You see someone collapse and you wonder if you can help. You're not certified in CPR and hesitate to perform mouth-to-mouth resuscitation.
Actually, you no longer need to worry about correctly performing cardiopulmonary resuscitation (CPR). Mouth-to-mouth breaths are not even needed, according to medical experts.
The American Heart Association now recommends that untrained bystanders and medical personnel alike begin resuscitation efforts with chest compressions only.
This new approach is called cardio-cerebral resuscitation (CCR), also known as chest-compression-only CPR, and it is much more likely to save lives than traditional CPR.
The new, simpler technique doubles a person's chance of survival, according to Dr. Gordon Ewy, director of the University of Arizona Sarver Heart Center and a developer of the new resuscitation method.
The UA Sarver Heart Center Resuscitation Research Group first advocated CCR in Tucson in 2003. A statewide effort was launched in 2004.
The old method called for chest compressions followed by breaths, but Ewy and fellow researchers discovered victims have a far better chance of survival with continual chest compressions.
Ewy visited Yuma last week to train first responders in the new continuous chest compressions CPR. The Yuma Friends of the Arizona Health Sciences Center also organized a lecture, his final before retiring in June.
About 50 first responders with the Yuma, Rural/Metro and Marine Corps Air Station fire departments, local health providers and Yuma Regional Medical Center Emergency Room and education staff attended the training.
Interim Battalion Chief Mike Walton said the Yuma Fire Department has shifted to CCR and encourages bystanders to use it.
“It's easier for the general public to perform this lifesaving act. There's no training involved. It just takes a few minutes to become familiar with it.”
If CCR is being performed when first responders arrive on scene, “there's a dramatic difference in the success rate. It's much better, and there's a much greater chance of having a successful outcome,” Walton noted.
“The idea is to oxygenate the brain and get the heart pumping again, circulating blood.”
Ewy urged bystanders who witness someone collapse to immediately start chest compressions. If cardiac arrest is not witnessed, death is almost guaranteed, he said.
“The battle for life or death ... is won or lost in the field,” he noted.
Ewy and fellow researchers looked at survival rates in the past 30 years and compared them with survival rates from 2005-2010. The survival rate with traditional CPR had not improved significantly through the decades.
“Was it Einstein who said doing the same thing over and over and expecting something different is the definition of insanity?” Ewy quipped.
They found that survival rates for patients with out-of-hospital cardiac arrest are better when bystanders do chest compression only, compared with chest compressions interrupted with mouth-to-mouth breaths.
Patients who received CCR survived 13.3 percent of the time, compared with 7.8 percent of those in which bystanders performed conventional CPR.
They found that mouth-to-mouth breaths actually inhibit blood flow to the heart and draw blood to the chest, instead of the heart.
CCR requires forceful chest compressions at a rate of 100 per minute to pump blood to the head. Don't stop even if the victim is gasping, which is a sign of cardiac arrest.
“I've had women tell me, ‘My husband was snoring and when I woke up this morning, he was dead,'” Ewy said.
Bystanders often misinterpret this abnormal gasping, described as snoring, gurgling, moaning or snorting, as breathing and do not call 911 or begin chest compressions. This is a waste of “precious” time during which the patient's brain and heart do not receive any blood flow.
Every minute of delay in getting oxygen to the brain, the survival rate drops by 10 percent, Ewy said.
In addition, a person should continue compressions even if a victim who stopped gasping resumes gasping.
Won't the chest compressions harm the victim? “It won't hurt the victim. He's dying or he's soon to be dead. He might be sore later, but he'll be happy to shake your hand,” Ewy said.
Besides, he noted, Good Samaritan laws protect bystanders who try to help.
However, Ewy warned, the new method is not for infants, small children or drowning victims. For them, it's best to use traditional CPR.
Ewy noted that the greatest chance of surviving is when a collapse is witnessed and the heart rhythm is restored with defibrillator shock.
However, a common misconception is that an automated external defibrillator (AED) is only for use by emergency responders. They are actually designed for use by bystanders until paramedics arrive at the scene.
An AED provides voice instructions and visual prompts, including how to attach the pads and when to deliver an electric shock.
Nearly 1,000 people die every day from sudden cardiac arrest in the United States alone. A 40-year-old American male has a 1 in 8 chance of experiencing sudden cardiac death. A female has 1 in 32 chance.
“The first sign is often the last — sudden death,” Ewy said.
“If chest-compression-only CPR and other protocols of cardio-cerebral resuscitation were implemented nationally, an estimated 58,000 lives could be saved each year in the United States alone,” he added.
For more information or to watch a video demonstration of the chest-compression-only CPR, visit heart.arizona.edu/learn-cpr.
Mara Knaub can be reached at firstname.lastname@example.org or 539-6856. Find her on Facebook at Facebook.com/YSMaraKnaub or on Twitter at @YSMaraKnaub.