Developed by the University of Arizona Sarver Heart Center

Resuscitation Research Group

• Are the most common cause of death in the United States

• Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often cardiac arrest

• Since most occur out of the hospital

• Out-of-hospital cardiac arrest is a major public health problem

• Blockage in coronary artery

• Person usually conscious

• Upper body discomfortor pain

• Electrical issue, heart stops pumping

• Person is unconscious

• Often no previous symptoms

Heart Attack vs. Cardiac Arrest

Heart Attack vs. Cardiac Arrest

Heart Attack: Cardiac Arrest:

Primary vs. Secondary Cardiac Arrest

Primary vs. Secondary Cardiac Arrest

• Heart stops pumping

• Blood in arteries full of oxygen

• Unexpected witnessed collapse

Secondary

• Heart stops pumping due to lack of oxygen

• Drowning, Drug Overdose, Lung Failure (severe asthma or emphysema)

Primary

Out-of-Hospital Cardiac Arrest

Out-of-Hospital Cardiac Arrest

The majority of all out of hospital cardiac arrests are Primary Cardiac Arrest

Unexpected, witnesses (seen or heard) collapse in an individual who is not responsive

Chest Compression Only CPRAnn Emerg Med. 1997 Jul;30(1):69-75.

What is Chest Compression Only

CPR?

What is Chest Compression Only

CPR?• A new method of resuscitation developed

through extensive research at The University of Arizona Sarver Heart Center for primary cardiac arrest

• Continuous forceful chest compressions to circulate the person’s blood to their brain and heart

• Mouth-to-mouth breaths may actually be harmful

Why isn’tRescue Breathing

Necessary?

Why isn’tRescue Breathing

Necessary?

–Lungs are full of airLungs are full of air

–Blood is full of oxygenBlood is full of oxygen

–Circulating the oxygenated blood is the key Circulating the oxygenated blood is the key

During Cardiac Arrest:During Cardiac Arrest:

Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest?

Why Might “Rescue Breathing” be Harmful in Primary Cardiac Arrest?

• People less likely to perform

• Causes interruption of chest compressions: stops blood flow to the brain

• Increased pressure in the lungs and chest decreasing blood return to the heart

Aufderheide TP et al.., Death by hyperventilation: a common and life-threatening problem during CPR. Crit Care Med 2004;32:S345-51

Aufderheide TP et al.., Hyperventilation induced hypotension during CPR Circulation 2004;109:1960-5

Why Chest Compression Only

CPR?

Why Chest Compression Only

CPR?

• It saves more lives

• More likely to survive over:

– Doing nothing

– Traditional CPR

Bobrow, et al. JAMA October 2010

What Stops People from Doing CPR?

What Stops People from Doing CPR?

Coons SJ, et al. Resuscitation 80;334-340:2009 This study was designed and funded by the Sarver Heart CenterThe University of Arizona College of Medicine and SHARE

Mouth-to-Mouth

Harming the Person

Legal Consequences

Won’t Perform Properly

Physically Unable

Chest Compressions Only

Better than dead

Good Samaritan Law

Easier to Do

Do Your Best / Call For Help

Fear / Concern

Solution

40%

30%

25%

20%

15%

10%

5%

0%

17.6% 17.7%

33.7%

Surv

ival to

Hosp

ital D

isch

arg

e

NoCPR

TraditionalCPR

CCOCPR

Bystander CPR in Arizona (2005 to 2010)

Witnessed & Shockable Out of Hospital Cardiac Arrest

Bystander CPR in Arizona (2005 to 2010)

Witnessed & Shockable Out of Hospital Cardiac Arrest

Rates are for ventricular fibrillation; from Bobrow, et al. JAMA October 2010

When to useChest Compression Only

CPR?

When to useChest Compression Only

CPR?

• Obvious Breathing Problems:– Drowning – Drug overdoses

• Someone who unexpectedly collapses, and is unresponsive.

TraditionalCPR

Chest CompressionOnly CPR

• Vast Majority• Vast Majority

What to do:What to do:

Compress: Chest compressions at 100 Per Minute

Call: 911 & send someone for an A.E.D. (if available)

Are You Alright? Check: Shake & Shout

Are They Breathing?Are They Breathing?

• Gasping is a sign of cardiac arrest

• Majority of people with cardiac arrest gasp

• Can be a sign of minimal but adequate blood flow to the brain.

• DODO NOTNOT stop chest compressions if they gasp

How to Do Chest Compression Only CPR

How to Do Chest Compression Only CPRWith the victim on the floor:

1. Kneel beside them2. Place the heel of one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum between the nipples)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.

Chest Compressions:Rate and Depth

Chest Compressions:Rate and Depth

• Allows the heart to refill

• Beat of “Staying Alive!!”

• After each compression, take all weight off the chest

100100Compressions per MinuteCompressions per Minute

2 inches2 inchesin depthin depth

Bystander CCO CPR Improves Chance Bystander CCO CPR Improves Chance ofof

Survival from Cardiac ArrestSurvival from Cardiac Arrest

Bystander CCO CPR Improves Chance Bystander CCO CPR Improves Chance ofof

Survival from Cardiac ArrestSurvival from Cardiac Arrest100%

80%

60%

40%

20%

0%

Time between collapse and defibrillation (min)0 1 2 3 4 5 6 7 8 9

Surv

ival (%

)

Nagao, K Current Opinions in Critical Care 2009EMS Arrival Time based on TFD 90% Code 3 Response in FY2008. Standards of Response Coverage 2008.

EMS Arrival

No CPRNo CPR

CPRCPR

CCO CPRCCO CPR

What to do:What to do:

COMPRESSChest Compressions at 100 Per Minute

CALL 911

Are You Alright? CHECK Shake & Shout “Are

you all right?”

If available; Send for an A.E.D.

AEDsAEDsThey may look different, but they all function the Same!

Open and Follow Instructions

• Turn AED ON• Apply Pads to Bare Chest• Plug in Pads (if necessary)• Analyze Patient (CLEAR!)• Push Shock to defibrillate,

if directed (CLEAR!)• Immediately resume CPR

The Universal SymbolThe Universal Symbol

•Safe

•Easy

•Voice Prompted

Save your Breath…Save a Life

How to Do Chest Compression Only CPR

How to Do Chest Compression Only CPRWith the victim’s back on the floor:

1. Kneel beside them2. Place one hand on top of the other 3. Lock your elbows4. Aim for the middle of the chest (on the sternum between the nipples)5. Push hard and fast (try for 100/min.)6. Take turns with another person when tired.

Ewy GA, et al. Circulation. 2007;116(22):2525-30.

Blood FlowingTo The Brain

Blood FlowingTo The Brain

Chest Compressions Only

Compressions + Breaths (30:2)

Pausing forbreaths meansNo Blood Flow

Three-Phase Model of Resuscitation

Three-Phase Model of Resuscitation

Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8

0 2 4 6 8 10 12 14 16 18 20

Arrest Time (min)

0

100

Myocardial ATP

Per

cen

t

SOS-Kanto study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet. 2007;369:920-6.

25%

20%

15%

10%

5%

0%5.2%

7.8% 13.3%

Surv

ival to

Hosp

ital D

isch

arg

e

NoCPR

TraditionalCPR

CCOCPR

150/2,900

52/666

113/849

Bystander CPR in Arizona (2005 to 2010)

All out-of-hospital cardiac arrests

Bystander CPR in Arizona (2005 to 2010)

All out-of-hospital cardiac arrests

Rates are for all cardiac arrests; from Bobrow, et al. JAMA October 2010