CPR - CardioPulmonary Resuscitation

[GordMay]

If you witness a cardiac arrest, your actions could save a life. Here's what to do:

The cause of cardiac arrest is an electrical problem, that stops the heart from beating. This is different from a heart attack, which is a blockage of one of the blood vessels in the heart.

How do you know that someone may be in cardiac arrest?
They're going to collapse. They're going to be unresponsive, and not breathing. And, if they are breathing, they'll have gasping sounds, that you might hear.

When someone experiences a cardiac arrest, it's key to act quickly:
• Recognize the cardiac arrest and call 911.
• Start CardioPulmonary Resuscitation, or CPR, with an emphasis on chest compressions.*
• Quickly defibrillate using an automated external defibrillator or AED.

* CPR can save lives. And, you're not going to do any harm to these people, by doing CPR, until the professional arrives.
Most bystanders are not trained in mouth-to-mouth resuscitation, which is why it's not included in the steps to take for basic CPR. Even without it, chest compressions are what is going to keep the blood flowing to the brain, and other vital organs.

You're placing the heel of your hand in the centre of the chest, you're interlocking your fingers of your other hand on top, and you're pushing hard and fast.
The compressions should be about five centimetres deep, or the height of a credit card.
You want to position your shoulders right over top of someone, and really push using your upper body, as opposed to letting your arms bend every time.
Press in a quick rhythm, about 100 to 120 beats per minute. To stay in time, sing Stayin' Alive in your head — or a song with a similar beat.
Keep going — even if you're worried you're not doing it right. Even if it's not as fast as a professional, you're doing something, and you're delivering blood flow, and oxygen, to the brain.

If someone brings you an AED, stop the compressions and start using it immediately. AEDs analyze the person's heart rhythm and deliver a shock to the heart if necessary. The device has an audio component, that walks you through how to use it, as well as pictures of where to place the pads, on someone's chest.
The AED will also tell you when to continue chest compressions — which you should do until the ambulance arrives.

You may be concerned about hurting the person, by pressing too hard, or deep on their chest, but experts say the benefits of giving CPR far outweigh those risks.

For those who want to learn more about CPR and basic life support, there are many types of training available, including classes from Heart and Stroke, and other groups.


How to do basic cardiopulmonary resuscitation, or CPR
➥ http://www.cbc.ca/player/play/2315187779605

Learn CPR in less than 90 seconds ➥ https://www.youtube.com/playlist?lis...ctU7CQJKVfjzxF

[Kettlewell]

And the other side of the coin is that the survival rate after administering CPR is much lower than many people think.

But the true odds are grim. In 2010 a review of 79 studies, involving almost 150,000 patients, found that the overall rate of survival from out-of-hospital cardiac arrest had barely changed in thirty years. It was 7.6%.

https://www.npr.org/sections/health-...n-enduring-cpr

The traumatic nature of CPR may be why as many as half of patients who survive wish they hadn't received it, even though they lived.

It's not just a matter of life or death, if you survive, but quality of life. The injuries sustained from the resuscitation can sometimes mean a patient will never return to their previous selves. Two studies found that only 20-40% of older patients who survive CPR were able to function independently; others found somewhat better rates of recovery.

[bgallinger]

Thanks for that Gord. I just bought an AED for my boat. I truly hope that I never need it, but it's comforting to know that I have it!

[GordMay]

Originally Posted by Kettlewell

And the other side of the coin is that the survival rate after administering CPR is much lower than many people think.

But the true odds are grim. In 2010 a review of 79 studies*, involving almost 150,000 patients, found that the overall rate of survival from out-of-hospital cardiac arrest had barely changed in thirty years. It was 7.6%.

https://www.npr.org/sections/health-...n-enduring-cpr

Interesting.

The cited Study:

“Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis” ~ by Comilla Sasson et al [2010]
➥ https://www.ahajournals.org/doi/10.1...MES.109.889576

”... Conclusions:
Overall survival from OHCA has been stable for almost 30 years, as have the strong associations between key predictors and survival. Because most OHCA events are witnessed, efforts to improve survival should focus on prompt delivery of interventions of known effectiveness by those who witness the event...

... WHAT THE STUDY ADDS

This meta-analysis brings together 30 years of research, involving more than 142 000 patients. Our findings conclusively affirm the value of bystander CPR, the critical importance of “shockable” rhythms, and the predictive value of ROSC in the prehospital setting.

Forty percent of patients with OHCA are found with ventricular fibrillation/ventricular tachycardia, yet only 22% achieve ROSC. This group may be a priority population for future efforts to improve ROSC and survival to hospital discharge.

The magnitude of effect sizes for the 5 clinical factors, such as provision of bystander CPR and an initial rhythm of ventricular fibrillation/ventricular tachycardia, are higher in communities that have low baseline survival rates. This suggests that efforts such as targeted CPR training to increase bystander CPR rates will have their greatest effect in communities with low baseline rates of survival.

Survival from OHCA has not significantly improved in almost 3 decades, despite enormous efforts in research spending and the development of novel drugs and devices. The aggregate survival rate, recorded across various populations, is between 6.7% and 8.4%.”

See also: Similar articles ➥ https://pubmed.ncbi.nlm.nih.gov/20123673/

[GordMay]

AUTOMATED EXTERNAL DEFIBRILLATORS (AEDs)
When an AED and CPR are immediately available, the chance of survival from sudden cardiac arrest is substantially improved.[1]
Combined with CPR, the use of an AED may increase the likelihood of survival by 75% or more. [2]
For every one minute delay in defibrillation, the survival rate of a cardiac arrest victim decreases by 7 to 10%. After more than 12 minutes of ventricular fibrillation, the survival rate is less than 5%. [6]

Canadian Heart & Stroke Foundation
POSITION STATEMENT:
“PUBLIC ACCESS TO AUTOMATED EXTERNAL DEFIBRILLATORS (AEDs)”
➥ https://www.heartandstroke.ca/-/medi...eng-final.ashx

[The Boat Galley]

The DC Boat Show is going to have a Red Cross Adult First Aid/CPR/AED class at reduced rates. 2-year certification. $80 for the 3+ hour class: https://dcboatshows.ticketspice.com/...at-school-2024

[leecea]

Originally Posted by bgallinger

Thanks for that Gord. I just bought an AED for my boat. I truly hope that I never need it, but it's comforting to know that I have it!

What model did you buy?

[wholybee]

Originally Posted by bgallinger

Thanks for that Gord. I just bought an AED for my boat. I truly hope that I never need it, but it's comforting to know that I have it!

A great device, I also hope you never need it. For those that have not had training on CPR or using an AED, the AED is designed to be used by an untrained person. You open it up, and it talks you through it's use and the administration of CPR. It is also able to determine on its own if shocking is necessary and won't if it isn't, so if someone isn't breathing, always use it.

[wholybee]

Originally Posted by The Boat Galley

The DC Boat Show is going to have a Red Cross Adult First Aid/CPR/AED class at reduced rates. 2-year certification. $80 for the 3+ hour class: https://dcboatshows.ticketspice.com/...at-school-2024

You can also go to redcross.org to find first-aid and CPR classes near you. Online classes are only $37, and in person vary between $70 and $99 ish.

[Hoodsail]

No question that CPR is not a panacea, but it can be used successfully to restore someone's cardiac rhythm enough to sustain life. Also use of an AED is no guarantee, but an advanced tool beyond CPR. Points to remember, that I was taught as a member of our hospital code blue team. Assuming the evaluation of the person's cardiac rhythm is correct, either asystole (no beats) or arrhythmia (irregular beats that result in little/no blood output), they are dead, so breaking ribs etc (a possibility in geriatric patients), is not an issue. Knowing a person's health history/allergies and desire to be resuscitated is essential when sailing offshore. If we are days away from land the odds of using CPR successfully are remote. Heck, even in an acute care hospital we lost more than we saved...BUT underlying pathology/disease that led to the cardiac arrest/arrhythmia is working against you. thnks

[Tom_F]

Not to be pedantic, but CPR does not "restore someone's cardiac rhythm." What it does is circulate the blood through the circulatory system to keep somewhat oxygenated blood flowing to vital organs, especially the brain. It's why CPR should be performed for as long as possible once started - even if it is clear it is not restarting someone's heart. Also, an AED is not used when someone is asystole (has no heartbeat) or is in cardiac arrest. An AED is used when someone is suffering from fibrillation (I forget whether atrial fibrillation, ventricular fibrillation or both) - when the heart is beating so fast that it cannot fill with blood sufficiently to pump oxygenated blood throughout the body. An AED works by stopping the person's heart and hopefully resetting the electrical issue that is causing the fibrillation. The nonsense you see on TV and in movies where they use a defibrillator to save someone who has flatlined is just that - nonsense. Or at least so I was told in EMT class. You also have to be very careful when using an AED because it can also stop the heart of someone in contact with the victim. As sailors, we are often surrounded by water - both outside the boat and on wet surfaces in or the boat. Standing in a puddle in the cockpit and shocking someone who happens to be in the same puddle can kill the rescuer. Please make sure when using an AED that you are not in physical contact with the victim, whether by touching them directly or by being connected to the same conductive surface. They are great devices, but they require care and caution when using them.

That being said, AEDs and CPR both unquestionably save lives, and they are often used in combination. If ashore, the first step is always to alert emergency services personnel (usually by asking a bystander to call them). CPR is easy enough to learn and perform for most of us, so the advice above to take a class is good advice - especially for those of us who (and whose spouses, significant others and friends) are getting older. Classes are available many places for very modest cost. Stay safe.

Tom

[NorthCoastJoe]

As an X-paramedic with over 200 codes outside the hospital setting. ZERO survived, a few lasted a bit in the hospital before passing. By the time we got there it was too long of a down time.

With an AED and drugs you might stand a chance if available on the spot out at sea.

Doing CPR is hard physical work and most people cannot keep it up long, maybe 5 minutes. I cannot picture doing it in the tight confines of a bouncing boat for very long.

Real world experience, I would try but not expect the best.

[Kd9truck]

I’ve done compressions and BVM ventilations on 200+ people and supervised 150+ CPR emergencies. Snapping ribs is unfortunate but a regular occurrence when called to senior care facilities.CPR only really works on the otherwise healthy. The compressions to ventilation ratios keep changing because they still have not found a ratio that has made a noticeable difference.
So don’t get caught up on the numbers.
Defibrillators save lives but they don’t keep them alive, unless you can get the afflicted to a hospital or higher care with in a short period of time (3hrs max) they will most likely tap out again if you can get them back.

I will not go off shore with an individual with a cardiac condition, I’ve done CPR in vain to many times. A dead body on a boat offshore is something I never want to experience.

Cheers

[SV-Viento]

CVICU RN here. Lots of good experience shared. Two things I would add. I think the value of knowing cpr on A boat would be if youre very close to land and additional help is close enough to assist quickly. Secondly and in the words of one of my favorite intinsivist - when we do cpr you are dead - happy to compress, shock, give med, intubate or do nothing but keep you comfortable - always best when we know what the patient wants. When not we give you the full monte.

[GordMay]

Originally Posted by Tom_F

... Also, an AED is not used when someone is asystole (has no heartbeat) or is in cardiac arrest. An AED is used when someone is suffering from fibrillation (I forget whether atrial fibrillation, ventricular fibrillation or both) - when the heart is beating so fast that it cannot fill with blood sufficiently to pump oxygenated blood throughout the body. An AED works by stopping the person's heart and hopefully resetting the electrical issue that is causing the fibrillation. The nonsense you see on TV and in movies where they use a defibrillator to save someone who has flatlined is just that - nonsense...

To shock or not to shock?
That is the question for your AED.


In fact, that is exactly what an AED determines, once its pads are attached to a patient: whether or not the detected heart rhythm can be treated with defibrillation.
Contrary to many fear-based narratives, an AED will NOT deliver a shock, until it has fully analyzed the patient’s heart rhythm, and determined that a shock is medically necessary.
When an AED detects VT [V-tach] or VF [V-fib], quick defibrillation is a crucial treatment that can help save lives.

As Tom notes, Asystole and Pulseless Electrical Activity [PEA] aren't shockable rhythms.

The best treatment for these rhythms is continued CPR, medications, and trying to correct any underlying identified causes.

Asystole [AKA: “flat-line”] is when your heart's electrical system fails entirely [no detectable activity, at all], which causes your heart to stop pumping [completely], resulting in “clinical death”.
Asystole is part of cardiac arrest, which is a medical emergency where every second counts. While it’s only possible to confirm asystole with an EKG, the treatment for cardiac arrest is the same, no matter what the cause.
Asystole typically occurs as a deterioration of the initial non-perfusing ventricular rhythms: ventricular fibrillation (V-fib) or pulseless ventricular tachycardia (V-tach).
Asystole isn't a shockable rhythm, and defibrillation may actually make it harder to restart the heart. Defibrillation is only an option, if your heart goes from asystole, to a shockable rhythm, which is possible, when someone with asystole receives effective CPR.


When cardiac arrest happens, outside of a hospital, the most important thing is to immediately start CPR, and continue it until emergency medical personnel arrive. Effective, continuous CPR offers the best chance of survival.

See also :
“Shockable Rhythms: Ventricular Tachycardia, Ventricular Fibrillation, Supraventricular Tachycardia” ~ by Advanced Cardiac Life Support (ACLS)
➥ https://acls.com/articles/shockable-rhythms/

Cleveland Clinic ➥ https://my.clevelandclinic.org/healt...defibrillation


London Health Sciences Crentre, Critical Care Trauma Centre:
➥ https://www.lhsc.on.ca/critical-care...a-centre-263#2