The vast majority of first responders and aid givers have been taught the internationally approved, traditional method of cardio-pulmonary resuscitation (CPR) for several decades now; the technique has, until very recently, been regarded throughout the world as best medical practice. There is, however, a significant problem with this technique: it treats two entirely different conditions – cardiac arrest and respiratory arrest – as though they were the same. A recent modification is resulting in a significantly better survival rate for people who collapse with cardiac arrest – by far the most common cause of sudden unexpected collapse.
Respiratory arrest accounts for just 20% of sudden collapse casualties and is nearly always due to drowning, choking or drug intoxication. By contrast, a massive 80% of such casualties have suffered a heart attack. The CPR method involves compressing the collapsed patient’s chest rhythmically, at the rate of 30 compressions per minute, followed by two mouth to mouth breaths. The routine is repeated until paramedics arrive, who will continue to use it until the patient is conveyed to the hospital. Tragically, national statistics show that only about 2% of cardiac arrest casualties who collapse outside of a hospital will survive without significant long-term damage. The harm, in other words, has already been done by the time the patient arrives in the emergency room and little if anything can be done to reverse it in the vast majority of cases.
There is, however, some wonderfully exciting news in the midst of this gloom. A simple but highly effective new innovation is radically changing this depressing survival rate. If CPR is replaced by CCR – Cardio-Cerebral Resuscitation – significantly more lives can be saved and full health can very often be restored over time. What exactly does this innovation consist of? Just what does CCR involve?
No Pause for Breath: The Importance of Chest Compression
Against the weight of established medical opinion, the new method places its emphasis on chest compressions rather than the mixture of chest compression and mouth to mouth lung ventilation currently practiced. And the rate of compression rises significantly, from the 30 per minute advocated in CPR to 200 in two minutes for CCR. CCR is undoubtedly a method which has to be administered by properly trained professionals, using the right equipment. Mouth to mouth breathing assistance after chest compressions is replaced by shocks from defibrillator pads – one shock after three sets of 200 compressions (as opposed to two breaths after one set of 30 compressions).
Immediately, a concern appears. If a lay individual is confronted with a suddenly collapsed patient, what should he or she do? With increased chest compression and defibrillation, 60 to 65% of patients are revived before reaching the hospital, as opposed to the 24% saved by CPR.
The new technique allows a degree of cautious discrimination: if the collapse has clearly been the result of choking or drowning, CPR may still be the revival method of choice. But where cardiac arrest is suspected, CCR is far more likely to result in recovery. In these scenarios, it is vastly more important to keep the heart pumping reliably than it is to administer breath to the lungs. The evidence is that there is already sufficient oxygen in the blood to refrain from breathing assistance and concentrate purely on manual heart massage in CCR in the immediate aftermath of a suspected cardiac arrest. And this appears to be enabling far more people to come forward as first responders and aid givers than had been possible previously.
In the past, a significant number of lay first aiders appear to have been dissuaded from administering CPR when confronted with a collapse victim, with the most commonly cited reason being fear of contracting potentially dangerous infection during mouth to mouth resuscitation. CCR abolishes this risk – rapid chest compression is all that is necessary until the medics arrive with their defibrillators and other equipment. If onlookers are averse to placing their mouths on a stranger’s mouth, just keeping the blood flowing will in and of itself yield significant benefits in the majority of cases.
Accounts of this new technique’s effects are as moving as they are inspirational. A relatively fit and healthy 51 year old from Olathe, Scot Goddard, collapsed after a routine sports workout at his athletic club. Two people at the club administered CPR for a couple of minutes until the paramedics arrived, whereupon CCR was started. At that point, Goddard had no heartbeat and was not breathing. The ambulance crew kept the CCR going until his arrival at the hospital, where he was fully revived, undergoing heart by-pass surgery shortly after the ordeal. The surgeon who operated was forthright: Goddard was alive because of CCR. All the surgery did was repair a pre-existing problem – his life was saved long before he arrived in the operating theater.
Another casualty from Arizona cited in Dr. Sanjay Gupta’s book collapsed whilst driving home from work. Luckily, a UPS driver happened upon his crashed vehicle and administered chest compressions to the victim. Literally seconds later, when the fully-trained team from the nearby fire station arrived, the full CCR technique was implemented. The victim recovered a short time later.
The help of bystanders can be crucial – even CPR alone can help a cardiac arrest victim survive. But with greater public awareness of the advantages of CCR, more and more people may follow their immediate instincts and help a fallen stranger, with no risk of mouth to mouth infection. Survival depends not merely on people near to the casualty who know what to do, but on people being willing to do what it takes. Removing the mouth to mouth scenario promises to significantly increased the rate of bystander assistance – human beings overwhelmingly want to help one another at times of crisis and CCR may well encourage many, many more to come forward in an emergency to give life saving assistance.
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