CICM SAQ 2010.1 Q15

Question

Chest compression only CPR should replace the current guidelines on CPR.

Critically evaluate this statement.


Answer

Answer and interpretation

Reasons supporting the statement:

Physiological:

  • In cardiac arrest heart dilates acutely. Decompression of the heart occurs with good compressions
  • Ventilation can lead to decreased venous return
  • Passive ventilation still occurs with compression only CPR
  • Gasping can provide adequate ventilation and in presence of a partial airway obstruction may lead to increased venous return

Logistic reasons:

  • Reluctance to perform mouth to mouth by rescuers therefore some people do not attempt CPR.
  • Interruption to compressions therefore limiting their effectiveness
  • Easier to teach compression only CPR.
  • Out of hospital arrests it will minimise time to hospital. e) Useful particularly in the setting of a single rescuer

Studies:

  • Mostly observational or animal. Some RCT
  • No difference in outcome using compression only versus standard CPRs in most studies Evidence of value of good compressions

Against:

  • Most studies are observational.
  • Reported survival is no better with compression only therefore why change.
  • Data for most studies are prior to the change in recommendation to 30:2 RATIO Ventilation is important for many arrests e.g. drowning/children/in hospital arrests ARC not recommend as standard practice

Present position:

  • Not standard currently. Wait further studies. It can be used if rescuer is reluctant to use mouth to mouth

Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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