaths may be all that is needed. Chest compressions in such a case could interfere with normal cardiac rythmn.". 1) Pulse check has been shown to have tremendously poor sensitivity and specificity for cardiac arrest, when performed by almost anybody, and internationally agreed guidelines (at least in the western world - Asia have I believe taken a different view) have therefore removed or de-emphasised it 2) There is no evidence of the harm of chest compression in respiratory arrest, and infact some experts have suggested it may be helpful. Whilst there is a theoretical risk of inducing a lethal arrythmia in a patient in solo respiratory arrest, there are to my knowledge no documented cases of this actually happening 3) Wikipedia is not a how-to. The article does, however, contain some information on pulse-checking and why it is no longer the preferred diagnostic criterion, and this user, if they are interested, is absolutely welcome to add to that information. I think this would be a particularly good idea if they have any experience with CPR protocols developed by bodies other than ILCOR, as they may be able to offer some explanation for differences between the approaches: this is an area which is not adressed at all in the article. --John24601 22:09, 4 July 2007 (UTC)

Agree! Owain.davies 05:52, 5 July 2007 (UTC)

Instruction Call 911

Many people use Wikipedia as a first source of information, and are likely to use this article if they need to conduct CPR.

The first action for anyone witnessing cardiac arrest is calling an ambulance.

It was decided above not to include a link to a CPR instruction manual at the top of this article. However, it is possible that in the stress of the moment someone will come to this page and forget that calling 911 is the appropriate action. As such, it seems reasonable to add an instruction to call 911 if the reader is in an emergency situation. Something like, "If you are in an emergency situation, dial 911 immediately. This article is not intended to provide instruction." Can somebody do this? 142.151.169.167 16:39, 29 July 2007 (UTC)

Consensus to Archive CPR Talk

I didn't think I should go ahead and archive a talk page without discussing it first. Just thought that this talk page was getting rather long and archiving would be beneficial. See How to Archive -- MacAddct1984 18:30, 17 August 2007 (UTC)

good idea, go ahead. Owain.davies 21:03, 17 August 2007 (UTC)
Archive This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.