CPR Standards

Over the past decade, CPR standards have drastically changed. We have seen a change from what health care workers have done and also what lay people are being instructed to do if someone happens to go into cardiac arrest (this is when someone stops breathing and their heart stops -- this is different from a heart attack, although one can precede the other).

What we were once told was, after we determined that the person is not breathing, to perform a series of rescue breaths and chest compressions. Compression and breathing ratios have changed over the years, as well. We have seen a 30:2 ratio and also a 15:2 ratio. I honestly don't know what the current standards are because, well, we don't follow them where I work. We do something a little different and it works.

We do continuous chest compressions. These chest compressions are not stopped except for two things: to check a rhythm and to defibrillate (shock the heart). Even though we stop for these times, our goal is to minimize the time that compressions are not being performed to next to zero. The more time that you are not performing these chest compressions, the patient has an exponentially higher chance of not surviving. We want to give them every chance we can and thus we do everything we can to bring them back. Sometimes this happens and sometimes it doesn't. That's just the nature of the problem.

When I have talked about this in the past, I have been asked why we don't breathe for patients anymore. Well, we do. When EMS gets to the patient, we breathe through the compressions. However, what is now being recommended to the lay population if they witness a cardiac arrest is to also do the continuous compressions and not breathe for the patient, either through mouth-to-mouth or with some kind of barrier device (which also is a good thing because it eliminates part of the "eww...gross" factor from helping someone in need). This article caught my attention from Fox News about this very thing. I have not seen the study but I can tell you that with what we have done where I work, we have increased survival rate just by changing the way we do CPR with continuous compressions rather than some ratio of compressions to breaths.


The next question I get is usually: "why is it so important to just do the compressions?" For starters, the thing that transports oxygen and nutrients around the body is the blood. There is no substitution for the heart to move around the blood...but the best thing we've got is chest compressions (and, I'll be one of the first to say that the fire departments I work with can do a really amazing job at keeping that blood going around the body). So, we work with what we got. Like I said earlier, every time that you stop, the chances of the patient surviving decrease. It is important to make sure that we give the patient every chance they can get.

The other part of why the initial breaths aren't as important as we once thought is because as the chest compressions are being performed, the changes in pressure within the chest cavity draw air in and out of the lungs. This allows for some oxygen to get into the blood stream and to keep the vital organs filled with the nutrients they need. This obviously does not provide as much oxygen as providing breaths through (what the medical community uses) a bag-valve mask or intubation but it provides a rather significant amount.

So, if you ever happen to stumble across a situation where someone is in cardiac arrest, first thing's first: stop and help them. Call 9-1-1 so you can get you some relief (you'll get real tired real quick). And then, provide this person with a single life-saving measure: chest compressions. Once your start, don't stop until you have someone there to relieve you. We'll come as quickly as we can. We thank you for your efforts in helping to save a life...and the patient and their family thank you for providing the top level of medical care that you know how.