# 2010 CPR guidelines



## dangerboy (18 Oct 2010)

http://www.windsorstar.com/health/guidelines+abandon+kiss+life/3690171/story.html

New life-saving CPR guidelines call on rescuers to skip mouth-to-mouth and just keep pushing on the chest.

Too many precious seconds were being wasted going back and forth from compression in the rib cage to provide mouth-to-mouth — while others hesitated — so a consortium of stakeholders has called for hands-only rescue under the new CPR protocol being released this week across Canada.

“We are definitely supportive,” said Brian Bildfell, chief of Essex-Windsor Emergency Medical Services.

“What it will do is take hesitancy away from the public in starting CPR.

“We are very lucky the public in this area — more than others — jumps right in (to perform CPR) and this will just add to it.”

More than 250 paramedics across Windsor and Essex County switched to bag valve masks 20-plus years ago, while the number of available defibrillators in public locations has also dramatically increased, Bildfell noted.

“But this is something that had been discussed for a period of time,” he said. “It’s a great incentive for people to just start CPR on the street until we can get there.”

The switch is huge because it clarifies resuscitation efforts for rescuers well versed in CPR skills and those who know nothing, said Dr. Andrew Travers, an emergency physician in Halifax and chairman of the The Heart and Stroke Foundation of Canada’s policy advisory committee on resuscitation, which co-authored the new guidelines.

“The average person can do something to save a life — compression-only CPR,” Travers said.

The changes emphasize life savers should just push hard and fast on the centre of the chest with at least 100 compressions per minute. Previous guidelines called for 30 compressions on the chest to be alternated with two mouth-to-mouth breaths.

Recent U.S. studies showed seconds were being lost going back and forth, or victims were dying because would-be rescuers were hesitating.

An analysis published last week by The Lancet found cardiac arrest victims are 22 per cent more likely to survive if rescuers skip mouth-to-mouth breathing and, guided by 911 dispatchers, do chest compressions only.

“This is good news for patients because it reflects the different ways people respond to cardiac arrest,” Travers said. “It gives a different option.

“Even with people trained in CPR there are reservations because, a lot of times, they worry their skills are not right or (they fear) contracting something from the patient. Compression-only overcomes those limitations.

“Just apply chest compressions. All rescuers, regardless of training, should give effective chest compressions until paramedics arrive.”

St. John Ambulance also supports the new CPR guidelines, said Alan Milner, business administrator for the organization — a lead agency in providing instruction for the life-saving technique. But St. John won’t alter teaching methods in its CPR classes until next year, he said.

“We will be changing, but that’s going to depend on Ontario council to change the books,” Milner said. “Next, we have to teach instructors the new protocols and then we can pass it on to students. That won’t be until some time in 2011.”

Dr. Donald Levy, chief of Emergency Medicine at Hotel-Dieu Grace Hospital — this region’s cardiac care centre — described the CPR change as a positive direction.

“There has been good evidence in the last two years that strongly demonstrates adult patients receiving CPR have just as much benefit from compression only,” he said.

“They have just as good quality of outcome when they arrive at the hospital — and long-term after being discharged.

“I think when you have more people doing (CPR) you will end up saving even more lives.”

The changes do not apply to infants, children or in cases where cardiac arrest is related to near-drowning, choking or other respiratory ailments. For those victims, the complete CPR technique, which includes both chest compressions and rescue breathing, is recommended.

But if rescuers are hesitant for any reason, chest compression is better than nothing, Levy said.

“But for those patients,, if a person is comfortable in training, they should do airway breathing in conjunction with compressions,” he said.

About 40,000 Canadians experience cardiac arrest each year. Without CPR and defibrillation, less than five per cent of those who have a cardiac arrest outside hospital survive.

“There are very few things in medicine where you can double your chance of surviving,” Levy said. “(CPR) is one of them.”
© Copyright (c) The Windsor Star





Read more: http://www.windsorstar.com/health/guidelines+abandon+kiss+life/3690171/story.html#ixzz12lmvcx4F


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## mariomike (19 Oct 2010)

“Even with people trained in CPR there are reservations because, a lot of times, they worry their skills are not right or (they fear) contracting something from the patient."

Chances are, a mouthfull of puke. Babies and children are another matter entirely.


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## Snakedoc (19 Oct 2010)

I know these changes are to the Heart and Stroke guidelines, does anybody think these will affect the CPR portion of the St. John's course CF members take?


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## Rafterman1 (19 Oct 2010)

Sure its easy for the untrained public to remember, but if EMS takes longer than 4-7 minutes for what ever reason to arrive, the Pt is still not getting no O2.  The Pt's going to be brain dead or deceased by the time EMS arrives.   Blood circulation and oxygenation are absolute requirements in CPR.


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## Fishbone Jones (19 Oct 2010)

Snakedoc said:
			
		

> I know these changes are to the Heart and Stroke guidelines, does anybody think these will affect the CPR portion of the St. John's course CF members take?



I took a refresher course almost a year ago, for my civie job, and we were taught it then. Pretty sure they were St John's instuctors.



			
				Rafterman1 said:
			
		

> Sure its easy for the untrained public to remember, but if EMS takes longer than 4-7 minutes for what ever reason to arrive, the Pt is still not getting no O2.  The Pt's going to be brain dead or deceased by the time EMS arrives.   Blood circulation and oxygenation are absolute requirements in CPR.



I guess all those people in high places are wrong then. Perhaps you should apply for thier jobs instead of going to BMQ in January.


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## dangerboy (19 Oct 2010)

Snakedoc said:
			
		

> I know these changes are to the Heart and Stroke guidelines, does anybody think these will affect the CPR portion of the St. John's course CF members take?



The article says


> St. John Ambulance also supports the new CPR guidelines, said Alan Milner, business administrator for the organization — a lead agency in providing instruction for the life-saving technique. But St. John won’t alter teaching methods in its CPR classes until next year, he said.
> 
> “We will be changing, but that’s going to depend on Ontario council to change the books,” Milner said. “Next, we have to teach instructors the new protocols and then we can pass it on to students. That won’t be until some time in 2011.”


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## northernboy_24 (19 Oct 2010)

As a Red Cross First Aid Instructor we just got a directive yesterday that we are to continue teaching the original CPR but we are allowed to tell them to do compression only CPR if you feel uncomfortable giving breaths or dont have protection (face shield/pocket mask).  Personally, if you vomit, I will not be giving you breaths no matter if I have a pocket mask or not.  If I dont have a BVM I will not be going near your mouth.

The only times I have to give breaths is when the person needs CPR because of respiratory failure or from drowning.  And we always are supposed to give breaths when dealing with babies and children (since their primary reason for cardiac arrest is respiratory failure).

I have been thinking about the physiology and while I may be wrong.  I am wondering if the compressions themselves will mimic breathing by creating negative pressure in the chest on the upstroke and positive pressure on the downstroke allowing for the exchange of small amounts of oxygen and C02 during compression only CPR.  Obviously not as good as an actual rescue breath but it is something.


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## mariomike (19 Oct 2010)

Rafterman1 said:
			
		

> Sure its easy for the untrained public to remember, but if EMS takes longer than 4-7 minutes for what ever reason to arrive, the Pt is still not getting no O2.  The Pt's going to be brain dead or deceased by the time EMS arrives.   Blood circulation and oxygenation are absolute requirements in CPR.



Paramedic response times are not getting any better, Rafterman:
"In all GTA municipalities, ambulances do respond to almost all "Code 4" 911 calls, those classified as the most urgent, within 15 minutes. But responses have become progressively slower over time – nowhere more than in Toronto.":
http://www.healthzone.ca/health/article/572736
Chances are, it could just be a "Clock-stopper". ie: A one-Paramedic Emergency Response Unit ERU ( Crown Victoria or SUV ). No partner. No stretcher. No transport. Sometimes, if they have no available ambulance or ERU, they have to send a Supervisor in an SUV, a bus or truck, ( or an ambulance with a lower priority patient already on the stretcher- they really try to avoid that. ) Anything to "stop the clock". When considering response time statistics, this has to be taken into consideration.

"In Toronto, now the 11th-fastest responder in Ontario, calls are up 23 per cent since 2002. Over the same period, ( Deputy Chief Norm ) Lambert said, the number of paramedics has increased only 1 per cent. "It gets back to resources and vehicle availability ... a 1 per cent increase in paramedics with a 23 per cent increase in demand is quite a difference."

Doing something is better than nothing:
"Torontonians are nice, unless you're having a heart attack":
http://www.healthzone.ca/health/newsfeatures/article/723018--torontonians-are-nice-unless-you-re-having-a-heart-attack?bn=1

"Toronto has "one of the lowest rates of bystanders helping others in the developed world," according to the study."


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## Blackadder1916 (19 Oct 2010)

So, it has taken only three plus years for a wider implementation in Canada of new CPR guidelines to encourage compressions only.

This was previously mentioned on these means at  "There's a New CPR" 



			
				Yrys said:
			
		

> Did the CF change it's CPR ?
> 
> http://www.msnbc.msn.com/id/19762047/site/newsweek/
> 
> ...



And there were comments about "compressions only" in the 2007/2009 thread New CPR.


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## Rogo (19 Oct 2010)

Rafterman1 said:
			
		

> Sure its easy for the untrained public to remember, but if EMS takes longer than 4-7 minutes for what ever reason to arrive, the Pt is still not getting no O2.  The Pt's going to be brain dead or deceased by the time EMS arrives.   Blood circulation and oxygenation are absolute requirements in CPR.



As pointed out by another member, there is negative pressure being created. Now I don't know how much Air is entering the lungs but considering many people cannot perform adequate CPR due to lack of practice this does seem a much safer bet.   

This having been said and being trained in CPR Health Care Provider level I am curious to know the impact on this more advanced certification because we on Carleton use Bag-valve masks and carry oxygen/defibs on our person when on call with the medical team. I hope this does not change us to compression only CPR because 100% pure O2 will easily be more beneficial in CPR using the BVM so long as CPR is done properly.


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## Occam (19 Oct 2010)

From Part 4: CPR Overview: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care  

Rescuer
Everyone can be a lifesaving rescuer for a cardiac arrest victim. CPR skills and their application depend on the rescuer’s training, experience, and confidence. Chest compressions are the foundation of CPR (see Figure 2). All rescuers, regardless of training, should provide chest compressions to all cardiac arrest victims. Because of their importance, chest compressions should be the initial CPR action for all victims regardless of age. Rescuers who are able should add ventilations to chest compressions. Highly trained rescuers working together should coordinate their care and perform chest compressions as well as ventilations in a team-based approach.


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## Blackadder1916 (19 Oct 2010)

The 2010 Guidelines for CPR and Emergency Cardiovascular Care

The Heart and Stroke Foundation of Canada is co-author of the 2010 Guidelines for CPR and Emergency Cardiovascular Care (ECC) in North America and the Canadian leader in resuscitation science, education and training.  

The guidelines are reviewed every five years and updated only when evidence is clear that changes will improve survival rates. The 2010 guidelines are based on input from 356 resuscitation experts from 29 countries.  

New 2010 CPR & ECC Guidelines make it easier to save a life Foundation survey finds that only 40% of Canadians trained in CPR would try to revive someone who has had a cardiac arrest. Read more.

Highlights of the 2010 Guidelines for CPR/ECC (PDF 4 MB)

The 2010 Guidelines for CPR and Emergency Cardiovascular Care (full document)

Heart&Stroke TV: CPR – one size does not fit all (link to HSFC page to view)

Heart&Stroke Position Statement on Cardiopulmonary Resuscitation


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## medic_man17 (19 Oct 2010)

Another really good reason as to why they've changed has been stated as seconds being lost when switching back and forth between the chest and the mouth to give the ventilations in classic CPR.  An analysis of the efficacy of this technique, or rather the elimination of, showed a 22% increase in survival rate of compressions only CPR in comparison to classic CPR.  
    That being said, many times, the lay rescuer can only be expected to do so well seeing as how many people are only taught or refreshed about once a year and sometimes even less.  The simplification of the CPR to compressions only CPR makes it simple for the lay rescuer to provide adequate circulation, despite not ventilating.  The simple mechanical compression of the chest in many cases can provide enough oxygenation to continue to perfuse vital organs and tissues until further emergent medical care can arrive and perform more advanced and effective airway management.


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## Rafterman1 (19 Oct 2010)

medic_man17 said:
			
		

> The simple mechanical compression of the chest in many cases can provide enough oxygenation to continue to perfuse vital organs and tissues until further emergent medical care can arrive and perform more advanced and effective airway management.



In BC, the average EMS response time is approx, 9min from 911 call to EMS arrival.

http://www.bcas.ca/assets/About/PDFs/Annual%20Report.pdf    -Pg 10

So 9mins of straight compression w/o vents performed by a person being told over the phone from the 911 dispatcher, zero O2 going into the body, wouldn't one think this Pt's outcome at best would be a "vegetable" for the rest of their human life.  Why not just tell them to throw a few breaths in.


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## Occam (19 Oct 2010)

Rafterman1 said:
			
		

> In BC, the average EMS response time is approx, 9min from 911 call to EMS arrival.
> 
> http://www.bcas.ca/assets/About/PDFs/Annual%20Report.pdf    -Pg 10
> 
> So 9mins of straight compression w/o vents performed by a person being told over the phone from the 911 dispatcher, zero O2 going into the body, wouldn't one think this Pt's outcome at best would be a "vegetable" for the rest of their human life.  Why not just tell them to throw a few breaths in.



Did you miss this part?



			
				medic_man17 said:
			
		

> The simple mechanical compression of the chest in many cases can provide enough oxygenation to continue to perfuse vital organs and tissues until further emergent medical care can arrive and perform more advanced and effective airway management.


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## Rafterman1 (19 Oct 2010)

What about a unwitnessed collaspe?  Go straight to compression, don't focus on good oxygenation of the organs & tissue for the 2min CPR 30:2 cycle?


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## medic_man17 (19 Oct 2010)

Rafterman1 said:
			
		

> So 9mins of straight compression w/o vents performed by a person being told over the phone from the 911 dispatcher, zero O2 going into the body, wouldn't one think this Pt's outcome at best would be a "vegetable" for the rest of their human life.  Why not just tell them to throw a few breaths in.



     In quite a few cases, this may be the cold reality of the patient outcome, but if CPR is performed as close to the time of collapse patient outcome increases dramatically.  Especially if accompanied by the applications of AED's and further Basic and Advanced Life support. 
      But another reality is that ventilating a patient is a difficult skill to perform and I daresay near impossible to master with or without a barrier device (whether it be a commercial simple barrier device or a pocket mask), especially if you are doing single person CPR.  In my experience being a paramedic, I do know that,  the patients with the best outcome are those who have received CPR from the lay rescuer, sometimes from those who were not comfortable doing mouth to mouth ventilations (as they did not have a barrier device) and did only perform compressions.  I know that it does sound wrong and against everything you've been trained to do, but having seen the outcome firsthand, I can fully agree with the experts who have decided to make this move in training.


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## Rogo (20 Oct 2010)

Rafterman the compressions create negative pressure providing some oxygenation.  Unless you have a face shield, pocket mask, BVM with mask, you are going to have a difficult time likely to form an effective seal. 

We must also remember the most crucial moments in CPR is the first few minutes when likely well trained medical help is not close by. The lay responder must be able to help and rather than do poor CPR the idea is that they can do adequate CPR with compression only.


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## X Royal (20 Oct 2010)

As an instructor for SJA I just recently received their *News Release* on this issue.
Here is a cut & paste of it.


*New Guidelines Aimed at Saving More Lives*

October 18, 2010 (Ottawa) — St. John Ambulance supports the recently released CPR guidelines particularly as they relate to compression only CPR.  Recent studies illustrate the benefit of compression-only or hands-only CPR. This technique involves pressing on the chest of a person in cardiac arrest without providing mouth-to-mouth ventilations. This technique has been shown to be of benefit in certain situations e.g. a witnessed cardiac arrest in an out-of-hospital situation, particularly where the first aider is untrained or is reluctant to provide rescue breathing.
The complete CPR technique, which includes both chest compressions and rescue breathing, is recommended for infants, children and in cases where the cardiac arrest was not witnessed or was due to special circumstances such as near-drowning. For those individuals confronted with a cardiac arrest who have not been trained, are unsure of their ability to perform CPR or are reluctant to perform mouth-to-mouth resuscitation, compression-only CPR is recommended.
St. John Ambulance will continue to teach all CPR components in our classes including an emphasis on the early use of a defibrillator.  It is important to note that if you have had CPR training, the skills you were taught are still okay to use and by immediately beginning CPR you can make a valuable difference in helping to save a life.
For information on CPR classes go to www.sja.ca


Please contact:	
Les Johnson, Director Client of Training
St. John Ambulance Canada
613-236-1283 ext 261
Les.johnson@nhq.sja.ca
www.sja.ca


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## ModlrMike (20 Oct 2010)

This change builds on some previously known statistics. For every minute without CPR, the chance of survival decreases by 10%. Therefore, starting compressions right away can account for about 20% of deaths vs starting with respiration. Compressions also depress the diaphragm, and create negative pressure in the lungs thereby drawing fresh air. Remember, this change is meant for lay person, one rescuer CPR.


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