Savaser: I think this helps in the context of drowning. If a lay responder has no other training but is willing and able to perform chest compressions, they should do so regardless of the type of arrest. In drowning, the heart typically doesn’t stop beating until oxygen reserves in the blood are depleted. In VF and VT, there is still oxygen in the blood after the heart has stopped. Compression-only CPR is not appropriate for drowning. Bystander CPR does not address drowning or any other causes of cardiac arrest. Schmidt and Sempsrott: Compression-only CPR administered by bystanders is applicable only to witnessed ventricular-fibrillation (VF) and ventricular-tachycardia (VT) arrests as a bridge to be used until an AED can be applied. Do you think this approach helps or hurts in cases of cardiac arrest that result from drowning? The beauty of an algorithm is that it is simple to follow - you have one task and one series of actions to complete there are no alternatives.Įmphasis on bystander CPR (CPR by people with minimal training) has been moving toward compression-only CPR because it is easier to do and does not delay compressions with ventilation time. ![]() As long as the compressions are done well, it probably doesn’t matter which is done first.ĭavut Savaser: When it comes to resuscitation I would recommend that everyone trained in BLS use the CAB algorithm. Whether the ventilations or compressions are initiated first, the other is delayed by less than 30 seconds. The bottom line for health-care providers is that chest compressions should be performed at the correct rate and depth with minimal interruptions, and ventilations should be performed at the correct rate and volume. In the past, a big focus was placed on the airway at the expense of chest compressions. ![]() ![]() For the most part, the discussion about whether to do ABC or CAB for drowning patients is academic. Do you believe it makes a difference in patient outcomes?Īndrew Schmidt and Justin Sempsrott: To date, there is no good data to show that CAB or ABC is superior in the treatment of drowning patients. This dilemma is especially present in case of drowning. BLS protocols taught to health-care providers, however, still include the idea of using clinical judgment to decide whether to do compressions or ventilations first. The 2010 guidelines changed the traditional ABC format to CAB. Another revision of the guidelines is expected in late 2015, but in the meantime, we ask the experts. 3 In light of these various messages, there is some confusion about how best to train lay providers in CPR. This is echoed in recent recommendations by drowning experts that providers follow a classic ABC approach, emphasizing the importance of rescue breaths. 2 These guidelines state that the most significant consequence of submersion is hypoxia and thus recommend that health-care-provider CPR employ a traditional ABC approach in submersion incidents. All other causes of cardiac arrest, including drowning, are considered special conditions and are covered by separate guidelines. The ILCOR guidelines primarily address the most common and treatable types of sudden cardiac arrest: ventricular fibrillation and ventricular tachycardia. To further emphasize the importance of circulating the existing oxygen in the blood, the current guidelines recommend that lay providers perform compression-only (“hands-only”) CPR until emergency medical services (EMS) or an automated external defibrillator (AED) arrives. In these situations, compressions alone will not restart the heart but are a temporizing measure to preserve as much as the brain as possible until an AED arrives to “shock” the heart back into a normal rhythm. Insufficiently trained rescuers often spend too much time not performing chest compressions, focusing excessively on ventilations or other tasks. In sudden cardiac arrest caused by irregular heart rhythms, the blood still contains several minutes worth of oxygen, and the immediate priority is to circulate blood and deliver that oxygen to the brain. 1 These guidelines emphasize high-quality chest compressions, which means compressing the chest of an adult at least 2 inches (5 cm) at a rate of 100-120 times per minute while minimizing the period in which chest compressions are not being done to eight seconds or less. The current set of guidelines, published in 2010, established a major change in basic life support (BLS) techniques for cardiac arrest - from Airway, Breathing and Circulation (ABC) to Compressions, Airway and Breathing (CAB). ![]() Every five years the International Liaison Committee on Resuscitation (ILCOR) announces revisions of CPR guidelines based on review of new scientific evidence.
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