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Overview

The current push for the adoption of compression only or cardio-cerebral resuscitation (CCR) for lay person rescuers has gained some momentum in the market. The American Heart Association (AHA) has made clear statements about the use of CCR by those who are unwilling or unable to provide mouth to mouth ventilations¹  [read more=”Read more” less=”Read less”]

However, the studies supporting CCR do not provide adequate scientific evidence of sufficient power to make recommendations for a change in the Guidelines. Certainly there are a number of studies that point out the negative aspects of CCR for a number of patient groups – unwitnessed arrest, asphyxial arrest, drowning etc. The studies undertaken to date also do not show improved survival with CCR over standard CPR. In fact some show a slightly lower survival rate with CCR³. In a 2017 Guidelines for CPR Update published in Circulation² it is stated that: ”patients receiving continuous chest compressions had a lower rate of return of spontaneous circulation, worse 1-month survival (odds ratio, 0.75; 95% CI, 0.73–0.78), and worse 1-month survival with good neurological outcome (odds ratio, 0.72; 95% CI, 0.69–0.76) compared with those receiving CPR using a ratio of 30 compressions to 2 breaths”.

However, if the CCR method of providing resuscitation is used by lay persons, then the importance of providing good ventilations to remove the hypoxic and hypercapnic effects of CCR (created by no ventilations being provided by the lay person responders) falls squarely on the shoulders of those with a duty to respond – Fire Fighters, Police Officers and EMS personnel.

 

Discussion

While old technologies for ventilation used by responders generally fail to provide adequate ventilation, the adoption of new technologies to aid ventilations has been slow. Not only does technology create new devices to provide ever more sophisticated protocols to improve patient survival, it also creates devices that assist in the way in which everyday skills are applied. And yet, often despite a lack of high level clinical evidence, the former (and some might say more glamorous) technologies are often more readily adopted by the market than the latter. This is certainly true of ventilation where there appears to be a general overconfidence amongst healthcare providers that ventilations are being well performed and that they do not require any technological assistance in ventilating their patients. This is despite strong clinical evidence to the contrary⁵.

 

Conclusions

There are many new technologies that can assist healthcare workers in providing significantly better ventilations with less deleterious effects on the patient. If these technologies are not embraced then, where response times are greater than 5 minutes and the patient is not gasping, the detrimental effects of no ventilations being provided, while hopefully improving circulation, may not provide for improved survival rates and may even reduce the success levels still further if current research provides an accurate indication.

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