The American Heart Association CPR guidelines have recently changed. Resuscitation outcomes improve when high quality chest compressions are started immediately. High quality CPR is defined as “pushing hard and fast”. Below are 6 key changes to understand and keep in mind from the American Heart Associations’ 2015 Guidelines for CPR & Emergency Cardiovascular Care.:

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PUSH HARD & FAST

1. Rate:

In 2010, the recommended rate was “at least 100 compressions per minute”. The 2015 update to the CPR guideline now reflects a target compression rate of 100 to 120 per minute. The reason for the addition of an upper rate limit is that rates faster than 120 will likely result in decreased cardiac output due to incomplete cardiac filling during chest recoil.

2. Depth:

A similar refinement of the guideline is compression depth. The 2015 guideline now defines the target depth for compressions as between 5 and 6 centimeters, or between 2 and 2.4 inches. Why this change? Research reviewed by the AHA revealed that compressions delivered beyond that depth may result in increased risk of resuscitation-related injuries to the victim.

3. Technique:

The AHA’s guidelines continue to point out that rescuer technique will play a major role in the quality of compressions delivered. In resuscitations outside the classroom, rescuers are likely to provide compressions that are too slow, too shallow, and interrupted too often. The importance of psychomotor skill training to develop good technique, with frequent knowledge and skill refresher training continues to be emphasized by the AHA. During training and refreshers, detailed feedback, especially on rate and depth of compressions, should be provided.

4. Sequence:

The 2010 change from the traditional A-B-C sequence to the C-A-B sequence was confirmed in the 2015 guidelines. The emphasis on early initiation of chest compressions without delay for airway assessment or rescue breathing has resulted in improved outcomes.

5. Ratio:

For trained rescuers, the guidelines continue to recommend traditional CPR’s cycles of 30 chest compressions to 2 rescue breaths for single rescuer CPR in all age groups, and 2 rescuer CPR in adults. The 15:2 ratio of compressions to breaths remains the guideline for 2 rescuer CPR for children and infants.

6. AED:

AHA continues to call on communities to increase public access to AEDs. Additionally, the focus on high-quality compressions is also reflected in the continued recommendations supporting compression only CPR, or “hands only” CPR delivered by the general public. The AHA points out that most responders are likely to have a speakerphone equipped cell phone, and bystanders calling 911 can be instructed by EMS dispatchers to perform hands only CPR.

After a person completes corporate onsite CPR training, they’ll be prepared to respond in a number of different emergency situations. If someone collapses, they will be able to apply their training and respond appropriately. They’ll even be trained to use the AED, the automated external defibrillator, to provide electrical stimulation to the heart and help the heartbeat at a normal rhythm. Some of the reasons why someone may need CPR include choking, suffocating, electric shock, severe allergic reaction, and drowning.

Though there are a variety of reasons why a person may require CPR, two of the most common reasons are heart attack and sudden cardiac arrest. These two conditions are related, but they are not the same. Unfortunately, if you don’t have a medical background, it is likely that you don’t know the difference between a heart attack and sudden cardiac arrest.

Understanding the difference is important because it can help you respond more effectively during an emergency. It can also help you communicate more accurately over the phone and with medical professionals who arrive on the scene, and this can save precious seconds when they work to revive the victim. Corporate onsite CPR training can be a great way to teach coworkers more about heart attacks and sudden cardiac arrest and give them the tools to respond correctly in these life-or-death situations.

What Is a Heart Attack?

There is a lot of confusion among the general population about what is and isn’t a heart attack. A heart attack is caused when the blood flowing to a section of the heart is reduced or stopped completely due to blockage in an artery. Though heart attacks can be acute and happen suddenly, they are often more gradual. The artery becomes significantly clogged, and the reduced blood flow causes a part of the heart to get weaker and weaker until the symptoms become very severe.

During many heart attacks, the heart continues to beat, but not enough blood is reaching the heart. However, sometimes the person goes into sudden cardiac arrest. Individuals with corporate onsite CPR training may be able to provide CPR and use an AED to help the heart start beating normally.

What Is Sudden Cardiac Arrest?

Sudden cardiac arrest is when a person’s heart suddenly stops beating. There are many different reasons for sudden cardiac arrest, but it typically is related to the electrical signals that control the rhythm of the heart. If a person’s heart begins to beat too quickly, too slowly, or at an irregular rhythm, this can lead to sudden cardiac arrest. Corporate onsite CPR training can help teach employees how to check for a person’s heartbeat and identify if sudden cardiac arrest has occurred.

Though heart attacks and decreased blood flow can affect the ability of the heart to beat at a healthy rhythm, these two conditions are not always related. Sometimes a heart attack is not followed by sudden cardiac arrest, and sometimes sudden cardiac arrest occurs even though the person never had a heart attack.

Whether it’s a heart attack or sudden cardiac arrest, it’s important that the person get medical attention immediately. Coworkers should call 911 as soon as possible. If the person stops breathing or if their heart stops beating, it is very important that someone begins CPR and finds a nearby AED. Corporate onsite CPR training can be crucial in these situations. AEDs are especially important during sudden cardiac arrest, as they can restart the heart and prevent further damage or death. If you’d like to learn more about how we can provide corporate onsite CPR training to your company, contact us today.

Sources:

http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Heart-Attack-or-Sudden-Cardiac-Arrest-How-Are-They-Different_UCM_440804_Article.jsp

Today CPR is one of the most accepted and standardized techniques used by emergency responders, and corporate onsite CPR training is offered in almost every major company and business in the United States. Though this has been the case for decades, there was a time when the technique was less accepted by the public and the medical community.

Like other medical breakthroughs, CPR was not discovered all at once. Instead it was slowly studied and refined until it became the standardized life-saving procedure that it is today. From its beginnings in the 1700s, cardiopulmonary resuscitation has continued to evolve as doctors have learned more about the human body, and now it is an extremely effective way to provide emergency medical response to a person suffering from sudden cardiac arrest.

The Beginning

The first mentions of the procedures that would one day become CPR appeared in the middle of 18^th century. The Paris Academy of Science began to endorse mouth-to-mouth resuscitation for drowning victims in 1740.

Around the same time, the Society for the Recovery of Drowned Persons was organized. This organizations was founded in Amsterdam in response to the hundreds of citizens who died by drowning in the canals every year. Though not all of the society’s ideas were medically accurate or effective, some of their practices were very similar to how CPR is performed today. These practices would spread to other organizations that provided medical assistance to drowning victims, but it would still be some time before doctors and others studied these techniques in detail.

In the next 150 years, the medical community learned more about the human body and began to study resuscitation. Finally at the end of the nineteenth century two doctors, Dr. Friedrich Maass and Dr. George Crile, independently documented the medical use of chest compressions to resuscitate someone who had drowned. Dr. Maass performed and documented chest compressions, and Dr. Crile had similar success in 1903. From then on, medical organizations adopted chest compressions as a way to revive those who had drowned.

Mouth-to-Mouth CPR

Then in the 1950s, there was another breakthrough in cardiopulmonary resuscitation research. Dr. Peter Safar, Dr. James Elam, and Dr. Archer Gordon were able to prove that mouth-to-mouth resuscitation could provide adequate oxygen to the body and increase the chance of survival of a drowning victim. In 1956, they developed techniques that made mouth-to-mouth CPR more effective, and soon these practices were adopted by the U.S. military and emergency medical services.

In 1960, the American Heart Association started to teach physicians how to perform CPR. In the next decades, the practice became more and more accepted. The first large scale CPR training occurred in Seattle, Washington in 1972. Leonard Cobb led the training program called “Medic 2” which trained more than 100,000 people in the program’s first two years.

CPR in Businesses

Businesses also started providing corporate onsite CPR training, so employees could perform the technique during an emergency, and this became more and more common. Corporate onsite CPR training is now found in many of the world’s largest corporations and businesses. Not only does it help make offices safer, but it’s also a great team-building and leadership opportunity for organizations.

If you are interested in corporate onsite CPR training, there are many ways that you can provide training on a flexible schedule and give participants the chance to get certified in CPR. Our corporate onsite CPR training programs are designed to make CPR approachable and easy to learn, so that your staff will be able to use these techniques to save the lives of coworkers, family members, and anyone else who needs help.

Sources:

http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/History-of-CPR_UCM_307549_Article.jsp

Though CPR, which stands for cardio pulmonary resuscitation, has been around for a long time, many people don’t know exactly how it works, the science behind it, or how effective it is. This is too bad, because if the public better understood how important CPR is, more people would enroll in CPR training in NJ. Fortunately, more and more public schools are providing CPR training in NJ, and this is making all communities in the state safer. The number of corporations offering this training to employees is also increasing around New Jersey.

Though some people are turned off by the idea of having to perform CPR on total strangers, the truth is that most medical emergencies occur at home and at work. In addition to potentially saving the lives of strangers, CPR training in NJ can also help you save the lives of your family, friends, and others you care about. CPR training is most likely to save the life of someone you know and care about, and that’s why so many people are interested in learning how to safely perform it. Additionally, there are hands-only CPR techniques that can be learned that avoid mouth-to-mouth resuscitation for those who are squeamish about that type of technique.

CPR Saves Lives

Research conducted on CPR continues to show that CPR can potentially save a person’s life — about 92,000 lives every year. CPR can be an effective way to restore breathing and normal heart function, and it can increase a person’s chance of survival after

• sudden cardiac arrest
• heart attack
• choking
• suffocating
• almost drowning
• suffering an allergic reaction
• getting shocked with electricity
• overdosing on drugs

This isn’t to say that CPR will always save a person’s life. When a person requires CPR, their body is already under an extreme amount of stress, and the problems that caused their heart to stop may be too serious to repair with CPR. About 92% of people who experience sudden cardiac arrest do not survive before they arrive at the hospital; however, performing CPR immediately can double or triple that person’s chances to survive.

When a person stops breathing, every second counts. That’s why it’s so important that one of the first people who reach the victim can perform CPR without any hesitation. CPR training in NJ doesn’t just teach people how to perform CPR, which is relatively simple; it also provides each participant with the confidence they need to act decisively in an emergency situation.

Who Can Use CPR Training?

Everyone can benefit from learning how to perform CPR. It is not just something for lifeguards and medical professionals. Many businesses offer corporate onsite CPR training to their employees because it’s a great team-building exercise and increases the safety of every employee in the office. Most offices now have AED devices, which use electricity to restart the heart. During CPR training, employees can also learn how to use these devices which can save someone who’s in sudden cardiac arrest.

CPR training in NJ is also popular among private citizens who want to be able to perform CPR for their family members and friends. When there is an emergency, it is very important that someone nearby can perform CPR immediately before the medical professionals arrive.

If you have family members with heart problems, children with congenital defects, or just want to be prepared for an emergency, CPR training is right for you. We provide different types of training and certification to give you the tools you need to save someone’s life. Contact us for more information about our next session of CPR training in NJ.

Sources:

http://lasvegassun.com/news/2015/jul/13/how-perform-adult-cpr/

Do you provide corporate onsite CPR training for your employees and coworkers? If not, you should think about looking into CPR training programs and seeing if it’s something that your employees would be interested in. CPR training is important and useful for everyone, no matter their age or profession. The skills were once limited to lifeguards and medical professionals, but now more and more people are learning how to perform CPR because of the great benefits that the training can provide. Here are some of the biggest benefits of corporate onsite CPR training. If you’re interested in providing training to your employees, contact us today.

1. Giving Your Employees Confidence

The idea of being thrust in a situation where you have to save someone’s life is very intimidating for most people. Without an understanding of CPR and training, many people feel helpless in these situations, and even if these situations never occur, the fact that they don’t know how to act can make them less confident. After completing CPR training, your employees will feel more confident because they know that they could potentially save someone’s life during an emergency.

2. Team-Building and Leadership

Whenever your team has to work together, learn something new, and take on a new task, it’s a great opportunity for team-building in the office. Office safety is a fantastic project that can bring together employees from different departments and parts of an office, allowing them to collaborate and work together. Corporate onsite CPR training and first aid training can be part of these types of projects, or can be a great way to kick off an office safety program.

3. AED and First Aid Training

CPR programs do not focus solely on how to provide CPR. These programs can also teach your employees how to provide first aid and how to use an automated external defibrillator. This type of training will give your employees the skills to respond in any type of emergency situation in the workplace.

4. Saving Lives at Work

Ultimately, you provide corporate onsite CPR training so that your employees can use it if there is ever an emergency. Immediate CPR and defibrillation can be the difference between someone living or dying, so it’s extremely important that someone nearby is trained and ready to help. Only about 10% of people who suffer sudden cardiac arrest are able to survive by the time they reach the hospital. Providing CPR and defibrillation correctly and right away can double or even triple a person’s chance of surviving.

5. CPR for Families and Children

Not only will CPR training make the office safer, it will also make your employees’ homes much safer in the event of an emergency. Almost 90% of sudden cardiac arrests occur in the home, and with the proper training, your employees will be able to perform CPR on loved ones and family members. This type of training is especially important if family members have heart problems or if there are young children in the household. If a child has an issue, someone trained in CPR will know how to adjust the technique to make it more effective on a child.

These are just a few of the many benefits of corporate onsite CPR training. Your employees will be very grateful to you for providing corporate onsite CPR training, and the program will be very beneficial for your organization as well. Corporate onsite CPR training programs can be customized to include AED and first aid training, and they can be scheduled to be more convenient for a busy office with lots of deadlines. Contact us for more information.

Sources:

http://www.cprcpr.com/5-benefits-of-learning-cpr-in-san-jose/

I want to get a certification. That’s it!

Well, a large number of people want to enroll for CPR classes only for the sake of a certification. Most hospitals and healthcare organizations require their employees to have basic knowledge regarding First-Aid, CPR and AED. A person looking for a certification to just get employment in such organizations, has endless options of classes to choose from.

A simple “CPR class” search on Google will fetch a long list of agencies and a variety of training classes for enrollment. However an overwhelming majority of these online agencies have absolutely no standards in granting a certification. They are there to just make money. These agencies may provide a handbook on CPR and conduct an online test before granting a certification. As a matter of fact, a large number of them just hand over a certification for simply registering for the course and paying the fees.

Nonetheless, whether the employing organization will accept the certification from a particular online agency or not is completely at their discretion. Therefore, it is better to know which certifications they accept beforehand, if possible.

I want to learn to administer CPR

It is impossible to learn CPR without some actual practice in the presence of an instructor. The actual practice is done on a mannequin in a CPR class. Only some agencies go to the lengths of providing a mannequin and an experienced instructor to train the students. When I say experienced instructor, he should be someone who has had hands-on experience of administering a CPR. Having someone who has worked as a paramedic or a nurse is the best bet. Likewise, the classes which require their students to demonstrate competence in CPR administration, for awarding a certification are trustworthy.

Various hospitals and EMS providers conduct weekend CPR classes, which are, more often than not, quite good too. But, generally they do not offer certifications for attending their classes.

Remember to ask these questions before enrolling for a CPR class.

• Is hands-on training available?
• Is there a mannequin available on which you can perform chest compressions? Will each student get one to practice? 
• Is the instructor experienced?
• What was the nature of his previous job? Did he have the opportunity to perform CPR?
• How rigorous is the training?
• Are there any tests for awarding the certification at the end of the training?

I want to learn as well as get a CPR certification

The certifications awarded by various CPR classes are not valid universally. Whether a certification is considered valid is purely at the discretion of the person and/or the organization asking for it. Overall, there are only 2 organizations whose certifications are widely, if not universally, accepted. They are American Heart Association and American Red Cross. These organizations are known for their excellent training programs. On the other hand, depending on your location, they may not have year-round classes. It is therefore recommended to check for their class schedules in advance.

1. No practical Exposure

Let me be blunt about this. You are not competent enough to administer a CPR unless you have practiced it on a mannequin in a live class with an instructor monitoring your actions. Despite of this, the online agencies offer nothing more than some reading material on CPR and a test for awarding a certification. As a matter of fact, most agencies do not even conduct the test and when they do, it is only a formality and has no bearing on your being awarded a certification. There is absolutely no learning involved in the online CPR certifications that would help you in a real-life situation.

2. Absence of a Regulatory Norm

There is no dedicated government body to oversee the operations and certifications awarded by the various CPR training agencies. All the agencies, whether online or traditional, have their own approaches. They have their own course material and practice guidelines. Although American Heart Association releases updated CPR guidelines, it is up to the agencies whether to adapt the latest guidelines or continue with the older procedure. American Heart Association and American Red Cross are two of the most trusted agencies which offer reliable online certification programs. Granted, these organizations have online training programs, but they too mandate in-person skills assessment to award the certification.

3. Certification Acceptance issues

If you are looking to get an easy certification to fulfill a job requirement, be wary of the online certifications. The acceptance of a certification from a particular agency is solely at the discretion of the employer. If the employer feels the online agency is not qualified or credible enough to grant a certification, then the certification has no weight to it. This is especially true in case of obscure online agencies with no practical training involved.

4. Complications of CPR

About 330,000 cardiac arrests happen every year in U.S. alone. A majority of them are at home. That is to say that, an overwhelming majority of people suffer cardiac arrests at home in the presence of other people. The people present at the location during such an emergency, could be the only hope of survival for the victim. A good CPR can considerably improve the chances of the patient’s survival. If the person giving CPR is not well versed with the technique and only knows theoretical concepts from the course material provided by an online certification agency, the victim`s chances of survival are greatly reduced. A badly administered CPR may leave the patient with broken ribs, lung contusion, heart contusion or other injuries.

Whether you wish to learn a lifesaving skill or get the certification to land a job, it is paramount that you enroll for a traditional classroom CPR training class.

1. Am I allowed to do a CPR if I have do not have a certification or never attended any CPR class?

Yes. CPR certification or class training is not mandatory for you to spring to action and extend your valuable help to save a fellow human being`s life. However, some country laws require you to ask for victim`s permission before you perform a CPR on them. CPR classes make you aware of such legal obligations to be mindful of, in the event of such emergencies.

2. Am I obligated to perform a CPR on a victim in emergency, if I am CPR certified?

Except in the state of Vermont, there is no legal obligation in the U.S. for a fellow-citizen to administer a CPR on an emergency victim. The state of Vermont has the Good Samaritan Law (Duty to Aid the Endangered Act), which puts an obligation to a fellow-citizen present in an emergency to extend all the reasonable help that could be provided to the victim. This includes a CPR as well. However, the case is different for professional rescuers such as a firefighters, EMS’s, lifeguards and so on, for whom it is a duty to perform CPR on the victim, if required.

3. Is it better to join a traditional classroom CPR class or an online CPR class?

There is no better way to learn the lifesaving skills than practicing them live on a mannequin. The experience of practicing while being continuously monitored and advised by an instructor is the best method to learn the procedure. Online classes neither offer the depth of knowledge nor the experience that is characteristic of traditional CPR classes.

4. How often do I need to take CPR classes to remain competent in administering a CPR?

With advances in medical science, our understanding of CPR and its effects improve continuously. The CPR guidelines are updated regularly to reflect these changes. In order to keep yourself updated to the latest guidelines and to have enough practice on a regular basis, it is generally recommended to retake the certification every 12 months or less.

5. Are online CPR certifications valid?

Since there is no national level regulatory body to monitor the activities of various CPR training agencies, a number of online CPR certification agencies have cropped up. Their standards for awarding a certification are very low and therefore, it is entirely up to the employer to consider or reject the certification from an online agency.

6. Are the CPR classes different for amateurs and professionals?

Yes. A professional agency such as the American Heart Association has customized training programs for amateurs learning to become capable of saving a loved one in emergency and for professionals such as a daycare provider or a nurse. On a broad level, the CPR classes train students in administering CPR on adults, children and infants. While amateurs are generally trained to provide CPR to adults, the professionals are trained based on their professional requirements.

7. Do I need to pass an examination or a test to get a CPR certification?

All good CPR training agencies require their students to pass a skills test, during which they are required to demonstrate their CPR administration skills in practice. Depending on their performance in the test, they are awarded a certification. Even the well-known CPR training agencies which offer online programs, require the students to perform a physical skills demonstration to award a certification. Nevertheless, many agencies give away certifications without conducting any test and when the tests are conducted, the students are hardly rejected.

1. Legal Implications:

An emergency requiring CPR is naturally a life and death situation. Consequently, the legal implications of the actions by various parties during the situation are also serious. Although it is the duty of a CPR professional to act and tend to such an emergency, considerations such as consent, scope of practice, confidentiality, documentation and so on are equally important. The classes train participants on the legal considerations and proper behavior to be followed with the victim.

2. Protection against pathogens

The professionals are trained on the various methods of preventing the spreading of blood-borne pathogens from the victim. It is possible that an emergency victim is a patient of blood-borne diseases such as Hepatitis B, Hepatitis C and HIV. Therefore a professional should be well versed with precautions to be taken against exposure to such pathogens and also know the steps to be taken if an exposure occurs.

3. Primary Assessment

One of the first things a professional is required to do in an emergency is to assess the conditions of the victim. Unconsciousness, breathing, pulse and bleeding are to be checked. The accuracy of the assessment is critical, for the correct administration of life-saving techniques to the victim. Classes discuss in depth, the steps to be taken during assessment of victims in various emergencies such as spinal injuries, drowning, vomiting and so on.

4. Respiratory Distress Situations

In the pandemonium that ensues an emergency, it is difficult to notice important clues on the conditions of the victim such as Hypoxia, Choking or slow breathing. Professionals are trained to look for a dozen symptoms of respiratory distress in a victim and the assistances they can extend the victim.

5. Cardiac Emergencies

This could be a tricky subject for a non-professional since the symptoms of cardiac emergencies are easily confused with muscle spasms or indigestion. A late response in identification of and response to a heart attack could mean death to the victim. CPR Professionals are trained to recognize the various causes and symptoms of a heart attack so that they can tend to the victims.

6. Administration of CPR

CPR is a fairly complex technique and requires considerable skill on part of a professional. Factors such as hand position, chest compression rate, ventilations and others, have to be properly monitored while administering a CPR. These factors also depend on the age of the victim.

7. Two-Rescuer CPR

In this method, one of the rescuers gives chest compressions, while the other administers ventilations in a synchronized manner. Since those few precious moments of emergency can be a deciding factor between life and death for the victim, an extra pair of hands is an advantage. The CPR classes train the participants on how to administer a two-rescuer CPR in sync with each other.

8. Automated External Defibrillator (AED)

Most classes on AED may not cover the topic of AEDs for the simple reason that it is not something that is readily available to everybody in an emergency. They are available mostly with the Advanced Medical Personnel. However, some classes do cover AEDs in varying depths of detail. Typical knowledge explored in AED sessions include using an AED on adult, child and infant, precautions to be taken with AED and so on.

Most of the information on CPR is easily obtained online. But it is a fairly complex task and requires considerable skill on part of you to administering it. Therefore, it is your duty, as a responsible fellow human, to practice these skills in person in classes. What`s more, as someone with such life-skills, the people around you can depend on you to tend to them during an emergency.

Jeffrey M. Goodloe, MD, NREMT-P, FACEP | From the EMS State of the Science 2014 Issue

As you’ll read in multiple other sections of this supplement, we continue to discern insights into more effective treatment approaches to out-of-hospital sudden cardiac arrest. In reality, we’ve collectively learned more in just the last decade than ever before about the pathophysiology of cardiac arrest.

With considerations about cooling (therapeutic hypothermia), chest compression continuity and alternative ventilation strategies, is there really much to talk about when it comes to something as simple as the rate of chest compressions?

“So, Dr. G, what’s your interest in chest compression rate? The American Heart Association (AHA) says to compress the cardiac arrest victim’s chest at least 100 times a minute. That’s all there is to it, right?”

That’s a good place to start and an understandable question. For purposes of this particular conversation, let’s discuss victims who are of adult age. You’re correct in your interpretation of the AHA guidelines released in late 2010.1 How the 2015 guidelines on chest compression rate will change, if at all, is unknown.

There’s been some interesting science published regarding chest compression rates since those 2010 guidelines.2,3 I’m quite sure the clinicians and scientists charged with formulating those 2015 guidelines will certainly take such discoveries into account. The fact is — no surprise here, I think — nothing is very simple when it comes to a condition as dynamic, dramatic and challenging as cardiac arrest.

Key among the latest scientific papers on chest compression rate is work done by Dr. Ahamed Idris and his colleagues in the Resuscitation Outcomes Consortium. In short, Dr. Idris and the research team found that exactly 100 chest compressions per minute didn’t produce the highest number of survivors among the large group of cardiac arrest victims who were treated by systems that participate in the ROC.4

The “sweet spot” of chest compression rate in that review, published in 2012, was much nearer to 120 chest compressions per minute.4 So, you might say that the AHA is still right because 120 compressions per minute fits the definition of “at least 100 times a minute,” although so does 140 compressions per minute, correct?

“The patients (and their families) we treat often think more is better, and if we want to be honest, many EMTs and paramedics subscribe to that belief about a lot of interventions. That said, I bet you’re getting ready to burst that bubble and tell us 140 compressions per minute may not be better?”

Actually, I’m not going to say 140 compressions per minute may not be better than a rate of 120. Instead, I’m going to say, based upon the Idris paper, that 140 compressions per minute are definitely not better for survival than 120. In that report, a very compelling graph is presented that I choose to describe as a “wave of survival per compression rates.”

The reason I call it a “wave” is that a curve implies an even rise and fall and this isn’t that. The scientific term for the actual curvilinear shape is a cubic spline model, but that’s hard for a guy like me to immediately grasp. I can visualize a wave that rises and then fades out, and I think most people can as well.

So back to that study, it’s not too hard to imagine that survival proved lower at rates less than 100 compressions per minute and then there is a slow increase to a peak in survival near 120 compressions per minute.

Here’s my key point: After 125 and towards 140 and beyond, the survival line drops off! That’s why this study is so important in my opinion, and I trust the researchers, their method of study, plus the number of patients involved was large. This is science you and I can use in our quest to produce more neurologically intact survivors from out of hospital sudden cardiac arrest.

“Why do you think 140 isn’t better than 120? Besides, are people in real life compressing at 140 anyway? That seems pretty fast and not what’s taught in the first place.”

Let me break that up into two answers. First, we have to think about this amazing organism that is the human body. What happens when you and I decide we’re going to get our particular organisms in better shape and do some aerobic conditioning or weightlifting? Why does our heart rate rise and breathing increase? We are doing the “Magic C” as I call it — compensating!

That workout-induced tachycardia and tachypnea is getting greater-than-usual oxygen-enriched blood flow to muscles that require it to perform what we’re asking of them. As long as we are pulsatile, and your patient is pulsatile, our human bodies will stretch compensation to impressive levels. But, what happens when pulsatile becomes pulseless? Compensation ceases, at least the intrinsic compensation.

So what’s the extrinsic compensation during CPR? You. Me. Your partner(s). Bystander(s). CPR is, in one word, compensation.

What percent of compensation do you and I have to attain for a person when we do CPR? 100%! Sobering, huh? We don’t even get to outsource 1%; that 100% needs to be the very best it can be, at least according to the best understanding of what works today.

As important as each compression is, the decompression phase is just as important because that’s when intrathoracic pressure drops and blood flow can return to the heart to be available for flow from the heart on the next compression. Think about the last sick patient you had in a true tachydysrhythmia with a pulse? Why were they so weak, hypotensive and likely even hypoxic? The rapidity of their pulse prevented good cardiac output and perfusion, both to central and peripheral circulation.

We may not be so worried about peripheral perfusion in cardiac arrest, but if our compressions are going to produce helpful cerebral and coronary perfusion pressures, we have to let enough decompression time occur. That doesn’t happen if we compress at 140 times a minute.

So do professionally trained EMTs and paramedics compress that fast anyway? Actually, yes, a lot do. Good – hearted, enthusiastic police officers, firefighters, EMTs and paramedics perform too many compressions. How do I know this? Back in 2011, we discovered in the process of reviewing chest compression fundamentals with each and every EMT and paramedic in the EMS System for Metropolitan Oklahoma City and Tulsa, that without a metronome to guide compressions, nearly 90% of these incredibly well-trained men and women were compressing somewhere between 135–145 times per minute!

That really opened my eyes. It affirmed to me several things: 1) We have EMS professionals in our system who really care about — and work hard at — treating cardiac arrest. Even in training scenarios, their adrenaline kicks in and they go after it! I had honestly thought if we did start using metronomes set at 120 beeps per minute, directly influenced by that ROC study we’ve been talking about, those metronomes would be needed to speed up the rates. But, I was wrong. The reverse was true; we were compressing too fast and the metronomes would help us to slow down.

It became crystal clear to me we needed to begin using metronomes to change natural compression rate tendencies. This turned out to not just be a positive for the patients, but our crews also, because we were actually able to reduce the physical work necessary in performing optimal manual chest compressions.

“Cool, Dr. G. So just compress at 120 a minute in adults, use metronomes set to that and that’s all there is to it?”

Even with what we’ve discussed so far, there’s more to it. To prove the point, I’ll share with you now that we recently changed our compression rate guideline, and metronomes, to 110 compressions per minute in rate.

“What?!?! How does that make sense based upon what we’ve been talking about?”

Back to the “nothing is really simple when it comes to cardiac arrest” mindset. In our particular system, we currently don’t use mechanical chest compression devices like the Physio-Control LUCAS 2 chest compression system or ZOLL AutoPulse non-invasive cardiac support pump. We use a team dynamic plan for coordinated resuscitation (aka the “pit crew” approach). The most common resuscitation in metro Oklahoma City or Tulsa has 5–8 EMS professionals on scene within 4–10 minutes.

In addition, one of the devices we choose to use in our airway management and cardiac arrest care is the ResQPOD impedance threshold device (ITD) for its capability of reducing intrathoracic pressure during decompression — another important factor in cardiac arrest resuscitation.

Further, because of the emphasis we’ve been placing on the continuity of chest compressions and getting quick feedback to our colleagues about how consistent in rates and continuity that their compressions were or were not in individual resuscitations, we’ve seen our chest compression fraction (time of resuscitation in which chest compressions are occurring) move from a typical 85% to more than 95%.

Without getting too far down in the weeds of science, it’s important to point out that use of mechanical chest compressors and/or the impedance threshold device can influence the basic physiology of hemodynamics produced by compressions.

Through very in-depth conversations that I’ve had over the past few years with the clinical scientists who developed the impedance threshold device, it appears that the ideal compression rate for CPR without an ITD, as reported in the Idris paper, differs from what’s ideal if an impedance threshold device is used in-line in the airway circuit.

It seems the best rate when using an impedance threshold device is much closer to the 100 compression rate per minute; in fact, in subsequent data analysis, the best overall survival in the ROC study occurred in patients who received an active ITD with chest compression rates close to 100/min. So, we’re slowing down to 110 for now, primarily based upon both this specific data analysis and our system-specific chest compression fraction and effective compressions per minute. We’ll continue to follow our survival outcomes and adjust our chest compressions rates as further observation and science dictates.

To illustrate how complex this can get, if active compression – decompression CPR with an ITD finds its way to the streets of the United States, that ideal chest compression rate may be as low as 80/min according to a recent U.S. study!

It does make sense when you appreciate that all of these things produce different compression types and intrathoracic pressure and, thus, different compression types and adjuncts, like the ResQPOD ITD and mechanical compression devices, will produce different optimal rates.

Just remember, it still is all about survival and there are a lot of “fine tuning” knobs to turn back and forth as science gives us updates to our user’s manual for resuscitation.

“Wait, Dr. G. So you’re talking a lot about rate, but not so much specifically about metronomes. Seems like those are more important than you first thought and if anything, they’re getting even more important. Why don’t the monitor/defibrillators have metronomes adjustable from 100 per minute? Should we ignore those? And, what metronomes should we be buying?”

First, you’re right. Metronomes are far more important than I first thought. In fact, credit goes to paramedics in our system who pushed the concept. I’ll claim to be smart — smart enough to listen to what proved to be their great idea.

Those early metronomes came about because not all the responding companies (fire-based) had manual monitor/defibrillators and not all of our monitor/defibrillators had built-in metronomes at the time. And, for my manufacturing colleagues reading this article, I’ll admit some frustration at the lack of their built-in metronomes being changeable in rate. But, I’ll also admit that I understand the frustration that these manufacturers have themselves because they can’t put a “dial the rate up or down” knob or touchscreen on their devices without a time-intensive and costly journey through the Food and Drug Administration review and approval process.

Should you ignore those metronomes that come with the cardiac monitor/defibrillators? Not if your local medical oversight physician(s) want you to use them. If they do, please use them per your system-specific treatment guidelines.

In our system, we’ve purchased musical metronomes that do allow for rate changes. This made it possible to start at 120 beeps per minute, change to our current 110 beeps per minute, and still allow for future changes. I’m pretty sure these music industry companies have no idea what paramedics are doing ordering dozens of metronomes. They probably think we’ve got some great garage bands in urban Oklahoma!

Many options exist in the marketplace. I recommend you try to find something that’s easy to activate and see or hear, with the durability of the proverbial EMS steel ball, something that allows for rate changes (but doesn’t allow crews to change it to undesired rates or allow unintended changes in rates), and something sized to promote ready accessibility.

There are a lot of smartphone apps with audible and visual metronomes that are adjustable as well. We considered use of smartphone apps, but didn’t want to ask our EMS professionals to use their personally owned devices in the provision of resuscitation.

Many of the agencies in our EMS system have found great ways to physically attach  metronomes to the outside of their AEDs or manual monitor/defibrillators so initial arrival EMTs and paramedics don’t have to go fishing in a pocket or compartment to find it in the early and chaotic first minutes of resuscitation. Easy access always promotes consistency in early use.

“So, Dr. G.: What kind of improvement have you seen in resuscitation practices in the EMS System for Metropolitan Oklahoma City and Tulsa since your crews started using these metronomes during cardiac arrest resuscitations?”

We made an assumption when the pit crew protocol was finalized and initially implemented, that the medics were providing 120 compressions per minute per our protocol. All of the involved agencies had metronomes at that time and there was nothing to lead us to believe this rate was in question.

When we participated in a cardiac arrest resuscitation analytics annotation pilot project sponsored by one of our industry partners in February and March of 2014, we found that the compression rates on some cases were alarmingly high while others were at or near 120. So we added a field to the data we collect and the CPR rates have been continuously tracked since that time.

One of the things we found early on was that some of the smaller sized metronomes were not being used for various reasons. In some cases, it was simply because the crews forgot to use them, though in others it was because the Velcro that had been used to attach them to the monitors had become worn and the metronomes either fell off and were lost, or they were simply placed in the monitor case where EMTs and paramedics didn’t know they were relocated. Like they say, out of sight can equal out of mind!

We also learned that environmental noise can cover the sound of the metronome, so, whatever metronome you use, it has to be capable of being heard and/or seen. The metronomes built into the cardiac monitor/defibrillators do seem to solve that problem, but I want to caution that I personally don’t think 100 compressions per minute for all cardiac arrest patients, in all resuscitation practices is the optimal rate as we know it today.

In all of the cases in our specific system when the metronome wasn’t used, the compression rate was certainly faster than the 120/min we desired. Interestingly, when the ambulance would go en route to the hospital, rates often jumped almost immediately from around 120 to 130 and above.

After we mounted a concerted effort to have the providers utilize the metronomes and began revealing the patterns in compression rates at our monthly CQI meetings and additionally in emails to the education departments in our system agencies, we found almost immediate elimination of extreme compression rate deviations (e.g., greater than 160/min).

Our typical rate is now 123/min. Keep in mind we’re still rolling out the change to 110/min. This is down from 129/min. It doesn’t sound like much, but there are nearly 100 workable arrests every month in our system and that’s a great achievement by our fire and EMS crews in focusing on hitting that compression “sweet spot” of compressions per minute. We believe it has strongly contributed in  increasing our successful resuscitations.

“Thanks, Dr. G. Do you have any parting thoughts?”

It’s an exciting time in EMS resuscitation.  It takes work on everyone’s part to keep pace with the findings we’re putting into practice. Thanks for your commitment to excellence in out-of-hospital EMS medicine by reading this article. Together we’re finding better answers to challenges like cardiac arrest, answers that truly make a life or death difference to people we serve, and when they need those answers most. Keep reading and asking questions because scientific discoveries are happening in EMS medicine now more than ever.

References

1. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(suppl 3):S640–S656.

2. Field RA, Soar J, Davies RP, et al. The impact of chest compression rates on quality of chest compressions: A manikin study. Resuscitation. 2012;83(3):360–364.

3. Jäntti H, Silfvast T, Turpeinen A, et al. Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins. Resuscitation. 2009;80(4):453–457.

4. Idris AH, Guffey D, Aufderheide TP, et al. The relationship between chest compression rates and outcomes from cardiac arrest. Circulation. 2012; 125(24):3004–3012.

5. Aufderheide TP, Nichol G, Rea TD, et al. A trial of an impedance threshold device in out-of-hospital cardiac arrest. N Engl J Med. 2011;365(9):798–806.

6. Aufderheide TP, Frascone RJ, Wayne MA, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: A randomized trial. Lancet. 2011;377(9762):271–352.

7. Kern KB, Stickney RE, Gallison L, et al. Metronome improves compression and ventilation rates during CPR on a manikin in a randomized trial. Resuscitation. 2010;81(2):206–210.