Wednesday, October 21, 2015
Some of the questions you get asked as an ER nurse are very interesting. Some I can talk about . . . and some I can't. One fairly consistent question is, "How hard is is to do CPR on someone?"
It's hard people . . . flat out hard.
The goal of CPR is to do the work that your heart does from the outside of the body. Keep in mind all that protects your heart from getting injured: layers of skin, fat, muscle and bone. All that has to be overcome to squish the heart enough for it to generate blood flow.
Research has proven two things. The first is that CPR done effectively is the best thing that can be done to save your life if you go into cardiac arrest. Every minute you go without CPR your percentage of survival decreases precipitously. The second is that the effectiveness of one person doing CPR also significantly decreases after about two minutes which is why the American Heart Association encourages changing out those people doing compressions every two minutes.
This story of an EMT suffering a stroke after performing CPR for 30 minutes highlights how much exertion a body sustains from performing chest compressions.
So, there is a definite balance between doing effective CPR with the amount of physical strength you have on hand.
Studies are also showing that continuous CPR, without pausing for breathing, is also increasing a patient's likelihood of survival. Some EMS organizations have gone to doing two continuous minutes of CPR immediately upon arrival and then going into the appropriate advanced life support protocol.
The newest approach is what is called Pit Crew CPR. Just as in car racing where everyone has a defined role and becomes an expert at that role-- the same is true for this style of CPR. The importance of this method is that there is little pause in compressions. The concern with stopping CPR is that it takes anywhere from 15-30 compressions to get pulsatile flow again which is never good for the patient in cardiac arrest.
In Salina, KS where they've trialed this their rates of return of spontaneous circulation (getting back a heartbeat) increased from 44% from 32%. That may not seem significant but it is a tremendous leap in terms of resuscitation medicine. Each of those points is a person living.
Basically, in Pit Crew CPR, two people alternate compressions at either side of the chest. The person at the head of the patient manages the airway but initially the patient is placed on oxygen but there is not an emphasis on providing breaths as in traditional CPR. One person at a leg manages the defibrillator and a provider at the other leg establishes IO access (drilling an IV into the leg).
After a few minutes of this style of CPR if the patient doesn't have a return of their pulse, they are placed on an AutoPulse and transported to the hospital.