Thursday, January 10, 2008

CPR, STAT!

This morning, I attended a CPR recertification for healthcare professionals, and was surprised at the significant changes therein. The very gung-ho presenter gave us an impassioned speech about the importance of CPR, and drive home the very salient point that most of us professionals who ever use CPR will most likely do so out in the community---at a shopping mall, grocery store, or even at home---rather than at work. Aside from those who work in the ICU or other critical care area, CPR is generally performed when one is off-duty, and we should be determined to get as many civilians certified as possible. Even more urgent is the need for more automatic electronic defibrillators out in the community, and unfortunately there are just not enough of those golden little machines around.

An interesting piece of information that I learned today was that, contrary to what has been taught for decades up until now, we were concentrating way too much on mouth-to-mouth resuscitation and performing woefully too few chest compressions. Statistics clearly demonstrate that the old CPR paradigm was falling far short of the mark, and of the people who actually survived following CPR, less than 40% actually experienced good quality of life. Due to the relative lack of chest compressions performed in traditional CPR, brain perfusion was a mere shadow of what it could have been, thus many survivors were suffering unnecessary cognitive deficits from lack of cerebral oxygen flow.

The new and improved CPR instructions drill home the fact that it is compressions which save a life, not mouth-to-mouth. While keeping an open airway and providing periodic rescue breaths is still an intrinsic aspect of the entire procedure of CPR, it is the act of compressing the heart against the chest wall which perfuses the brain, coronary muscle and kidneys with the oxygenated blood needed to prevent negative sequelae. "Compressions, compressions, compressions" was the mantra that we heard all morning, and by the time we left, the new ratio of 30 compressions to 2 breaths was cemented in our brains, along with the strict instructions that compressions must be "deeper, harder, and faster" than ever before. No more fumbling around, re-checking the pulse and giving two breaths every 15 compressions. Get that heart pumping, and get a defibrillator on that chest stat!

Apropos of the notion of automatic electronic defibrillators (AEDs) we also learned about commotio cortis, a condition in which an otherwise healthy heart stops due to blunt trauma to the chest. Sadly, young athletes---school-age children, teens, and college students---die from this condition every year, which generally occurs when a young athlete is struck in the area of the heart by a ball, limb, or other implement at precisely the moment when the heart is at a specific point in the cardiac cycle. Of note, the use of AEDs by coaches and others involved in youth sports has shown dramatically increased survival rates for young people experiencing commotio cortis. Thus, it is in everyone's interest to lobby schools and youth athletic programs to obtain AEDs and train adults and young people in their correct use.

CPR is a crucial skill which can indeed save lives if used correctly, and especially if enough individuals in the society are properly certified. I encourage everyone to become certified, recertify every two years, and urge family members and friends to do the same. Someday the life that's saved may very well be your own---or that of someone you love.
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